PMS10202701554 LoanApplication

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PM Street Vendor’s AtmaNirbhar Nidhi(PM SVANidhi)

(Common Loan Application Form)


* Mandatory fields
** Only for SV's from Assam and Meghalaya, not having Aadhaar Number
# Data Fetching From Aadhaar

Application No. PMS10202701554 Name of Preferred Bank/Lender CANARA BANK

#Name of Street Vendor Geeta Dongre Father/Spouse Name* vasudev

#Date Of Birth 06/04/1976 Marital Status* Married

#Mobile Number* 9827731923 #Gender Female

Social Category* General

Are you vending in the same State you Are you vending in the same district
belong to?* you belong to?*

PwD (Divyangjan)* Minority*

KYC Details

#R-Token Number* Voter ID Card No.*


895844884141 NMU1546837

Family Details
Name* Relationship With Applicant* Age*
VASUDEV Daughter 49

Proof Of Vending
Vendor ID Card Certificate of Vending No. Letter Of Recommendation (LoR) No.
(Issued by ULB) (Issued by ULB) (To be issued by ULB electronically through PM SVANidhi Portal)
SVBHOBHO79296569156

Address as per e-KYC

#House No. / Locality H.NO - 149, VISHWAKARMA NAGAR #State MADHYA PRADESH

#Town/Dist Bhopal #Ward/Village BHOPAL

#Pin Code 462043

Current Address

House No. / Locality* H.NO - 149, VISHWAKARMA NAGAR State* MADHYA PRADESH

Town/Dist* Bhopal Ward/Village* BHOPAL

Pin Code* 462043


Vending Activity

Name Of Activity* Fruits and Vegetables

Other

Place Of Vending* Fixed Location

Duration Of Vending* 04/2016

Location/Area of Vending

Stationary Vendor AMRAI Nearest Landmark AMRAI

Mobile Vendor Nearest Landmark

State* MADHYA PRADESH Town/Dist* Bhopal

ULB Name* Bhopal Municipal Corporation Ward/Village* 55

Pin Code 462043

Total Monthly Family Income (₹) (Family means husband, wife and unmarried children)

Total Monthly Family Income (₹)* 10000

Bank Account Details


Name Of Bank* Name Of Branch* IFSC Code* Account No*
Canara Bank KUNJAN NAGAR, BHOPAL CNRB0004772 4772101000701

Digital Payment

Payment Aggregator * UPI ID / VPA * Durable QR Code

Canara Bank 103210873000027@cnrb

Existing Loan Outstanding


Bank/Lending Institution Outstanding Amount (in Rs.) Monthly EMI (in Rs.)

Loan Amount Required (₹) Loan Tenure Status

1stTerm Loan Amount 10,000/- 12 Months Closed/ Repaid

2nd Term Loan Amount 20,000/- 18 Months Closed/ Repaid

3rd Term Loan Amount 50,000/- 36 Months Active

Loan Purpose* Working Capital Business Expansion Purchase Of Assets

Declaration and Authorization:

A. I hereby certify that all information furnished by me is true, correct, and complete.I have not applied to any other lending institution under the PM
SVANidhi scheme. The information submitted herein may be exchanged by you with any agency, you may deem fit. You, your representatives, Lending
Institution (LIs) or MoHUA, or any other agency as authorized by you / MoHUA / LI, may at any time, inspect/ verify my/our assets etc. You may take
appropriate safeguards/action for recovery of lending institutions’ dues.

B. I understand that by submitting this application form, I am providing my consent for application for loans in remaining 2 cycles. After full repayment of
2nd loan; in the 3rd cycle, maximum loan amount will increase to ₹50,000/-. I will become eligible for the 3rd cycle of the loan only after full repayment of
current loan and submission of digital consent for the 3rd loan.

I understand that minimum repayment period of 9 months is required for the 2nd loan to be eligible for 3rd loan. If my loan is fully repaid before 9 months,
I would be eligible for the 3rd loan only after the stipulated period of 9 months from the date of disbursement of the 2nd loan.

C. I have no objection to authenticate my Aadhaar number, share the same with other Ministries / Departments under the Government of India or the State
Government for the purpose of extension of benefits under any of their Schemes, carry out e-KYC and accessing my credit history & credit score
from credit bureau by the lenders and their authorized agents. The consent and purpose of collecting Aadhaar has been explained to me in local language.
MoHUA/Lending Institution has informed me that my Aadhaar submitted herewith shall not be used for any purpose other than mentioned above, or as per
requirements of law. I have been informed that this consent and my Aadhaar will be stored along with my account details with MoHUA or their authorised
agent.

Place : Bhopal Signature of Applicant(s)

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