CO-Rural Banking Department

Common Application Format for Agriculture Loans (Other than KCC, SHG, Jewel& other
specified documents)

Application for Agriculture Loans (Other than KCC, SHG,

Jewel& other specified documents)
Date:
1. Name of the Farmer/ Agri Entrepreneur * Photograph to
2. Address of Factory/Shop* be pasted at the
3. Telephone No.* time of signing
4. E mail Address* of the
5. Mobile No.* application in the
6. PAN Card No. designated
7. Constitution (Please Select)* Individual/ Joint/ Prop. Concern/Partnership/ branch.
Pvt Ltd Co/
Limited Co/ Trust/ others
8. Udyog Aadhaar No. / Registration No. 10.(a)GST No. (if applicable)
9. Date of Establishment/Incorporation*
10. State *
11. City where loan is required* District
12. Branch where loan is required. (If any)
13. Name of Proprietors/ Partners/ Directors of Company and Their Addresses: *
S.No Name Date of Father/ Academic Category Mobile No
Birth Spouse Qualification SC/ST/OBC/
Minority/Women
1.

S.No PAN No. Residential Address Aadhar Telephone No. Experience in the line of
No./DIN (Residence) activity (Years)
No.
1.

Activity* Existing since

Proposed#
#if a different activity other than existing activity is proposed/ New unit

14. Names of Associate Concerns and Nature of Association:

Extent of
Interest as a
Name of Address of Prop./ Partner/
Presently Nature of
Associate Associate Director or Just
Banking With Association
Concerns Concerns Investor in
Associate
Concern
 CO-Rural Banking Department

15. Relationship of Proprietors/ Partners/ Directors with the officials of the Bank/ Director
of the Bank: Please select (Yes/ No)
16. Banking/Credit Facilities (Existing) (₹. in lakh)
Presently
Type of Limit Outstanding Rate of Repayment
Banking Securities
Facilities (in lakh) as on Interest Terms
With
Current
Account
Cash
Credit
Term Loan
LC/BG
Others
Total

If banking with our Bank, customer ID be given here:

It is certified that our unit has not availed any loan from any other Bank / Financial Institution
in the past and I am not indebted to any other Bank / Financial Institution other than those
mentioned in column no. 17 above.

17. Credit Facilities (Proposed)*

Security Offered
Whether Collateral
Purpose for Primary Security Offered (If , yes,
Type of Amount
which Security(Details with then provide details on
Facilities (in lakh)
Required approx. value to be column--23
mentioned) 20)
(Yes/ No)
Cash Credit**
Term Loan
LC/BG
Others
Total
*Mandatory Fields
**Basis of Cash Credit Limit applied

Projected
Cash Working Other
Credit Promoters
Sales Cycle in Inventory Debtors Creditors current
Contribution
months assets
 CO-Rural Banking Department

18. In case of term loan requirements, the details of machinery may be given as under:

Total Cost of
Machine ( in
case of
imported
machine, the
Whether Contribution
Type of Purpose for breakup of Loan
Imported Name of being made
Machine/ which basic costs, Required
or Supplier by the
Equipment Required freight,
Indigenous promoters
insurance
and
customs duty
may be
given)

19. Details of Collateral Securities Offered, if any, including third party guarantee
a) Third Party Guarantee:
Father Net
Name of / Residential Telephone No. worth Aadhar
S.No Mobile No. PAN No
Guarantor Spouse Address (Residence) (₹. in No.
name lakh)
1.
2.
3.

b) Other Collateral Security:

Name of owner of
Collateral Security
Collateral
S.
No. Value
Nature Details
(Rs. in lakh)
1.
2.
3.

20. Past Performance / Future Estimates

Past Performance / Future Estimates (Actual performance for two previous years, estimates for
current year and projections for next year to be provided for working capital facilities. However
for term loan facilities projections to be provided till the proposed year of repayment
of loan)
Past Year 1 Past Year 2 Present Year Next Year Installed Utilized
Rs. in lakh
(Actual) (Actual) (Estimate) (Projection) Capacity Capacity
 CO-Rural Banking Department
Net Sales
Net Profit
Capital (Net
Worth in case of
Companies)

21. Status Regarding Statutory Obligations:

Statutory Obligation: Remarks

22. a.) ID Proof (Any of following): Passport/ Voter Identity Card/ PAN Card/ Driving
Licence/ Job Card/ Aadhaar Card/
Identity Card (subject to the satisfaction of bank)
ID Proof No.
b.) Address Proof (Any of following):
Electricity Bill/ Telephone Bill/ Bank Account Statement of any other bank/ Letter
from reputed employer/ Letter from recognized public authority verifying the
address of the customer to the satisfaction of the bank/ Ration Card
Address Proof No:
Declaration:
I/We hereby certify/authorise that all information furnished by me/us is true, correct and
complete; that I/We have no borrowing arrangements for the unit except is in the
application; that there is no over dues/ statutory dues against me/us/promoters except as
indicated in the application; that I/We have not been declared as defaulter/wilful defaulter
by any Bank/FS and no Legal action has been taken/initiated against me/us by any
Bank/FIsI/We shall furnish all other information that may be required connection with my/our
application that this may also be exchanged by you with an agency you may deem fit and
you, your representatives or Reserve Bank of India or any other agency as authorised by
you, may at any time, inspect/ verify my/our assessment of account etc. in our
factory/business premises as given above; you may take appropriate safeguards/action for
recovery of Bank’s dues including publication of defaulters name in website/submission to
RBI; further agree that my/our loan shall be governed by the rules of your Bank which may
be in force from time to time..

Signature:

To be signed at the designated branch only

CO-Rural Banking Department
CO-Rural Banking Department