Vidya Lakshmi Common Education Loan Application Form

Student ID 4130666

Application ID 2305649

Bank Name Canara Bank

Bank Scheme Name IBAs Model Education Loan Scheme for study in India and Abroad

Preferred Bank IFSC Code CNRB0000542

Preferred Bank Branch Name KUTTA

Date of Application 13-Nov-2023

1. Personal Information

Field Name Student Parent / Husband Co-obligant / Guarantor

Title Mr. Mr. Mr.

First Name Siddhanth Belliappa Belliappa

Middle Name

Last Name Subbaiah Subbaiah Subbaiah

Father’s /Husband’s First Name Belliappa Subbaiah Subbaiah

Father’s /Husband’s Middle Name

Father’s /Husband’s Last Name Subbaiah Machimada Machimada

Date of Birth 24/12/1999 09/02/1971 09/02/1971

Category Others Others Others

Sex Male Male Male

Marital Status Single Married Married

Educational Qualification Bachelor of Engineering Master of Business Administration Master of Business Administration

Marks obtained in Highest

72.0 0.0 0.0
qualification %

Occupation Unemployed Employee Employee

Income from all sources (Rs) 2800000.00 2800000.00

PAN No.# JYZPS5903N AJBPB0753H

State Karnataka Karnataka Karnataka

House number 28, 19th main House number 28, 19th main Devagiri estate Nalkeri village and
Address Line 1
canara bank colony canara bank colony post

via Srimangala 571217 South

Address Line 2 Uttarahalli, 560061 Bangalore Uttarahalli, 560061 Bangalore
Kodagu

Village / Area/ Locality Chikkalasandra Chikkalasandra Nalkeri

Block/Taluka /Sub-district/Town Bengaluru Urban Bengaluru Urban Kodagu

PIN 560061 560061 571217

Contact No. 9686088267 9845290267 9845290267

e-mail Id siddhanth.belliappa@gmail.com belliappasubbaiah@gmail.com belliappasubbaiah@gmail.com

Present Banker Details

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Branch IFSC CNRB0000542 CNRB0000542

Banker CANARA BANK CANARA BANK

Bank Branch KUTTA KUTTA

Account Type Savings Account Savings Account

SB / OD A/c No. 110110197077 110110197077

Direct/Indirect liability details (Rs) 0 0

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 The University of Melbourne

Name of the Course Industrial Engineering

Duration of the Course 02 (Years) 00 (Months)

Date of Commencement 26/02/2024 Date of Completion 26/02/2026

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 2824000 2824000 5648000.00

Exam fees 0 0

Books Stationery 200000 200000 400000.00

Equipment/Computer 0 0

Hostel Expenses 900000 900000 1800000.00

Sundries/Travel 350000 350000 700000.00

TOTAL 4274000 4274000 8548000.00

Own Source / Scholarship 1100000 1100000 2200000.00

Loan Required 3174000 3174000 6348000.00

5.Details of securities offered Home documents

6.Prospects of earning after completion of the course

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

Repayment proposed

7.Uploaded Documents:

Marksheet

Proof Of Admission to the course

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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.

Other terms and conditions:

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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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