APPLICATION FOR THE GRANT OF SOLVENCY CERTIFICATE

							               APPLICATION FOR THE GRANT OF SOLVENCY CERTIFICATE


1. Name of the applicant ......................................................................................................
2. Father’s/Husband’s Name ................................................................................................
3. Permanent Address ...........................................................................................................
4. Temporary Address ..........................................................................................................
5. Total Amount for which the solvency Certificate is required .......................................
      ...........................................................................................................................................

6. Purpose for which the solvency Certificate is required .................................................
      ...........................................................................................................................................

7. Occupation of the applicant .............................................................................................
8. If applicant is the Govt. servant what is his salary (Total) per month (Attach Salary Certificate)


9. Property/owned by the applicant residential/commercial building ..............................
      ...........................................................................................................................................

10. Property/MCD No. ...........................................................................................................
11. Area of Plot .......................................................................................................................
     (i) Total annual rental value; House tax assessed ..........................................
     (ii) Whether the property is free from all encumbrances, if not state the nature of encum-
              brance alongwith an affidavit .................................................................................

     (iii) Present market value of the property .....................................................................
     (iv) Receipt showing payment of house tax .................................................................

12. AGRICULTURAL LAND
     (i) Name of the owner/Bhumidar ................................................................................
     (ii) Share of each owner/Bhumidar ..............................................................................
     (iii) Total area of land .....................................................................................................
     (iv) Whether the land is free from all encumbrances, if not the nature of encumbrances

                   ...............................................................................................................................
     (v) Copy of the latest revenue record in support of the verification .........................
                   ...............................................................................................................................

     (vi) Present market value of the land ............................................................................
13. In case the sureties are business men, they should produce copy of the latest income-tax
   together with receipt of payment of Income-tax ............................................................

14. Details of Bank Account if any:
   (i) Saving Bank Account No. with credit ...................................................................
   (ii) Current Bank Account No. with last credit ...........................................................


                                                DECLARATION

       I, declare that the statements made above in columns 1 to 14 of the application form are
true to the best of my knowledge and nothing has been concealed there from.




                                                                                      (Signature of the applicant)
Place:… … … … … … … … … … Name in BLOCK letters

Date:… … … … … … … … … … Shri/Smt… … … … … … … … … … … … ..