(This application is issued on free) For Office Use only Received date to PMU. Requested foan amount (TO BE FILLED BY THE LOAN APPLICANT) APPLICATION FOR CREDIT FACILITIES - UNDER THE SMILE III REVOLVING FUND. ( TA) “DELETE OR WRITE NON WHERE NOT APPROPRIATE 01. Name of Firm/Ins Official Address = Factory Address:- Business Registration No :~ Factory located District ‘Type of Business:- Contact Person & TelNo. : Business Telepkione No := Fax No — | Mobite: E-Mail address = ‘Share 02. Name of Partners/Directors | Holding% | NICNO Residential Address Telephone (ifrequire) 03.Preferred Bank & Branch to obtain Loan = 04, Brief Desorption of the Busines Project=_Fnot space enough, please use ano pape) 05. Loan Facility Requested (Please clearly indicate the purpose of loan using following space) “Amount06. Any Bank loans obtained (if any) Bank& Branch Original loan Amount Present outstanding 07. Financial Statements Information ‘Year as at... Sales ‘Trade Debitors Net profit Trade Creditors. 08. Number of Jobs creation - ‘The information above are truc to the best of my/ our knowledge & belief and I/we agree that the PMU/Bank may from time to time after receipt of this Application make inquiries about our affairs as it may think fit. ‘Namels of the Applicant/s 2 Signature 1 2 Date. Office Use Only ‘The Manager ‘Name of the Customer :... Amount Applied Bank and the Branch Reference No The above application was considered at the Operational Level Committee Meeting held om .........-» and the Committee is of the view that the proposed project is eligible/ not eligible for further consideration in terms of the Operating Instructions of the Loan Scheme. lease note that granting of the loan for eligible projects is strictly subject to respective bank’s credit evalus Date = Project Management UniMinistry of Industries For more details - 011-2329722 (Deputy Project Director) 011-2390142 (Project Management Unit)