Online Application for MSE Loans

(Please read the application form carefully before filling. Fields with * are Mandatory.)

1. Application Sl. No.

2. Date (dd-mm-yyyy):

2.Name Of The Enterprise*
3. Regd. Office Address*
4. Address of Factory/Shop*
5. Whether Belongs to SC/ST/OBC/Minority Community	Yes No	If Yes, then Please Select

6.Telephone No.*

7.E mail Address*

8. Mobile No.*

9. PAN Card No.

10. Constitution*

11. Date Of Establishment*

12. State

13.Select District where loan is required*

14.PNB branch where loan is required.

15. Name of Proprietors/ Partners/ Directors of Company and Their Addresses: *

Name	Age	Academic Qualification	Residential Address	Telephone No. (Residence)	Experience in the line of activity (Years)

16. Activity*

Existing

Proposed#

#If a different activity other than existing activity is proposed.

17. Names of Associate Concerns and Nature of Association:

Name of Associate Concern	Address of Associate Concern	Presently Banking With	Nature of Association	Extent of Interest as a Prop./ Partner/ Director or Just Investor in Associate Concern


Relationship of Proprietors/ Partners/ Directors with the officials of the Bank/ Director of the Bank

19. Credit Facilities (Existing) (Rs. in lacs)

Type of Facilities	Limit (in lacs)	Outstanding as on ...	Presently Banking With	Security Lodged	Rate of Interest	Repayment Terms




If Banking with this Bank, customer ID be given here:
It is certified that our unit has not availed any loan from any other Bnak / Financial Institution in the past and I am not indebted to any other Bank / Financial Institution other than those mentioned in 19 above.

18. Credit Facilities (Proposed)*

Type of Facilities	Amount (in lacs)	Purpose for which Required	Security Offered
			Primary Security (Details with approx. value to be mentioned)	Whether Collateral Security Offered (Please mention yes or no) (If yes, then provide details on column 12)
				Yes No
				Yes No
				Yes No

19.In case of term loan requirements, the details of machinery may be given as under:

Type of Machine	Purpose for which Required	Whether Imported or Indigenous	Name of Supplier	Total Cost of Machine ( in case of imported machine, the breakup of basic costs, freight, insurance and customs duty may be given)	Contribution being made by the promotors	Loan Required

20. Details of Collateral Security Offered, if any, including third party Guarantee #

(# As per RBI guidelines banks are not to take collateral security for loans upto Rs. 5 lakhs to MSME Units)

Past Performance / Future Estimates (Actual performance for two previous years, estimates for current year and projections for next year to be provided for working capital facilities. However for term loan facilities projections to be provided till the proposed year of repayment of loan)
Rs. in lacs	Past Year 1 (Actual)	Past Year 2 (Actual)	Present Year (Estimate)	Next Year (Projection)

21. Status Regarding Statutory Obligations:

Statutory ObligationRemarks( Any details in Connection with the relevant obligaiton to be given)

Whether Complied with (select Yes /No). If not applicable then select N. A.