A142_2022 - TD

SME APPLICATION FORM

Application No.: Date: d d m m y y y y

Term Loan Working Capital Non Fund Based Facilities

TL FCTL CC OD BLOD EPC PSFC Others LC BG Others

Type of facility Amount Applied (In Lakh) Tenure (In Months) Purpose Security Offered

Applicant/Company
Stamp & Sign

Banking Relation with CSB

New to Bank Existing Customer If Existing Customer, Customer ID

A. Business Details

Entity Constitution Type* Proprietorship Partnership Firm LLP Pvt. Ltd. Public Ltd. Trust

Society Others
Name of Firm/Company*
Udyam Registration
Certificate* PAN Card*
Corporate
Identification No. (CIN)
Import Export
Code (IEC)
Date of Incorporation/
Formation
Place of Incorporation/
Formation*
Constitution Self Employed Non Professional Self Employed Professional CA Doctor Architect

CS Engineer
Occupation/Nature of
Business/Industry Manufacturing Service Provider Trading (Retail/Wholesale) Others
Type (tick the
relevant option)

Nature of Business (As per the Nature of Business selected above, mention the details of Business. Example - Trading of metal items/Manufacturing of leather products.)

No. Of years in Business*

Annual Turnover ( As per the Balance sheet or ITR of the company/firm)
(Gross-In lakh)
Whether registered Yes No d d m m y y y y
under GST
GST Exemption* Yes No Exemption Reason (if yes)

GST Registration* Single Multiple Special Economic Zone* Yes No SEZ Code (If yes)

GST registration No.

Residence Address*
City/Town/Village*

District

PIN/Post Code State/UT

Country
Nearest Landmark
(Office Address)*
E-mail Address - 1*

E-mail Address - 2*
Preferred Mailing
Address
Phone Details
(STD Code - Tel. Off.)
Mobile Number* 1. 2.

Office Ownership Self Owned Parental Owned Rental Residence Cum Office Mortgaged Yes

No
No. of years in the Years Months
office address
Factory Address/Local
Address (if different
from Registered
Address)*

City/Town/Village*

District

PIN/Post Code State/UT

Country

Nearest Landmark*
Phone Details (STD
Code - Tel. Off.)

Factory Ownership Self Owned Parental Owned Rental Residence Cum Office Mortgaged Yes

No
No. of years in the Years Months
office address
Whether the MSME Yes No (If yes, the gradation obtained by the MSME unit (Tick appropriate one)) Bronze
unit is ZED rated
Silver Gold Diamond Platinum

No. of Employees*

Business Background Family Business 1st Entrepreneur

Gross Other Income
per year
Auditors Name
CA Registration TIN
Number
Any benefit availed under priority sector Yes No
lending?
Expected Monthly
Remittance
Expected Monthly
Withdrawals
Company Listed Yes No
Total No. of Branches/
Regional Offices
Presence in Other
Cities
 L.
C.
B. Customer
Income
Individual
Details/
Consent
Applicant/Guarantor/Proprietor/Partner/Director/Other
Past Performance /Future Estimates Details
Title Individual Applicant Guarantor Partner Proprietor Director-I Other-I ...................................................
Name* (Same as
ID Proof)
Maiden Name
(If any)
Spouse Name*

Father's Name*

Mother's Name*
Mother's Maiden
Name
Gender* Male Female Third Gender
Residential Status/ Non Resident Foreign National
Resident Individual Citizen of India Person of Indian Origin
Constitution Indian Overseas
Are you an existing customer.
If yes, provide Customer ID
PAN Card/Form 60*
Director Identification
Number (DIN)
Occupation* Salaried Self Employed Unemployed Retired House Wife Politician Student

Others/Not Categorised

If Salaried, Type of Pvt. Ltd. Public Ltd. Proprietorship Partnership Firm Public Sector Government
Organization (tick the
relevant option)* Multinational Trust/Association/Society/Club

Nature Of Employment* (As per the type of organization selected above,mention the details of profession example:Director/Banker/Agent)
If Self Employed, Manufacturer Trader Service Provider
Nature of Business (tick
the relevant option)* Agriculture Others

Description of Business* (As per the Nature of Business selected above, mention the details of Business example: Tour Operators/Trading of food products)

No. of Years in Business* Years Months

Annual Income
(Gross-In lakh)*
Source of Fund (tick Salaried Investment Professional Fees Business Earnings Commission
he relevant option)*
Agriculture
Nationality (tick the Indian Other (Kindly mention nationality, if apart from Indian)
relevant option)*
Community* Hindu Muslim Christian Sikh Buddhist Zoroastrian Parsi Jain

Others
Date of Birth* d d m m y y y y

Email Address*
Mobile No.* 1. 2.

Category SC ST OBC General Other

Education Matriculate Undergraduate Graduate Postgraduate Professional
Marital Status Unmarried Married Other
Number of Dependents
Person With Disability Yes No

Proof of Identity and Permanent Residence Address*

PAN No.

Aadhaar No.

Election ID
Any Other KYC (Specify)

ID No.

Issued Place

Issued Date

Residence Address*

City/Town/Village*

District

PIN/Post Code State/UT

Country

Nearest Landmark*

Type of Residence Self Owned Parental Owned Rental Residence Cum Office Mortgaged Yes No
If Self Owned
Ownership
No. of Years in the Years Months
Residence address
Current Address Same as Residence Address mentioned above

Residence Address*

City/Town/Village*

District

PIN/ Post Code State/UT

Country

Nearest Landmark*

Type of Residence
If Self Owned
Ownership
No.of Years in the Current
Residence address Years Months

Tel. (Off) Tel. (Resi)

L. Customer
C. Income Details/Past
Consent Performance/Future Estimates

Turnover Profit as per P&L

Financial Year Year Installed Capacity Utilized Capacity Capital/Net Worth
(in Lakhs) (in Lakhs)

Past Year ll

Past Year l

Provisional

Present Year (Estimate)

Next Year (Projections)

 D. Existing Loans/Facility
L. Customer Consent Details
Loan Tenure
Name of Lending Nature Purpose Loan Monthly Security
Loan Opening RIO of loan Current Outstanding
Institution of facility of loan Amount EMI Provided
Date (Mths)
1

L. Customer
E. Details of Associates/Group
Consent Entities (in Lakhs ) Details as on
Name Address of Presently Extent of Interest as a Prop./
Exposure Year of Nature of Net Net Nature of
of the Associate Banking Partner/Director or just Investor in
(in Lakhs) Incorporation Business Profit Worth Association
Entity Concerns with Associate Concern

F.
L. Banking
CustomerDetails
Consent
Name of Bank
Branch
Name of account
holder
Account No.
A/c operated since
Account Type
Customer ID
(if existing customer)

IFSC
MICR Code
G. Details of Partners/Directors & Existing Loans
Name of Complete Category Residence Profit Academic Experience
Partners/ Residence Father/ DOB Aadhar No./ PAN No. SC/ST/OBC/ Telephone Mobile Age Sharing/ Qualificat- in the line
Directors/ Address Spouse DIN No. Minority/ No. No. (in Years) Shareholding ion of activity
Proprietors Women % (years)

L. Customer Consent
Promoter/Partner Loans Details

Promoter/Partner Name Type of Loan Availed from Sanctioned Amount Present Outstanding

L. Customer
H. ANNEXUREConsent
A - Security Details
(a) Primary Security (b) Liquid Collateral
Type of Security Value as on Date (in Lakhs) Type of Security Relationship Value as on

Stock
Debits
Others

(C) Collateral Security

Type of Collateral Address Area (Sq Ft) Value (INR Crs) Ownership
Property 1
Property 2
Property 3
 Date: d d m m y y y y

Place:..................................................... Co-applicant 1, Partner 1, Co-applicant 2, Partner 2, Co-applicant 3, Partner 3,

Applicant Signature Proprietor / Director 1 Proprietor / Director 2 Proprietor / Director 3

I.L.Reference
Customer Details
Consent(Business Reference)

Buyers Supplier
Title
Reference 1 Reference 2 Reference 1 Reference 2

Name*

Relationship with applicant/co-applicant

(Friend, Customer, Supplier, Competitor)

Address
City, Pin, State

Mobile No.*

Telephone

E-mail ID*

J. Priority Sector Category / MSME

Investment in Plant & Machinery / Equipment and Annual Turnover

Classification Micro Small Medium

Investment in Plant and Investment in Plant and Investment in Plant and

Machinery or Equipment: Machinery or Equipment: Machinery or Equipment:
Not more than 1 crore Not more than 10 crore Not more than 50 crore
Manufacturing Enterprises and
Enterprises rendering Services
Annual Turnover: Not more Annual Turnover: Not more Annual Turnover: Not more
than 5 crore than 50 crore than 250 crore

Investment in plant
& machinery amount
Annual Turnover
I/We confirm that above mention cost is our Original Cost of Investment in Plant and Machinery (manufacturing enterprise) / Office Equipment (Service enterprises)
Date: d d m m y y y y

Co-applicant 1, Partner 1, Co-applicant 2, Partner 2, Co-applicant 3, Partner 3,

Place:..................................................... Applicant Signature Proprietor / Director 1 Proprietor / Director 2 Proprietor / Director 3

Details of insolvency proceedings/suits for recovery/attachment order/criminal proceedings initiated/pending/disposed against us

Details of director or relative/near relation(as specified by RBI) of a director of a banking company (including CSB Bank) or a relative (as specified by
RBI) who is the applicant(s), or a partner of applicant , or a trustee, member, director, manager, an employee of applicant, or of applicant’s subsidiary,
holding company, or a guarantor on applicant’s behalf, or holds a substantial interest in the applicant or its subsidiary or holding company.

K. FATCA - CRS Declaration

(Please tick the applicable tax resident declaration (Any one)*
I am a tax resident of India and not resident of any other country OR I am a tax resident of the country mentioned in the below table
Please indicate the country/ies in which the entity is a resident for tax purpose and the associated tax number below
City of Birth* Country of Birth*
Address type for Resident Business Registered Office
Tax purpose*

Identification Type Address for Tax Purpose*

Country Tax Identification Number
(TIN or Other, please specify) Communication Permanent

#To also include USA, where the individual is citizen/green card holder of USA In case Tax Identification number is not available, kindly provide functional equivalent
FATCA-CRS Certification: I have understood the information requirements of this form (read along with the FATCA/CRS instructions and Terms & Conditions) and
hereby confirm that the information provided by me/us on this Form is true, correct, and complete and hereby accept the same.
L. Customer Consent
I hereby expressly consent to and authorize the Bank (whether acting by itself or through any of its service providers, and whether in an automated manner or otherwise), to collect, store
and process my application details, personal data and sensitive information about me, information, papers and data relating to know your customer (KYC), credit information, and any
other information about me/pertaining to me or not as may be deemed relevant by the Bank (collectively, “Information”) and I hereby also expressly consent to and authorize the Bank to
download KYC details from the CKYC registry using my CKYC ID for the purpose of the loan application.
I expressly consent Bank to share and disclose the information to service providers, consultants, credit information companies, information utilities, other banks and financial institutions,
affiliates, group companies, subsidiaries, regulators, investigating agencies, judicial, quasi-judicial and statutory authorities, or to other persons / institutions / entities as may be
necessary in connection with the contractual or legal requirements or in the legitimate interests of the Bank or as per the consent, undertake to process information including by way of
storing, structuring, organizing, reproducing, copying, using, profiling, etc. as may be deemed fit by the Bank and for the purposes of credit appraisal, fraud detection, anti-money
laundering obligations, for entering into contract, for direct marketing, for cross-selling, for developing credit scoring models and business strategies, for monitoring, for evaluating and
improving the quality of services and products, or for any purposes as the Bank may deem fit. I expressly agree to the Bank, its service providers, agents and/or its affiliates for using the
Information and for marketing, promoting and cross-selling to me their various products and services of the Bank from time to time via telephone, SMS and/or email.

Yes No
Co-applicant 1, Partner 1, Co-applicant 2, Partner 2, Co-applicant 3, Partner 3,
Applicant Signature Proprietor / Director 1 Proprietor / Director 2 Proprietor / Director 3

M. Customer Declaration
1) I/We declare that all the particulars and information given in the application form are true, correct and complete and no material information has been withheld/suppressed, I undertake
to inform you of any charges therein immediately. In case any of the above information is found to be false or untrue or misleading or misrepresenting, I/We am/are aware that I/We may
be held liable for it. 2) I/We have no borrowing arrangements for the unit except is in the application; that there are no over dues/statutory dues against me/us promoters except as
indicated in the application; I/We would take prior approval from CSB Bank in case we resort to any borrowing arrangement with any other bank.; I/We have not been declared as
defaulter/wilful defaulter by any Bank/FS and no Legal action has been taken /initiated against me/us by any Bank We shall furnish all other agency as authorised by you, may at any time,
inspect/Verify my/our assessment of account etc. in our factory/business premises as given above; you may take appropriate safeguards/action for recovery of Bank's dues including
publication of defaulters name in website/submission to RBI: further, agree that my/our loan shall be governed by the rules of your bank which may be in force time to time. I/We have
not withheld any information whatsoever. I/We shall furnish such additional writings as may be required in connection with the facility required by me/us. 3) I/We confirm that the enclosed
copies of financials /tax returns /bank statements/Title/legal and other documents are submitted by me/us against my/our loan application and are true copies. 4) I/We shall advise the
CSB Bank in writing of any change in my/our residential or employment/ business address or any such change which may affect my creditworthiness. 5) I/We confirm that I/We shall
utilise the said facility only for the purpose of business as mentioned above. 6) I/We also authorize CSB Bank to check references about me/us from any bank/persons. 7) I/We agree that
CSB Bank reserves the right to retain the photographs and documents submitted with the application and will not return those to the applicant even if the facility is rejected. 8) I/We
understand that the sanction of this loan is at the sole discretion of the Bank and upon my/our executing necessary security (ies) and other formalities as required by the Bank. 9) I/We
confirm that I/We are not a director or a relative of the director of other banks, not a firm in which a director or a relative of directors or other banks are interested in partner/ guarantor,
not a director/senior officer/relative of a director or senior officer of the bank. 10) I/We waive the privilege of privacy and privity of contract I/We understand that the tenure
/repayment/Interest/other terms and conditions of the loan are subject to changes as a consequence of any changes in the money market conditions or on account of any other statutory
or regulatory requirements or at the Bank's discretion. The Bank reserves the right to review and amend the terms of the loan to such extent as it may deem fit. 11) I/We understand that
the purchase of any Insurance products is purely voluntary, and is not linked to availment of any other facility from the Bank. 12) I/We understand that the Bank reserves the right to seek
any information from any source or to give any information and /or assign any work to any third party at its sole discretion in connection with the facility required by me/us. I/We further
agree that the facility that may be provided to me/us shall be governed by the rules of the Bank that may be in force from time to time. I/We will be bound by the terms and conditions of
the facility that may be granted to me /us. 13) Except to the extent disclosed to CSB Bank, I/We confirm that no insolvency proceedings or suits for recovery of outstanding dues or monies
whatsoever or for attachment of my/our properties and/or any criminal proceedings have been initiated and/or are pending against me/us and that I/We have never been adjudicated
insolvent by any court or other authority. Details of any such proceedings/suits/recoveries/attachments as referred above. 14) Except to the extent disclosed to CSB Bank, no director or
relative/near relation(as specified by RBI) of a director of a banking company (including CSB Bank) or a relative (as specified by RBI) is the applicant(s), or a partner of our concern, or a
trustee, member, director, manager, an employee of our concern, or of our subsidiary, or our holding company, or a guarantor on my behalf, or holds a substantial interest in our concern
or my/our subsidiary or holding company. 15) I/We authorize CSB Bank to share information relating to facilities availed by me/us from CSB Bank, as the Bank may deem appropriate and
necessary, with any Credit Bureaus, Credit Reference Agencies, Credit Information Companies or any other entity formed and authorized by RBI for the purpose of collecting, collating and
disseminating credit information pertaining to borrowers. Accordingly, I/We give consent to disclose information to such entities. Such entities may further make available processed
information or data or products therefore of banks/financial institutions and other credit grantors. 16) I/We understand that all charges pertaining to the loan like processing fees and/or
prepayment penalty and/or any other charges mentioned in the sanction letter are to be borne by me/us. I/We further understand the relevant stamp duty. Legal expenses, valuation
expenses, expenses pertaining to the creation of charges with ROC, charges for documentation and any other out of pocket expenses as per actuals will be borne by me/us. I/We
understand that charges paid to the Bank towards out of pocket expenses and/or login/processing fees are non-refundable and upon the application being withdrawn by me/us or being
rejected by the Bank for any reason whatsoever in the pre-sanction or post-sanction stage, I/We will not be entitled to any refund either in part or in full. 17) I/We understand that
disbursement will be subject to the production of necessary documents as may be required by the Bank from time to time, satisfactory completion of the Bank's appraisal and
documentation process and compliance with the Bank's laid down norms/guidelines. I/We shall furnish at the end of every quarter/year a certificate in the form required by the Bank
regarding my/our sales turnover and net profit, I/We undertake to inform CSB Bank regarding any changes whatsoever in my/ our addresses, as specified hereinabove or
employment/profession and to promptly provide such further information that CSB Bank (or its designated group companies or agents or representatives) may require. 18) I/We declare
that: (i) I/We am/are competent and fully authorized to issue such declarations, confirmations, agreements and undertakings and submit this application form for the purpose of borrowing
/availing of the requested facility and to execute all other documents required by CSB Bank for such purpose. (ii) all such letter(s) of authorities/power(s) of attorney, if any, executed by
me/us in favour of any persons and which is/are valid, subsisting and has/have not been revoked by me/us. I/We authorize CSB Bank to obtain my/our Bank Statements' PDF Passwords
from me/us and use such password directly or share the same with third party agencies appointed by the Bank for fetching, accessing, and assessing the bank statements shared with
the Bank. 19) I/We undertake that the proceeds of this facility shall not be used for investment in the capital market.

1. CSB Bank will convey its decision (within 2 weeks for a credit limit up to Rs. 5 lakh and within 3 weeks for a credit limit above Rs. 25 lakhs for Micro & Small enterprises borrowers
and (within 30 working days for other borrowers) from the date of receipt of the application provided the application is complete in all respects and is submitted along with all the
documents as per 'check list' provided in the application for loan and/or any additional documents as may be required by the bank for proper appraisal of the application. The computation
of timelines shall start from the day on which all documents required for a proper appraisal of the application are provided by the Customer to bank. 2. The bank, at its sole discretion
sanction or decline the application. No commitment has been given to me/us with regard to sanction of the loan. 3. The bank will decide and assign the loan amount/ facility and no
commitment has been given to me/us for the same. 4. The DSA/Bank employee has not collected any commission/brokerage or any other fee (except login fee) by way of cash or cheque.
5. As per RBI guidelines, classification of accounts as NPA is done Borrower wise and not Facility wise and hence, it may be noted that in case of non-payment of dues by the customer
in case of any facility availed from the Bank and consequently the account is to be classified as NPA, all other loan accounts of the Borrower/Card Holder, with the Bank also shall be
classified as NPA as per the guidelines issued by RBI and it shall entitle the Bank to recall all such loans/facilities availed by the same customer from the Bank irrespective of the regular
repayment in such accounts. 7. All the terms and conditions agreed to by the Applicant hereunder are also applicable and to be abided by the Co Applicant. This duly filled application
form may be shared by the Bank with the Co-Applicant for the Co-Applicant to be aware of the terms and conditions that are agreed to hereunder. In addition to these terms and
conditions, specific terms and conditions applicable to the co-applicant will be obtained separately and which is to be read together with these terms and conditions.
Date: d d m m y y y y

Photograph, Applicant 1 Photograph, Applicant 2 Photograph, Applicant 3

Place:..................................................... Applicant Signature Signature Signature Signature

N. Sourcing Details (for Official Use Only)

Sourcing Channel* DSA Connector Digital Circle Open Market Branch Channel Others

DSA/RO Code DSA/RO Name

Business Employee Code
Lending Manager
Referral Referral Branch ID
Branch Name
CRM ID* Ref Employee ID
Account
Opening City*
Account Opening
Branch Name
Account Opening Employee Signature &
Institutional Stamp
Branch Sol ID

L. Customer
O. DocumentConsent
Checklist

PRE SANCTIONED DOCUMENTS POST SANCTIONED DOCUMENTS

5
 L. Customer Consent
Acknowledgment for Receipt of Application Form

Date: d d m m y y y y (To be handed over to the customer)

CSB Bank has received your application for a Loan/Facility of .........................................................................

I/We confirm that the executive collecting the application/document has/has informed me/us of the applicable rate of interest and the type of interest (fixed/floating).
Processing fees, Login fee & Legal and Technical Valuation Charges (non - refundable) will be charged towards the loan application. The tax as may be applicable
will be charged in connection with the fees. The other applicable charges as mentioned in the attached Table. In terms of small business loans, the details with
respect to the EMI will be communicated separately through a welcome letter post disbursement of the loan.

The credit decision is based on a credit model which includes factors like credit history, repayment track record, banking habits, business stability & cash flow
analysis which is assessed through a combination of personal discussion and documentation

Incomplete/defective/application will not be processed at CSB Bank. CSB Bank shall not be responsible in any manner for the resulting delay or otherwise. In terms
of the small business loan, the Equated Monthly Installment (EMI) will be due on the 4th of every month or the date specified in the sanction letter/welcome letter.

The loan Foreclosure charges are as per the Loan Agreement. The Loan terms as sanctioned are applicable for the specified product as indicated in the loan
application and are valid for a period of 30 days only. Where for some reason there is a delay in concluding the loan. The Bank reserves the right to revise the loan
terms as may be applicable at the time of actual loan availment.
I/We also confirm that; The executive has not made any commitments to me/us regarding the loan quantum/sanction process(or) promised any deviation/waivers.
The executive has collected self-attested copies of the documents mentioned on the front side and verified the same with originals produced by me/us. We have
not given/made any payment in cash, bearer cheque or kind along with or in connection with this loan application to the said executive (or) to any other employee
of the bank(or) to any other third party.

Details Of Charges*

Date: d d m m y y y y

Co-applicant 1, Partner 1, Co-applicant 2, Partner 2, Co-applicant 3, Partner 3,

Place:..................................................... Applicant Signature Proprietor / Director 1 Proprietor / Director 2 Proprietor / Director 3

Date: d d m m y y y y
Employee/DSA Signature Employee/DSA Name & Code

CSB Bank Ltd. - Regd. Office: CSB Bhavan, St. Mary’s College Road, Thrissur, Kerala 680 020 | 24x7 Toll-free: 1800 266 9090
CSB_01_06_05_22

E-mail: [email protected] | www.csb.co.in | CIN: L65191KL1920PLC000175