Vidya Lakshmi Common Education Loan Application Form

Student ID 4022194

Application ID 2293351

Bank Name Indian Bank

Bank Scheme Name IB EDUCATIONAL LOAN PRIME

Preferred Bank IFSC Code IDIB000M262

Preferred Bank Branch Name MEENAKSHI MEDICAL COLLEGE BRANCH

Date of Application 03-Nov-2023

1. Personal Information

Field Name Student Parent / Husband Co-obligant / Guarantor

Title Dr. Mrs. Mrs.

First Name Chandru Manimegalai Manimegalai

Middle Name

Last Name Elumalai E E

Father’s /Husband’s First Name Elumalai Elumalai Elumalai

Father’s /Husband’s Middle Name

Father’s /Husband’s Last Name K K K

Date of Birth 30/04/1992 08/08/1959 06/08/1959

Category OBC OBC OBC

Sex Male Female Female

Marital Status Married Married Married

Educational Qualification MBBS 7th Fail 7th Fail

Marks obtained in Highest

57.0 0.0 0.0
qualification %

Occupation Professional Doctor Unemployed Unemployed

Income from all sources (Rs) 300000.00 216000.00

PAN No.# ABTPE5627K AEXPE4320A

State Tamil Nadu Tamil Nadu Tamil Nadu

No 104/4, Murugammal Nagar, No 104/4, Murugammal Nagar, NO.38,Murugammal

Address Line 1
Velingapattari Velingapattari Nagar,Velingapattari

Address Line 2

Village / Area/ Locality Orikkai Orikkai orikkai

Block/Taluka /Sub-district/Town Kanchipuram Kanchipuram Kanchipuram

PIN 631502 631502 631502

Contact No. 9865032290 9791746161 9791746161

e-mail Id drchandru6055@gmail.com drchandru6055@icloud.com drchandru6055@icloud.com

Present Banker Details

Branch IFSC IDIB000M262 SBIN0000853 SBIN0000853

Powered & Maintained by Protean eGov Technologies Ltd. (Formerly NSDL eGovernance Infrastructure Ltd.) © 2015 Protean eGov.page 1
Banker Indian Bank STATE BANK OF INDIA STATE BANK OF INDIA

Bank Branch MEENAKSHI MEDICAL COLLEGE KANCHEEPURAM KANCHEEPURAM

Account Type Savings Account Savings Account Savings Account

SB / OD A/c No. 6191152869 39500720545 39500720545

Direct/Indirect liability details (Rs) 150000

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 Management Quota

Name of the Institution meenakshi academy of higher education and research

Name of the Course md anaesthesia

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

Date of Commencement 20/11/2022 Date of Completion 01/11/2025

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 0 3000000 3000000 6000000.00

Exam fees 0 0 0

Books Stationery 0 0 0

Equipment/Computer 0 0 0

Hostel Expenses 0 0 0

Sundries/Travel 0 0 0

TOTAL 0 3000000 3000000 6000000.00

Own Source / Scholarship 0 0 0

Loan Required 0 3000000 3000000 6000000.00

5.Details of securities offered LAND PROPERTY

6.Prospects of earning after completion of the course

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

Repayment proposed
96 35000.00

7.Uploaded Documents:

Marksheet

Proof Of Admission to the course

Applicant Photo

Parent Photo

Powered & Maintained by Protean eGov Technologies Ltd. (Formerly NSDL eGovernance Infrastructure Ltd.) © 2015 Protean eGov.page 2
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:

--------------------------------------------------------------------------------------------------------------------------------------------------------------------

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.

Other terms and conditions:

Powered & Maintained by Protean eGov Technologies Ltd. (Formerly NSDL eGovernance Infrastructure Ltd.) © 2015 Protean eGov.page 3
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

Powered & Maintained by Protean eGov Technologies Ltd. (Formerly NSDL eGovernance Infrastructure Ltd.) © 2015 Protean eGov.page 4