Haryana Backward Classes & Economically Weaker Sections Kalyan Nigam.
(ONLY FOR MINORITY COMMUNITIES)
LOAN APPLICATION FORM
Diary No._____________
Date:
_____________
Photo
Sir,
I/We request for a loan of Rs.__________(Rupees___________________)
for _______________________________________________________________
purpose.
Details of the Applicant:1.
Name
___________________________
2.
Father/Husband’s Name
___________________________
3.
Caste
___________________________
4.
Age
___________________________
5.
Name of Minority community
___________________________
6.
Educational Qualification
7.
Present Address
___________________________
___________________________
___________________________
8.
Permanent Address
___________________________
___________________________
Details of Occupation
9.
Present Occupation
____________________________
10.
Address of work place
____________________________
11.
Annual Family Income
Rs. _________________________
12.
Details of the work done by the applicant :
Work
Year
Experience
Details of Applicant’s Family
Sr.No.
Name
Relation
with
applicant
Age
Profession
Annual
Income
Details of Moveable/Immoveable property:
Details
Approximate Cost
House
Shop
Plot
Land
Others
Details about the Loan Proposal:
1.
Availability of means of Loan Proposal
Shop/ Plot/ Land/Machinery etc
_________________
Detail of Items to be purchased with Loan Amount:Particulars
Machinery
Raw Material
Animals
Others
Estimated Cost
Details of Guarantor
1.
Name
______________________
2.
Father/Husband’ Name
3.
Address
_____________________
______________________
______________________
4.
Occupation
5.
Annual Income
______________________
_____________________
Details of Moveable/Immoveable property:
Particulars
Estimated Cost
Machinery
Raw Material
Animals
Others
Details Loan Already Taken:-
Purpose
Amount
Institution
Details of
repayment of loan
Declaration:
a)
I/We have gone through the details of scheme carefully. I have acquaint
my self with the terms & conditions of the schemes and keeping in view these
conditions I/We solemnly declare that the above details are true and correct
to the best of my knowledge & belief.
b)
If any information given above is found false I/We will repay full loan with
interest in lumpsum.
c)
I/We are ready to give required security money/margin money, surety bond &
hypothe document etc to the Nigam.
d)
I will utilize the loan as per above mentioned purpose.
e)
I will not take any loan for any institution till this loan is repaid is full.
f)
I will abide by all the rules/regulations which ever will be enforced by the
Nigam/Bank from time to time.
Signature of Applicant / Thumb impression
___________________________________
Date:
Certificate relating to Caste, Age, Income, Minority Community
I
personally
know
Sh./Smt______________Son
of
Shri_____________Resident of ________________ District _______________________
& that he/she is bonefide resident of
Haryana State & he belongs to
_______________caste. His/her annual family income is Rs.________________& he
belongs to _____________ community.
Date _____________
Place _____________
Stamp_____________
Signature __________________
Name and Designation___________________
Note:
The
above
certificate
will
be
singed
with
office
seal
by
MP/MLA/Panch/Sarpanch/ Municipal Commissioner, First Class Magistrate/ City
Magistrate of Area to which applicant belongs before the issue of the certificate
caste/ annual income of applicant may be verified.
Recommendation of the District Manager.
Haryana Backward Classes & Economically Weaker Sections Kalyan Nigam.
LOAN APPLICATION FORM
FOR
PEOPLE BELONGING TO BACKWARD CLASSES
.
Diary No._____________
Date:
Photo
_____________
Sir,
I/We request for a loan of Rs.__________(Rupees___________________)
for _______________________________________________________________
purpose.
My Particulars are as under:1.
2.
Name
________________________
Father’s name
________________________
3.
Caste
_______________________
4.
Age
_______________________
5.
Correspondence Address
_______________________
_______________________
6.
Permanent Address:
_______________________
______________________
7.
Present Occupation
_______________________
8.
Annual Income
_______________________
9.
a)
10.
11.
Purpose of loan
______________________
b) Amount required
_______________________
Applicant’s Educational
Technical/Occupational Qualification
_______________________
Assets to be purchased under the scheme
_______________________
12.
Assets available for the scheme
i.e. – Shop Land etc.
______________________
13.
Particulars of Surety
1.
Name of Surety
______________________
2.
Father’s Name
______________________
3.
Full address
_____________________
_____________________
4.
Occupation
______________________
5.
Annual Income
______________________
Details of Moveable/ Immoveable Property
Details
Approximate Cost
House
Shop
Plot
Land
Others
Declaration
a)
I/We have gone through the loan schemes of the Nigam/Bank carefully. I have
learnt about the terms and conditions of the schemes and keeping in view these
conditions, I/We solemnly declare that the above details are true and correct to
the best of my knowledge & belief.
b)
I/we agree to provide
surety money/margin money ,surety bond and
Hypothecation deed and other loan documents under the scheme to the Nigam
as per requirement.
c)
I will utilize the loan for the purpose mentioned above.
d)
I will not get loan from any other institution till loan is fully repaid with interest.
e)
I will abide by the terms and conditions settled by the Nigam/Bank from time to
time.
f)
My/our annual family income is Rs. ________
Date _____________
Place ___________
Signature __________________
Name and Designation___________________
Stamp_____________
Certificate of Caste & Income
I, personally know Sh./Smt____________________________Son/wife of
Sh. ________________Resident of____________ District
________________
He is
permanent resident of Haryana state & he belongs to ________________ caste. His
family annual income is Rs.________________ & he belongs
to _____________
community.
Date _____________
Signature ___________________
Place _____________
Name and Designation____________
Stamp_____________
Note:
The above certificate will be singed with office seal by MP/MLA/Panch/Sarpanch/
Municipal Commissioner, First Class Magistrate/ City Magistrate of Area to which
applicant belongs. Before the issue of the certificate caste/ annual income of applicant
may be verified.
Report of District Manager of the Nigam
a)
I have verified the facts given by the applicant. I sanction a loan/subsidy to the
applicant amounting to Rs.________________ in which Nigam’s share is Rs.
___________, Banks share is Rs. ______________ and Loanee share is
Rs._________
under the scheme.
b)
I recommend to sanction on loan/subsidy to the applicant amounting to
Rs.________________ in which Nigam’s share is Rs. ___________, Banks share
is Rs. ________________ , Loanee share is Rs.__________ and subsidy under
the scheme.
Date _____________
Signature __________________
Place _____________
Name and Designation_____________
Stamp_____________
NATIONAL HANDICAPPED FINANCE AND DEVELOPMENT CORPORATION
RED CROSS BHAWAN, SECTOR 12, FARIDABAD- 121 007
COMMON APPLICATION FORM FOR
A
:
Loan for Self-Employment (Upto Rs. 2.50 Lakhs)
B
:
Loan for Agricultural Activities (Upto Rs.5.0 Lakhs)
C
:
Loan for Self- Employment
Amongst persons with Mental
Retardation, Cerebral Palsy and Autism (Upto Rs. 2.50 Lakhs)
CHECK LIST
1.0
Please submit the application form in two copies along with all required
documents to the Channelising Agency of your State.
2.0
The following documents are essential, please ensure that they are attached.
2.1
40% disability certificate from medical board of Central/State government.
2.2
Income declaration certificate ( on application form itself).
2.3
Birth/Age Certificate from panchayat /Municipal/ School certificate.
2.4
Education Qualification Certificate.
2.5
Caste Certificate for SC/ST/OBC.
2.6
One passport size photograph and one full size photograph.
2.7
Affidavit stating that no loan has been availed from any other Govt. agency for
the same purpose.
All clearances required has been obtained from respective Central/State Govt.
agencies including clearance from State Pollution Control Board if applicable.
Note :
Each column of the application format alongwith attached performas should be
properly filled up giving appropriate information/suitable remarks. No column
should be left blank, instead write “NA” (not applicable) in the blank column.
Haryana Backward Classes & Economically Weaker Sections Kalyan Nigam.
(ONLY FOR HANDICAPPED PERSONS)
LOAN APPLICATION FORM
Diary No._____________
Date:
Photo
_____________
Sir,
I/We request for a loan of Rs.__________(Rupees___________________)
for _______________________________________________________________
purpose.
1. PARTICULARS OF APPLICANT
1.
Name
_____ ________________
2.
Father / Husband’s Name
______________________
3.
Details of disability & percentage disability,
(attach attested photocopy of certificate
from competent authority).
______________________
4.
Family details.
______________________
5.
Annual income of individual. If depend, please
give income of family/spouse, (attach attested
copy of income certificate).
______________________
6.
Date of birth and age on Ist of the following
month during which the application is submitted
(attach attested copy of certificate)
______________________
7.
Educational and technical background, particularly ______________________
Related to the proposed project/scheme.
8.
Employed/self-employed/unemployed. Give
details if Employed or self-employed.
______________________
9.
Whether belong to SC/ST/OBC/Others.
______________________
10.
Existing activities and financial status including
land holding, fixed assets in the name of
applicant.
______________________
______________________
2.
PROPOSED ACTIVITY
(a)
Name of the Scheme/Project.
______________________
(b)
Detail of the project or proposed activity
______________________
(c)
i)
______________________
3.
Location of Unit
ii) Whether confirming or non-confirming
(Please Specify if location confirms to
location
policy
of
the
authority.)
______________________
COST OF THE PROJECT
(Rs. in Lakhs)
Sr. No.
1.
Items
Miscellaneous Fixed Assets
2.
Preliminary & preoperative expenses
3.
Contingencies & cost escalations
4.
Others if any (Please specify)
5.
Working Capital
State
govt./local
Cost
Total
Note :-
4.
a)
Furnish details of (I) obove.
b)
Working capital amount may be included as part of cost of project,
where total cost of the schemes does not exceed Rs. 50,000/-
MEANS OF FINANCE
Sr.
No.
1.
Source
2.
Subsidy, if any
3.
Team Loan
4.
Banks/other Fls
5.
Other, if any specify
Promoter’s Contribution
Total
Amount & % of Total cost
5.
TECHNICAL DETAILS & ECONOMIC OF PROJECT
6.
MANPOWER REQIREMENT
Sr. No
Source
1.
Managerial
2.
Supervisor
3.
Skilled
4.
Unskilled
Average salary p.m.
Total
7.
MARKETING ARRANGEMENTS
(a)
8.
Note:
Demand and Supply position in the area
Selling Arrangements
REPAYMENT SCHEDULE
(a)
Please indicate Moratorium Period needed;
With justification.
(b)
Repayment in terms of quarter/half yearly/
yearly installments (maximum repayment
period is 7years including moratorium period)
For loans for agricultural activities, the Repayment has to made in
yearly installments.
9.
IMPLEMENTATION SCHEDULE
10.
WORKING CAPITAL REQUIREMENT
11.
OTHERS
i) Government consents.
ii) Environmental clearance.
iii) Other Govt. clearance, if ant etc.
CERTIFICATE
I/We certify that all information furnished by me/us is true; that i/we have
no borrowing arrangements for the unit with any bank/financial institutions, expect
as mentioned above; that no legal action has been/is being taken against me/us;
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 deem fit; and that you , your representative of RBI of an
application; that this may also be exchanged by you with any agency you may deem
fit; and that you , your representative of RBI of any other agency authorized by you
may at any time, inspect/verify our assets. Of account, etc. in our factory and
business premises.
2.
I/We further certify that I/We do not have any overdues in respect of any
financial assistance I/We have availed so far.
Place : ________________
Date : _________________
Signature of applicant
For Office Use Only
1.
Name of official who interviewed the applicant
2.
Remarks
a)
Repayment Programme
b)
Repayment capacity
Monthly surplus (term 1(c)
Rs._______________
Monthly installments proposed
Rs._______________
Monthly installments for existing term
Loan and other obligation (to be specified)
Rs._______________
Total monthly/ obligations
Rs._____________(F)
Debt Service ratio
(F:F)=
a)
Comments
b)
Remarks of the technical report, if obtained
c)
Loan sanctioned
d)
Other remarks
Place _________________
Date__________________
B:
______________________
Remarks of Recommending authority.
Place: ____________
Date: _____________
Appraising official
NO
Haryana Backward Classes & Economically Weaker Sections Kalyan Nigam.
(ONLY FOR HANDICAPPED PERSONS)
LOAN APPLICATION FORM
1. Name of Applicant
________________________
2. Father/Husband’s Name
________________________
3. Caste
________________________
4. Age
________________________
5. Present Address
________________________
________________________
6. Education Qualification
________________________
7. Permanent Address
________________________
________________________
8. Purpose
________________________
9. Amount of Loan
________________________
DETAILS OF THE SURETY
1. Name
_________________________
2. Father’s/Husband’s Name
_________________________
3. Caste
4. Age
________________________
5. Present Address
________________________
________________________
6. Permanent Address
________________________
________________________
7. Occupation
________________________
8. Annual Income
_______________________
DETAILS OF THE IMMOVABLE ASSETS OF THE APPLICATION AND SURETY
Property
APPLICANT
Description
SURETY
Estimated
Value
Description
Estimated
Value
House
Shop
Plot
Land
Others
CERTIFICATE
I personally know Sh./Smt.________________________ S/o /W/o Sh.____________________
R/o ________________________who is permanent resident of Haryana, is ____________years
old & that annual income of the family from all sources is Rs.______________.
Place : ______________
Signature ____________
Date : ______________
(Name & Designation)
Stamp
REMARKS
This certificate is to be issued by MP/MLA/ Sarpanch/Panch/Muncipal Commissioner/Ist class
magistrate/City Magistrate belonging to the resident area of the applicant.
REPORT BY DISTRICT MANAGER, HBC & EWSKN
I have verified all the contents given by the application from & certify the correctness of the
facts given therein Loan of Rs.________________________ for the purpose of __________is
recommended.
Place:
Date:
(District Manger)
Stamp