Loan/Investment Application Form for SME Entrepreneur(s)

GmGgB D‡`¨v³v wn‡m‡e FY/wewb‡qvM Gi Av‡e`b

Date/ZvwiLt
To/eivei
Head of Branch/e¨e¯’vcK
……………….Branch/kvLv
Bank Alfalah/e¨vsK Avjdvjvn&

Dear Sir,

I / We, the SME Entrepreneur (s), am / are applying for loan / Investment of BDT ………………… in the form of
working capital / business expansion & purchase of Machineries / other purpose at your Branch……………… of
your organization in favor of my / our enterprise for a period of ………………… months. Details of my / our
personal, business related and proposed SME loan / Investment related information are provided below:
wcÖq g‡nv`q,
Avwg/Avgiv GmGgB D‡`¨v³v wn‡m‡e Avcbvi cÖwZôv‡bi.........................................kvLv n‡Z Avgvi/Avgv‡`i cÖwZôv‡bi AbyK~‡j PjwZ
g~jab/e¨emv m¤úªmviY I hš¿cvwZ µq/Ab¨vb¨ eve`................... gvm †gqv`x .....................UvKvi FY/wewb‡qvM Gi Rb¨ Av‡e`b KiwQ| wb‡†æ
Avgvi/Avgv‡`i e¨w³MZ, e¨emv msµvš— Ges cÖ¯ZvweZ GmGgB FY/wewb‡qvM welqK Z_¨ †ck Kiv njt

1 Details of the Applicant Enterprise for loan/investment:

FY/wewb‡qvM Gi Rb¨ Av‡e`bKvix cÖwZôv‡bi e„Ëvš— t
1.1 Name of Enterprise :
1.1 cÖwZôv‡bi bvg :
1.2 Address (Owned / Rented) :
1.2 wVKvbv (wbR¯^/fvov) :
1.3 Nature of Business : □ Manufacturing □ Commercial □ Service
1.3 e¨emv‡qi cÖK…wZ : □ wkí □ e¨emv □ †mev
1.4 Ownership Structure : □ Sole-Proprietorship □ Partnership □ Joint-Venture
1.4 gvwjKvbvi aiY : □ GKK gvwjKvbvaxb □ Askx`vwi □ †hŠ_ g~jabx
1.5 Paid-up Capital :
1.5 e¨emvq wewb‡qvMK…Z g~jab :
1.6 Trade License No. & Expiry :
1.6 ‡UªW jvB‡mÝ b¤^i I ‡gqv` :
1.7 Date of Incorporation :
1.7 e¨emv ïi“i ZvwiL :
1.8 TIN (Tax Identification Number) :
1.8 wUb (U¨v· AvB‡Ww›Uwd‡Kkb b¤^i) :
1.9 Bank Account Type & Number :
1.9 e¨vsK wnmv‡ei bvg I b¤^i :
1.10 Annual Sales of the Enterprise (where :
applicable)
cÖwZôv‡bi evwl©K weµq (cÖ‡hvR¨ ‡¶‡Î) :
1.10
1.11 Annual Revenue of the Enterprise :
1.11 cÖwZôv‡bi †gvU evwl©K Avq :
1.12 Annual Expense of the Enterprise :
1.12 cÖwZôv‡bi †gvU evwl©K e¨q
1.13 Fixed Assets of the Enterprise :
(excluding Land & Building)
1.13 cÖwZôv‡bi ¯’vqx m¤ú` (f~wg I BgviZ e¨ZxZ) :
1.14 No. of Employees at the Enterprise :
1.14 cÖwZôv‡b wb‡qvwRZ Rbe‡ji msL¨v :
1.15 Value of Inventory :
1.15 gRy` c‡Y¨i g~j¨ :
2 Liabilities of the Applicant Enterprise:
Av‡e`bKvix cÖwZôv‡bi `vq t
2.1 Bank / NBFI :
2.1 e¨vsK/A-e¨vsK Avw_©K cÖwZôvb :
2.2 Others :
2.2 Ab¨vb¨ :
3 Details of the Applicant (In case of Partnership / Joint-Venture Enterprise, separate sheets to be added with similar
information for other Sponsors)
Av‡e`bKvixi e„Ëvš— (Askx`vwi/†hŠ_g~jabx Kviev‡ii ‡¶‡Î cwiPvjK‡`i Abyiƒc Z_¨ c„_K KvM‡R mshy³ Ki‡Z n‡e)
3.1 Name (in Bengali) :
3.1 bvg (evsjv) :
3.1 Name (in English) :
3.1 bvg (Bs‡iRx) :
3.2 Birth Date & Place :
3.2 Rb¥ ZvwiL I ¯’vb :
3.3 Academic Qualification :
3.3 wk¶vMZ †hvM¨Zv :
3.4 Training :
3.4 cÖwk¶Y :
3.5 Father's Name :
3.5 wcZvi bvg :
3.6 Mother's Name :
3.6 gvZvi bvg :
3.7 Marital Status :
3.7 ˆeevwnK Ae¯’v :
3.8 Spouse's Name :
3.8 ¯^vgx/¯¿xÕi bvg :
3.9 Present Address (including Phone No. :
& E-mail Address)
3.9 eZ©gvb wVKvbv (†dvb b¤^i I B-‡gBj :
AvBwWmn)
3.10 Permanent Address :
3.10 ¯’vqx wVKvbv :
3.11 Income from Other Sources :
3.11 Ab¨vb¨ Drm n‡Z gvwmK Avq :
3.12 Ownership in Other Entities :
3.12 gvwjKvbvaxb Ab¨vb¨ cÖwZôv‡bi bvg :
3.13 TIN (Tax Identification Number) :
3.13 wUb (U¨v· AvB‡Ww›Uwd‡Kkb b¤^i) :
3.14 NID (National Identification) Number :
3.14 RvZxq cwiPqcÎ b¤^i :
4 Liabilities of the Applicant:
Av‡e`bKvixi `vq t
4.1 Bank / NBFI :
4.1 e¨vsK/A-e¨vsK Avw_©K cÖwZôvb :
4.2 Others :
4.2 Ab¨vb¨ :
5 Purpose of Loan/Investment:
FY/wewb‡qvM MÖn‡Yi D‡Ïk¨ t
5.1 Working Capital :
5.1 PjwZ g~jab :
5.2 Business Expansion & Purchase of :
Machineries
5.2 e¨emv m¤úªmviY I hš¿cvwZ µq :
5.3 Others :
5.2 Ab¨vb¨ :
6 Details of Security (where applicable) :
Rvgvb‡Zi weeiY (cÖ‡hvR¨ †¶‡Î) :
 7 Guarantor's Name :
Rvwgb`v‡ii bvg :
7.1 Details of Guarantor
7.1 Rvwgb`vi m¤úwK©Z Z_¨
7.1.1 Name (in Bengali) :
7.1.1 bvg (evsjv) :
7.1.1 Name (in English) :
7.1.1 bvg (Bs‡iRx) :
7.1.2 Birth Date & Place :
7.1.2 Rb¥ ZvwiL I ¯’vb :
7.1.3 Academic Qualification :
7.1.3 wk¶vMZ †hvM¨Zv :
7.1.4 Father's Name :
7.1.4 wcZvi bvg :
7.1.5 Mother's Name :
7.1.5 gvZvi bvg :
7.1.6 Spouse's Name :
7.1.6 ¯^vgx/¯¿xÕi bvg :
7.1.7 Address
7.1.7 wVKvbv
7.1.7.1 Present (including Phone No.) :
7.1.7.1 eZ©gvb wVKvbv (†dvb b¤^imn) :
7.1.7.2 Permanent :
7.1.7.2 ¯’vqx :
7.1.8 Occupation :
7.1.8 †ckv :
7.1.9 Monthly Income :
7.1.9 gvwmK Avq :
7.1.10 Guarantor’s Net Worth :
7.1.10 Rvwgb`v‡ii m¤ú‡`i cwigvY :
7.1.11 TIN (Tax Identification Number) :
7.1.11 wUb (U¨v· AvB‡Ww›Uwd‡Kkb b¤^i) :
7.1.12 NID (National Identification) Number :
7.1.12 RvZxq cwiPqcÎ b¤^i :
7.1.13 Bank Account Type & Number (if :
available) :
7.1.13 e¨vsK wnmv‡ei bvg I b¤^i (hw` _v‡K)
7.1.14 Loan/Investment Availed from Bank / :
NBFI :
7.1.14 e¨vsK/A-e¨vsK Avw_©K cÖwZôvb n‡Z
FY/wewb‡qvM MÖn‡Yi cwigvY
7.1.15 Others :
7.1.15 Ab¨vb¨ :
7.1.16 Relationship with the Applicant :
7.1.16 Av‡e`bKvixi mv‡_ m¤cK© :

(If required, separate sheets to be added with this application form.)

(cÖ‡qvR‡b c„_K KvMR mshy³ Ki‡Z n‡e)
_______________________
Guarantor Signature & Date
Rvwgb`v‡ii ¯^v¶i I ZvwiL

[The applicant must provide any other information, proof, and documentary evidences to the Bank / NBFI
necessary for sanctioning of loan / Investment.]
[*FY/wewb‡qvM gÄywii Rb¨ Avek¨Kxq Ab¨ †h †Kvb Z_¨, cÖgvYcÎ Ges `wjjvw` e¨vsK/A-e¨vsK Avw_©K cÖwZôv‡bi Pvwn`v Abyhvqx MÖvnK cÖ`vb
Ki‡Z eva¨ _vK‡e ]
(This Form is Free of Charge)/ (webvg~‡j¨ cÖ‡`q)
______________________
Applicant Signature & Date
Av‡e`bKvixi ¯^v¶i I ZvwiL