Vidya Lakshmi Common Education Loan Application Form

Student ID 3807907

Application ID 2120850

Bank Name State Bank of India

Bank Scheme Name SBI STUDENT LOAN SCHEME

Preferred Bank IFSC Code SBIN0001244

Preferred Bank Branch Name SOUTH GUWAHATI

Date of Application 18-Jul-2023

1. Personal Information

Field Name Student Parent / Husband Co-obligant / Guarantor

Title Shri Mr.

First Name Darshan Praneswar

Middle Name

Last Name Saloi Saloi

Father’s /Husband’s First Name Praneswar Kashi

Father’s /Husband’s Middle Name Ram

Father’s /Husband’s Last Name Saloi Saloi

Date of Birth 16/02/2003 02/07/1970

Category OBC OBC

Sex Male Male

Marital Status Single Married

Educational Qualification Diploma in Civil Engineering Graduate

Marks obtained in Highest

68.0 0.0 0.0
qualification %

Occupation Student Employee

Income from all sources (Rs) 1000.00 400000.00

PAN No.# OBQPS3889L CCDPS2330A

State Assam Assam

Address Line 1 B.K. Kakati Road, Near DGP Office B.K. Kakati Road, Near DGP Office

Address Line 2 Irrigation Colony, Ulubari Irrigation Colony, Ulubari

Village / Area/ Locality Guwahati Guwahati

Block/Taluka /Sub-district/Town Kamrup Metro Kamrup Metro

PIN 781007 781007

Contact No. 8011915780 9678792253

e-mail Id darshansaloi14@gmail.com darshansaloi14@gmail.com

Present Banker Details

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Branch IFSC SBIN0001244

Banker STATE BANK OF INDIA

Bank Branch SOUTH GUWAHATI

Account Type Savings Account

SB / OD A/c No. 40752551771

Direct/Indirect liability details (Rs) 00

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 Girijananda Chowdhury University

Name of the Course Bachelor of Technology in Civil Engineering

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

Date of Commencement 06/07/2023 Date of Completion 06/07/2027

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 100000 100000 100000 300000.00

Exam fees 2000 2000 2000 6000.00

Books Stationery 10000 10000 10000 30000.00

Equipment/Computer 4000 4000 4000 12000.00

Hostel Expenses 12000 12000 12000 36000.00

Sundries/Travel 3000 3000 3000 9000.00

TOTAL 131000 131000 131000 393000.00

Own Source / Scholarship 0 0 0

Loan Required 131000 131000 131000 393000.00

5.Details of securities offered

6.Prospects of earning after completion of the course

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

Repayment proposed
2 10000.00

7.Uploaded Documents:

Marksheet

Proof Of Admission to the course

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Schedule Of Expenses for the course, as given by institution

Proof of Income

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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