; Facility Application Form Revised 2012
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Facility Application Form Revised 2012


  • pg 1
1)Business Details:
Complete Name:_______________________________________________________________
Doing Business As / Brand Name:_________________________________________________
Address         : ___________________________________________City_________________
PIN Code        : _________________________________________Tel No:________________
Registered Office Address (If different from above):___________________________________
Since when does the business exist at this above-mentioned location? ____________ ____(Year)
Date of Incorporation:_____________________
Email           : __________________________________Website_______________________
Key person     : Mr. /Mrs. __________________________Contact Number:_________________
Designation     : Proprietor      Partner        Director /Others: ________________________
Sales/Service Tax Reg : _________________________________________________________

Name of all directors/ Age Designation Experience Educational Shareh Complete Residential  PAN             Date of
partners / proprietor of                (In Yrs)  Background olding address and Telephone Number            Birth
       the firm*                                                             No.

 3) Business Details
 Business Segment/ Key Products                               % Sales             Description

 4) Details of Sister Concerns (If Any)
 Name of Sister and    Business             Promoters        Turnover        Banking       % shareholding of
 associate concerns                                          (In Rs Lakhs)   With          promoters in company

  5) Details of major 5 buyers & suppliers (along with their contact details)
 Name of the    Person name &     Contact          Product purchased         Dealing   % Of Total   Credit period
 Supplier       Designation       Number           from supplier             since     Purchases    (In Days)

 Name of the    Person name &     Contact          Product sold to Buyer     Dealing   % Of Total   Credit period
Buyer           Designation       Number                                     since     Sales        (In Days)

 6) Existing and Proposed Banking Facilities
 a) Existing banking facilities availed for working capital purpose
Facility                            Amount        Outstanding Interest Type of Security Owner’s Market
                                   (In Rs Lakhs)  as on……        Rate(%) (Res/Comm/Ind)     Name       Value
Cash Credit/OD
Term Loan
Letter of Credit
Bank Guarantee
Others (Fund/Non-Fund),if any
 b) Your association with current bankers ____(In Yrs) c) Your association with RBS Bank  Yes /  No
    If Yes, Please specify__________________________________________________________________
 d) Proposed banking facilities for working capital purpose with RBS Bank (In Rs Lakhs)
Facility                            Amount        Interest Type of Security       Owner’s        Market
                                   (In Rs Lakhs)  Rate(%) (Res/Comm/Ind)          Name           Value
Cash Credit/OD
Term Loan

                                               -    1    -
 Letter of Credit
 Bank Guarantee
 Others (Fund/Non-Fund),if any
  **Security provided to the Bank (with owner name and Market Value)

  7) Past Performance & Future Estimates:-
 Facility                       FY 2009-2010            FY 2010-2011             2011-2012                      2012-2013 Projections
 Net Sales (In Lakhs)
 Net profit (In Lakhs)
 Capital (In Lakhs)

  8) Status Regarding Statutory Obligations:-
 Statutory Obligations                                                  Yes /No /Not Applicable           Remarks (If Any)
 Registration under shops & establishment act
 Registration under SSI(Provisional/Final)
 Drug License
 Latest Sales Tax return filed
 Latest Income Tax return filed
 Any Other Statutory dues remaining outstanding

  9) Please return this form along with the documents mentioned in the CHECKLIST attached to this form.

Name        :_____________Signature:________________Place                            :_____________Date             : _____________
Declaration:-I/We certify that all information furnished by me/us is true; that I/We have no borrowing arrangements for the unit except as
indicated in the application; that there is no overdues/statutory dues against me/us/promoters except as indicated in the application; that no
legal action has been/is being taken against me/us/promoters; 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 deemed fit & you, your
representatives, representatives of RBI or any other agency as authorized by you, may,at any time, inspect/verify my/our assets, books of
account etc in our factory/business premises as given above.
(Authorized Signatory sign and place the rubberstamp of the organization.)(Please read the standard charges applicable
mentioned below & mentioned in the annexure attached before signing the form & handing it over to our representative)

  10) Types of Charges                                                      Value of Charges
  Processing Fees:-                                                         __%p.a. of the total facility
  Interest Rate:-                                                           ___ %p.a.                            Affix Photo of the
  Valuation & Title Charges:-                                               At Actuals.                            person signing
                                                                                                                     the docs –
  Documentation Charges:-                                                   INR 10,000/-                        Client representative
  Early Facility Closure Penalty:-                                          NIL                                     Or Authorized
  Non Utilization Penalty (If utilization less than 60%):-                  ________                                 Signatory.
  Stamp duty / Franking Charges (including commission):-                    At Actuals
                                                                            (As per State Stamp Act)

  Name & Signature of Sourcing Person:_________________________________________________________
  (Please tick the points mentioned in the CHECKLIST attached before signing the Form & accepting the same from the client)
  Please Fill, Sign, Tear & Handover the Loan application acknowledgement receipt to the customer (shown below):-
  I have received the application form along with the desired documents mentioned in the checklist
  (Points 1-12). The documents pending are:-
  Name & Signature of Sourcing Person:____________________________________________________

  Designation:-______________________                            Mobile Number:-________________________________

                                                             -    2     -
                                                DOCUMENT CHECKLIST

1)* Audited Financials duly self attested by the promoters with sign + stamp
     For Below mentioned years-P&L A/C with B/S with schedules, Notes to A/C, Directors Report & Auditors Report

    a)   FY 09,                           b) FY 10,                          c) FY 11

    d)   FY 12–Provisional figures (if audited not available)

2)* ITRs and Tax Audit Reports duly self attested by the promoters with sign & stamp

    For Below mentioned years-ITR, Tax Audit Report – Form 3CA & 3CD

    a)   FY 09,               b) FY 10,                   c) FY 11                  d) FY 12(if available)

3)* Bank Statements for last 12 months (Against all bank accounts)

4)* Existing Bank’s sanction letter with terms & conditions (In case of takeover)

5)* Copy of the constitution docs- MOA/AOA/Partnership Deed/Sales Tax Regn Certificate etc.

6)* ID Proof & Address Proof (KYC documents) of Firm/Company & of Proprietor/ All Partners/ All Directors etc.

7)* Profile of the Firm/Company on Firm’s/Company’s Letter head covering the following points:-

  (Includes Name of promoters/directors, Business, Manufacturing/Trading process, Details about the major
  competitors, Company’s/ firm’s Strengths & Weaknesses, Addresses of plants & offices, Current
  Shareholding pattern, Month wise sales (quantity & value both), Production (quantity & value both), Imported
  & Indigenous raw material (quantity & value both), Last 3 months Debtors, Stock & Creditor’s figures etc.

8) Photocopies of lease deeds/title deeds of all properties being offered as collateral.

9) Position of accounts from the existing banker & confirmation about the asset being standard with them
   (In case of takeover)

10) Net worth Statements of Promoters & Guarantors.

11) Rent agreement (If business premises on rent).

12) Last 3 year’s B/S & P&L accounts of associate/group companies (If any).

 * Documents mentioned in point 1-7 are mandatory to login the case.

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