Vidya Lakshmi Common Education Loan Application Form

Student ID 3621506

Application ID 1997839

Bank Name Canara Bank

Bank Scheme Name IBA Skill Loan Scheme

Preferred Bank IFSC Code CNRB0000507

Preferred Bank Branch Name CHIKMAGALUR MAIN

Date of Application 18-Apr-2023

1. Personal Information

Field Name Student Parent / Husband Co-obligant / Guarantor

Title Mr. Mrs.

First Name FURKHAN ALMAS

Middle Name

Last Name FURKHAN BANU

Father’s /Husband’s First Name LATE LATE

Father’s /Husband’s Middle Name

Father’s /Husband’s Last Name TANVEER TANVEER

Date of Birth 26/06/2000 01/01/1981

Category Minority Minority

Sex Male Female

Marital Status Single Widow

Educational Qualification BCOM SSLC

Marks obtained in Highest

58.81 45.0 0.0
qualification %

Occupation Student Unemployed

Income from all sources (Rs) 70000.00 70000.00

PAN No.# AGEPF8655Q FELPB4792G

State Karnataka Karnataka

Address Line 1 NEAR NOORANI MASJID NEAR NOORANI MASJID

Address Line 2 NEHRU NAGAR NEHRU NAGAR

Village / Area/ Locality CHIKKAMAGALURU CHIKKAMAGALURU

Block/Taluka /Sub-district/Town Chickmagalur Chickmagalur

PIN 577101 577101

Contact No. 9353980349 9731422636

e-mail Id furkhankhan136@gmail.com imran43610@gmail.com

Present Banker Details

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Branch IFSC CNRB0000507 KARB0000133

Banker CANARA BANK Karnataka Bank Limited

Chikkamagaluru [Agriculture
Bank Branch CHIKMAGALUR MAIN
Development Branch]

Account Type Savings Account Savings Account

SB / OD A/c No. 110074512400 1332500103405701

Direct/Indirect liability details (Rs) 0 0

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 Merit

Name of the Institution RAJEEV INSTITUTE OF TECHNOLOGY, HASSAN

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

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

Date of Commencement 01/02/2023 Date of Completion 30/01/2025

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 66310 66310 132620.00

Exam fees 3660 3660 7320.00

Books Stationery 50000 0 50000.00

Equipment/Computer 23500 5000 28500.00

Hostel Expenses 0 0

Sundries/Travel 0 0

TOTAL 143470 74970 218440.00

Own Source / Scholarship 23470 24970 48440.00

Loan Required 120000 50000 170000.00

5.Details of securities offered

6.Prospects of earning after completion of the course

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

Repayment proposed
60 3000.00

7.Uploaded Documents:

Marksheet

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Proof Of Admission to the course

Schedule Of Expenses for the course, as given by institution

Proof of Income

Undertaking letter in the absence of PAN & Aadhaar

Applicant Photo

Parent Photo

Co-obligant / Guarantor 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:

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 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:

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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