Please paste

a recent
photograph of
the student

Please paste
a recent
photograph of
the student

EDUCATION LOAN APPLICATION FORM

The Branch Manager,
Bank of Baroda,
HADAPSAR Branch,
PUNE, MAHARASHTRA

Dear Sir,

I/my ward have/has secured admission to PG DIPLOMA course conducted by HUMAN ACADEMY JAPAN LANGUAGE SCHOOL, SAGA
CAMPUS, JAPAN School / University / College / Institute located at ___________. For my / his / her education we request you to provide us
financial assistance of Rs. 1,300,000 (Rs. Thirteen lakh ) the details of which are as given in this request application.

We undertake to repay the loan in ___________ monthly installments beginning ___________ months starting after-1-year after the course
period or-6-months after the borrower(student) getting the job.

Please complete all sections in BLOCK LETTERS and tick ☑ boxes wherever applicable.

PARTICULARS OF THE STUDENT:

Name: UMESH SURESH MANE
Date of Birth: 15 (DD) 4 (MM) 1984 (YYYY) Age: 34
Address: SR. NO. 204, HOUSE NO. 5556/55, A-11, SINHGAD COLONY, PAPADE WASTI, FURSUNGI, PUNE,
NEAR THORAT BUNGLOW, SANJUDA COMPLEX, FURSUNGI, HADAPSAR, PUNE, MAHARASHTRA, INDIA
(Overseas address if student going for overseas studies) ___________________________________________________
PIN: 412308
Telephone: Fax: Mobile No: 7709316154
Nationality: INDIAN Marital Status: MARRIED Caste/Religion: SC
Life Insurance Policy details (if any):

EDUCATIONAL DETAILS : Please enclose mark lists of the examination passed

Examination Institution/University from which Year Number of Percentage Class Specialization if
passed Passing Attempts of marks Obtained any

SSC

HSC

Degree

Post VISHWAKARMA INSTITUTE OF 74.0 MECHANICAL

Graduate* INFORMATION TECHNOLOGY ENGINEERING

Any Other*

* - To be specified in the column "Specialisation"

PARTICULARS OF SCHOLARSHIPS / PRIZES WON FOR ACADEMIC DISTINCTION:
Examination Specify the academic distinction for which the Name of the Amount of Duration of
scholarship prize was awarded Scholarship Prize Scholarship Scholarship

Rs. From To

Any other information (Extra curricular activities and distinction awards received if any): ___________
_______________________________________________________________________________________________________

PARTICULARS OF THE COURSE FOR WHICH THE LOAN IS REQUIRED

Name of the course: PG DIPLOMA

University Institution: HUMAN ACADEMY JAPAN LANGUAGE SCHOOL, SAGA CAMPUS, JAPAN

Course/Institution is affiliated to/recognized by: HUMAN ACADEMY JAPAN LANGUAGE SCHOOL, SAGA CAMPUS, JAPAN

Duration of the course: 1 YEAR, 3 MONTHS

Part time / Full time: _________________________________

Correspondence / Distance Education: _________________________________

Expected per month income after completion of the course Rs: _________________________________

In case of studies abroad state the details of R.B.I. approval (if necessary). Details of Foreign Exchange required, Copies of Passport, Visa
and other details to be submitted.

PURPOSE OF THE LOAN: (Rs. in '000)

Requirement Fee Examination Cost of Books Caution Other Edu. Lodging Travel Total
for Payable to / Library / / Equipments / deposits / Exp. (e.g. / Exp / Expenses
College / Laboratory / instruments / building fund Study tours, Boarding passage
School / fees Uniforms / refundable projects, money
Institution deposit thesis etc. )

1st Year 940.0 50.0 0.0 0.0 0 250.0 60.0 1300.0

2nd Year 0.0 0.0 0.0 0.0 0 0.0 0.0 0.0

3rd Year 0.0 0.0 0.0 0.0 0 0.0 0.0 0.0

4th Year 0.0 0.0 0.0 0.0 0 0.0 0.0 0.0

5th Year 0.0 0.0 0.0 0.0 0 0.0 0.0 0.0

6th Year 0.0 0.0 0.0 0.0 0 0.0 0.0 0.0

Source of finance : Details of Scholarship / Loans / Own Funds

Loan amount Own Sources Scholarship Total

1st 1300.0 1300.0

2nd 0.0 0.0

3rd 0.0 0.0

4th 0.0 0.0

5th 0.0 0.0

6th 0.0 0.0

GUARDIAN's / PARENT'S / GUARANTOR'S PARTICULARS: (If guardian & guarantor are different separate
sheet showing these particulars for each to be obtained)
Name: SURESH NAGU MANE

Relationship with Student: PARENT

Date of Birth: 1 (DD) 6 (MM) 1959 (YYYY) Age: 59

PAN/GIR No.: Driving License No:

Passport No (If any)

Residential Address (For Correspondence - with proof of residence )

Address: SR. NO. 204, HOUSE NO. 5556/55, A-11, SINHGAD COLONY,, PIN 412308
PAPADE VASTI, FURSUNGI, PUNE, NEAR THORAT BUNGLO, SANJUDA
COMPLEX, PUNE, MAHARASHTRA, INDIA
Telephone: Fax: Mobile No: 9850265915
Permanent Address:

PIN
Telephone: Fax: Email: [email protected]
Since when residing:
Whether residing in Own/Rented Accommodation ☐
Interest during study period will be serviced - Yes / No

Sex: Male ✔ Education: SSC Any Other Information

Female Under Graduate

Marital Status Graduate

Single Post-Graduate

Married ✔ Doctorate

Divorced If Professional: Doctor

Widowed Architect

No. of Dependents CA

(Excluding Spouse)

No. of Children MBA

Engineer

Lawyer

Others
If Salaried: If Self Employed / Professional / Business

Name of the Organization __________________________ Name of the Company _________________________

Designation Executive Managerial Clerk Office Address ____________________________________

___________________________________________________

Department PIN

Office Address: ________________________________________ Tel: ___________________ Fax: ____________________

________________________ PIN ________________________ E-mail: ____________________________________________

Tel: ____________ Extn No. ____________ Fax: ____________ Business Details Pvt. Ltd Partnership

E-mail: ____________________________________________ Proprietorship Others

Working with Govt./Public Public Ltd Established since: _______________________

Pvt. Ltd Partnership MNC Designation Executive Managerial

Proprietorship Gross Monthly Income: _________________

Working Since: _________ Retirement Age: _________ Year in Current Business:

>5 3-5 1-3 <1

(Greater) (Less)

Income Details of Parent / Guardian : Any other earning member in the

family

1. Gross Monthly Income Rs (Proof to be submitted) 27,589

2. Net Monthly Income

3. Appr. Monthly house hold expenses

4. Monthly repayment of other loan amount

5. Net Surplus available

6. Net Income of other family member/s ( Relation with the

( Excluding Co-applicant & Guarantor ) student ______________________ )
About Bank Account (including credit facilities if any)

Deposits

Name of the Bank, Type of A/c & A/c No. No. of years account Balance Outstanding Remarks
Branch, Address & held
Telephone No

AXIS BANK SAVINGS ACCOUNT

PANDHARPUR, 914010014304430
MAHARASHTRA

Loans

Name of the Bank Type of Loan & Security When sanctioned & Balance Overdues if any
Branch & Telephone Limit Repayment Outstanding
No Schedule-Amount of
Installment

Credit Card Details ________________________________

Credit Cards Owned: ________________ Card Issuer __________ Other Assets Colour Tv

Card No. ________________________________ Refrigerator

Bank of Baroda Account No. ________________________________ CA/SB Two Wheeler

Since (in Years): ______________________________ Cellular Phone

Branch Name: ______________________________ Computer

Washing Machine

Car

Landed Property

(Details to be submitted)
DECLARATION BY THE APPLICANTS:
1. The particulars furnished above are to the best of my/our Knowledge true and correct.
2. The advance, if granted, will be utilized for the purpose for which it is granted.
3. I/We hereby authorize the bank to pay the fee and other amounts as may be payable directly to the institution concerned.
4. I/We undertake to submit the receipt for all the disbursements made from the loan account.
5. I/We undertake to inform the progress of studies of the student in respect of education for which loan is applied.
6. I/We shall-keep the bank informed of my activities/Income/Scholarship etc. during the tenure of the loan.
7. Immediately on securing job by the student, I/We undertake to inform the employment details.
8. I/We undertake to maintain a Saving Bank Account and /or Deposit Account with your Bank exclusively.
9. I/We will not / have not borrowed from any other Bank or any other source during the currency of the advance without you prior
consent in writing.
10. I/We undertake to meet any contingent expenses to continue the course of study.

Date : ____________________ Yours faithfully,

Place : ____________________

STUDENT PARENT/GUARDIAN

I am willing to stand as guarantor.

Place : _______________________

Date : _______________________

Signature of the Guarantor/s