CGTMSE APPLICATION FORM (REVISED)

(All field is to be filled compulsory)

1. Name of the Bank :

2. Name of the Branch :

3. Whether Borrower already assisted by Bank : Yes / No

4. (If Yes) Outstanding amount on date of sanction

Of credit facility : Rs. NA

5. Whether Borrower covered by CGTMSE previously: Yes / No

6. Name of the Borrower / Unit :

7. Constitution of the Borrower :

7A. Term Loan/Cash Credit Account No. :

7B. Mobile No. of the Promoters :

7C. Aadhaar No. of the Promoters :

8. Borrower / Unit Address (Complete with State & PIN):

9. IT/PAN of the Firm :

9A.Udyog Aadhar No. :

10. SSI Registration No. :

11. Nature of Industry :

12. Industry Sector :

13. Type of Activity :

14. Number of Employees employed :

15. Projected Optimum Sales Turnover :

16. Full Name of the Chief Promoter :

17. Gender : Male / Female / Others

18. Whether the Chief Promoter belongs to

Minority Community : Yes / No

19. Date of Birth :

20. Social Category (SC/ST/OBC/Gen) :

21. Legal ID (Voter ID/Driving License/PAN Card No.):

22. Other Partners / Promoter Directors (Name/ITPAN):

23.Whether Unit assisted is New Unit : Yes / No

24.Whether the Unit assisted is women operated and /or
Women Owned : Yes / No

25.Whether the Unit assisted in an MSE as per the

MSMED Act 2006 definition of MSE : Yes / No

26. Whether Advance under PMMY : Yes / No

27.Collateral Security Taken : Yes / No

28. Third Party Guarantee : Yes / No

29. Whether the credit is sanctioned under ACC Scheme

For Handicraft Artisans operated by DC(Handicrafts), GOI: Yes / No

30. Whether Guarantee Fees/Annual Service Fees is

Reimbursable from O/O DC(Handicrafts), GOI : Yes / No

31. Internal Rating :

32. Guarantors (Name) :

33. Net Worth of the guarantor as on date of sanction:

34. Name of the Subsidy / Equity Support Scheme :

35. Primary security details :

Land / Building / Plant & Machinery / Movable assets :

36. Term Credit Sanctioned : TERM LOAN/CASH

CREDIT/COMPOSITE

Fund Based : Rs.

Non – Fund Based : Rs.

37. Whether provided as margin money under TL : Yes / No

38. Margin Money Amount : Rs.

39. Date of Sanction :

40. Credit to be Guaranteed :

41. Amount Disbursed : Rs.

42. Date of first disbursement (if already made) :

43. Date of last & final disbursement (if already made):

44. Tenure of loan (in months) :

45. Interest Type (fixed / floating) :

46. Rate of Interest :

47. Repayment Schedule :

48. Moratorium (in months) :

49. First Instalment Due Date :

50. Periodicity (Monthly/Quarterly/Half-Yearly/Yearly):

51. No. Of Instalments :

52. Outstanding Amount (as on date 19.03.2019) : Rs.

53. Working Capital Sanctioned :

Fund Based :

Non-Fund Based : Rs.

54. Date of Sanction :

55. Credit to be Guaranteed :

56. Amount Disbursed :

57. Date of first disbursement (if already made) :

58. Date of last & final disbursement (if already made):

59. Tenure of loan (in months) :

60. Interest Type (fixed / floating) :

61. Rate of Interest :

62. Repayment Schedule :

63. Moratorium (in months) :

64. First Instalment Due Date :

65. Periodicity (Monthly/Quarterly/Half-Yearly/Yearly):

66. No. Of Instalments :

67. Outstanding Amount (as on date 24.01.2019) :

68. Performance Parameters: (In Lakh)

Net Worth Rs.

Projected Rs.
Turnover

Operating Profit Rs.

PAT Rs.

DSCR

D/E RATIO

Current Ratio

UNDERTAKING
I / We irrevocably agree to get the proposed exposure covered by CGTMSE scheme and
abide by provisions of the said scheme, which may be revised from time to time. I / We
request / authorize you, in case of sanction of the advance, to recover and remit upfront
fees towards Guarantee Fees (GF) and Annual Service Fees (ASF) / Annual Guarantee Fee
w.e.f. 01/01/2013, as and when falls due during the currency of the advance.

Date : Signature of the Applicant /

Place : Proprietor/ Partners / Directors

Recommendation of the Branch :

Date : Branch Manager

(Seal)

Note : Documentary evidence as to the Date of Birth is to be obtained to facilitate

settlement of claim under CGTMSE scheme.