Vidya Lakshmi Common Education Loan Application Form

Student ID 962796

Application ID 1615741

Bank Name IDBI Bank

Bank Scheme Name Education Loan for Vocational Courses

Preferred Bank IFSC Code IBKL0000736

Preferred Bank Branch Name VELACHERY

Date of Application 06-Jul-2022

1. Personal Information

Field Name Student Parent / Husband Co-obligant / Guarantor

Title Master Mr.

First Name Kanna Balan

Middle Name

Last Name Balan Ramakrishnan

Father’s /Husband’s First Name Balan Ramakrishnan

Father’s /Husband’s Middle Name

Father’s /Husband’s Last Name Ramakrishnan Sundaram

Date of Birth 30/07/2006 23/03/1970

Category Others Others

Sex Male Male

Marital Status Single Married

Educational Qualification Class X B Com

Marks obtained in Highest

70.0 0.0 0.0
qualification %

Occupation Student Employee

Income from all sources (Rs) 216000.00

PAN No.# BRWPK7135C CNBPB2148Q

State Tamil Nadu Tamil Nadu

b-3, first floor, RR flat, 154 Bazaar b-3, first floor, RR flat, 154 Bazaar
Address Line 1
Road, Ram Nagar, Road, Ram Nagar

Address Line 2 Madipakkam Chennai Madipakkam, Chennai

Village / Area/ Locality Madipakkam Madipakkam

Block/Taluka /Sub-district/Town Chennai Chennai

PIN 600091 600091

Contact No. 6383158712 9444403175

e-mail Id balanramakrishnan@gmail.com balanramakrishnan@gmail.com

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 Present Banker Details

Branch IFSC ICIC0000519

Banker ICICI BANK LIMITED

Bank Branch SHOLINGANALLUR?

Account Type Savings Account

SB / OD A/c No. 051901526138

Direct/Indirect liability details (Rs) 15000

2. Whether related to Chairman /Directors / employee of our Bank or any other Banks. No

If yes, details of relationship

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

Whether under: Merit / Management Quota Management Quota

HINDUSTAN INSTITUTE OF ENGINEERING TECHNOLOGY

Name of the Institution
POLYTECHNIC COLLEGE

DIPLOMA MECHANICAL ENGINEERING(DIPLOMA IN MECHANICAL

Name of the Course
ENGG.)-3YEARS

Duration of the Course 03 (Years) 00 (Months)

Date of Commencement 01/08/2021 Date of Completion 31/07/2022

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 0 47000 0 47000.00

Exam fees 0 0 0

Books Stationery 0 0 0

Equipment/Computer 0 0 0

Hostel Expenses 0 0 0

Sundries/Travel 0 36000 0 36000.00

TOTAL 0 83000 0 83000.00

Own Source / Scholarship 0 0 0

Loan Required 0 83000 0 83000.00

5.Details of securities offered

6.Prospects of earning after completion of the course

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

Repayment proposed
36 2500.00

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7.Uploaded Documents:

Marksheet

Proof Of Admission to the course

Schedule Of Expenses for the course, as given by institution

Applicant Photo

Parent Photo

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.

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Other terms and conditions:

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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