Vidya Lakshmi Common Education Loan Application Form

Student ID 2845213

Application ID 1550140

Bank Name State Bank of India

Bank Scheme Name SBI Scholar Loan Scheme

Preferred Bank IFSC Code SBIN0000656

Preferred Bank Branch Name JAIPUR MAIN BRANCH

Date of Application 20-May-2022

1. Personal Information

Field Name Student Parent / Husband Co-obligant / Guarantor

Title Ms. Mrs. Mrs.

First Name Prachi Anju Anita

Middle Name

Last Name Chugh Chugh Meena

Father’s /Husband’s First Name Rajeev Rajeev XXX

Father’s /Husband’s Middle Name

Father’s /Husband’s Last Name Chugh Chugh XXX

Date of Birth 29/12/1999 15/02/1972 16/05/1986

Category Others Others Others

Sex Female Female Female

Marital Status Single Married Married

Educational Qualification Undergraduate Post graduation

Marks obtained in Highest

69.4 0.0 0.0
qualification %

Occupation Student

Income from all sources (Rs) 1000000.00

PAN No.#

State Rajasthan Rajasthan Rajasthan

Address Line 1 B 296 Janta Colony B 296 Janta Colony Malviya nagar

Address Line 2 Adarsh Nagar Adarsh Nagar

Village / Area/ Locality Jaipur Jaipur Jaipur

Block/Taluka /Sub-district/Town Jaipur Jaipur Jaipur

PIN 302004 302004 302017

Contact No. 7665950117 9828975852 9680505659

e-mail Id chughprachi8@gmail.com anju.chugh@sbi.co.in anita.meena@sbi.co.in

Present Banker Details

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Branch IFSC SBIN0000656 SBIN0000656 SBIN0000656

Banker STATE BANK OF INDIA STATE BANK OF INDIA STATE BANK OF INDIA

Bank Branch JAIPUR MAIN JAIPUR MAIN JAIPUR MAIN

Account Type Savings Account Savings Account Savings Account

SB / OD A/c No. 65056136320 55067304753 55067304753

Direct/Indirect liability details (Rs) 0 nil

2. Whether related to Chairman /Directors / employee of our Bank or any other Banks. Yes

If yes, details of relationship Daughter

3. Particulars of course, for which loan is required.

Whether under: Merit / Management Quota Merit

Name of the Institution INDIAN INSTITUTE OF MANAGEMENT TIRUCHIRAPPALLI

Name of the Course MASTER OF BUSINESS ADMINISTRATION(M.B.A)

Duration of the Course 02 (Years) 00 (Months)

Date of Commencement 04/07/2022 Date of Completion 31/05/2024

Cost of Finance Details

4. Cost of Course / Source of Finance: (All amounts are in (Rs))

Particulars Year 1 Year 2 Year 3 Year 4 Year 5 Year 6 Total

Tuition fees 825000 825000 1650000.00

Exam fees 15000 15000 30000.00

Books Stationery 50000 0 50000.00

Equipment/Computer 100000 0 100000.00

Hostel Expenses 60000 60000 120000.00

Sundries/Travel 25000 25000 50000.00

TOTAL 1075000 925000 2000000.00

Own Source / Scholarship 0 0

Loan Required 1075000 925000 2000000.00

5.Details of securities offered nil

6.Prospects of earning after completion of the course

No. of Installments Amount (Rs) p.m.

Repayment proposed
0.00

7.Uploaded Documents:

Marksheet

Proof Of Admission to the course

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I / We declare that all the particulars and information given in the application form are true, correct and complete and binding on me / us. Further,
the above particulars shall form the basis of any loan Bank may decide to sanction to me / us. The loan amount will be used for the purpose for
which it is granted.

Signature of the Signature of the Signature of the

Student Parent/Guardian Co-obligant/Guarantor

Place:

Date:

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For office use

Credit Report No. Date : Customer ID/Application ID:

Details of security including

Rate of Repayment Whether eligible under CSIS
Nature of limit Amount (Rs.) Margin(Rs.) Personal Guarantee/Co-
Interest* conditions Scheme / (Yes/No)
obligation.

Other terms and conditions:

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The Bank may revoke in part or in full or withdraw/stop financial assistance at any stage by giving reasonable notice to the borrower. Credit
facilities sanctioned are to be availed within 6 months from the date of this letter, failing which; the limits will automatically stand cancelled.

Manager/Senior Manager / Accepted all the terms and

Chief Manager /Asst Gen Manager conditions of sanction Borrower/s

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