BANK OF BARODA
APPLICATION FORM FOR MSEs
To be submitted along with documents as per the Checklist
(For Office Use)
1. NAME OF THE ENTERPRISE
2. REGD. OFFICE
ADDRESS
3. ADDRESS OF
FACTORY/SHOP
4. WHETHER BELONGS TO SC
ST/OBC/ MINORITY
COMMUNITY
TELEPHONE NO. - -
E MAIL ADD
(OFFICE)
PAN CARD NO
MOBILE NO.
5. CONSTITUTION Proprietary
6. DATE OF ESTABLISHMENT
7. NAME OF PROPRIETOR/PARTNERS/ DIRECTORS OF COMPANY AND THEIR
ADDRESS:
ACADEMIC
NAM RESIDENTIAL TELEPHONE NO. EXPERIENCE IN THE
AGE QUALIFI
E ADDRESS (RESIDENCE) LINE OF ACTIVITY
CATION
8. ACTIVITY:
EXISTING : New Business Start up
# If a different activity other than existing activity is proposed.
9. NAMES OF ASSOCIATE CONCERNS AND NATURE OF ASSOCIATION:
Extent of Interest
Name of Address of as a prop./
Presently Nature of
associate associate partner/ director
banking with association
concern concerns or just investor in
associate concern
10. Relationship of Proprietor/
Partner/ Director with the
NA
officials of the Bank/ Director of
the Bank
10(a) CREDIT FACILITIES (EXISTING) (Rs in Lac)
Limit Presently
Type of Outstanding as Security/ Rate of Repayment
(In banking
Facilities on 31.03.2022 Lodged Interest Terms
Lacs) with
OD NA NA NA NA NA NA
Cash
NA NA NA NA NA NA
Credit
Term Limit NA NA NA NA NA NA
Term Limit NA NA NA NA NA NA
Car Loan NA NA NA NA NA NA
LC/BG NA NA NA NA NA NA
If Banking with this Bank, Customer No. is given here.
10(b) 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 10(a) above
CREDIT FACILITIES (PROPOSED):
Type of Amount Purpose for
Facilities (In Lac) which required Security offered
Whether Collateral
PRIMARY
Security offered
SECURITY
(Please mention yes or
(Details with
no), (If yes, then
approx value to be
provide details in
mentioned)
column 12)
In case of term loan requirements, the details of machinery may be given
as under:
Total cost
of
machine
(In case
of
imported
Purpos machine,
e for Whether the Contribution
Type of Name of Loan
which imported or breakup being made
Machine Supplier Required
require indigenous of basic by promoters
d cost,
freight,
insurance
and
customs
duty may
be given)
TOTAL
Details of Collateral Security offered, If any including 3rd party guarantee*
(As per RBI guidelines banks are to take collateral security for loans Up to Rs. 5 Lakhs to
MSME Units)
NA
PAST PERFORMANCE / FUTURE ESTIMATES
(Actual performance for two previous years, estimates for current year and projection
for next year to be provided for working capital facilities. However for term loan
facilities protections to be provided till the proposed year of repayment of loan) :
2022 2023 2024 2025
(Rs. In Lacs)
Projected
Net Sales
Net Profit
Capital
(Net Worth in case of Companies)
Status regarding Statutory Obligation:
Statutory Obligations Whether Complied with Remarks
(Write Yes / No) If not (Any details in connection with
applicable then write NA the relevant obligation to be
given)
Registration under shop
YES -
and Establishment Act
Registration under SSI
NA --
(Provisional/ Final)
Drug License NA -
Latest Sales tax returns
NA -
filed
Latest Income Tax Returns
Yes -
Filed
Any other statutory dues
NA -
remaining outstanding
Certificate of Importer &
NA -
Exporter Code
SPACE FOR PHOTO SPACE FOR PHOTO SPACE FOR PHOTO
SIGNATURES OF PROPRIETOR WHOSE PHOTO IS AFFIXED ABOVE
Date: Place: Surat
I/We certify that all information furnished by me/us is true; I/We have no borrowing
arrangements for the unit except as indicated in the application; that there is no
overdues/statutory dues against me/us/promoters except as indicated in the
application; that no legal action has been/is being taken against me/us/promoters; that
I/we shall furnish all other information that may be required by you in connection with
my/our application that this may also be exchanged by you with any agency you may
deemed fit and you, your representatives, representatives of the Reserve Bank of India
or any other agency as authorized by you may, at any time, inspect / verify my/our
assets, books of account etc. In our factory/business premises as given above
