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site verification by the person in-charge) 1 2 Name of Unit Present Address (Business) Telephone No Proposed Address (Business) Present activity Proposed activity Date of establishment Constitution (Proprietorship / Partnership / Others) Name of Proprietor Date of Birth/ Age Qualification Experience Whether SC/ST/MC Present address (Residence)
3 4 5 6 7 8
10
Past performance (Last 2 yrs financial statements attach if available): Not applicable During the year (Current year financial statement attach if available): Not applicable (In lakhs) Particulars Turnover Raw materials purchases Other expenses / Profit Infra-structure available: Business premises Area Leased / Owned Lease rental per month Advance money paid Power Existing 25 HP as per the lease agreement For proposed Same as above No of employees: Existing Proposed List & details of existing machinery and other assets Previous years Last year Current year A detailed analysis is enclosed to this application.
Various clients - details enclosed. The unit regularly supplies the food artciles in a packed plastic bag.
Total Sources of Finance Promoter's contribution @15% Loan from Bank- TL Total Sources of margin money (Specify): Own source Other details Source of funds Repayment p.m. Present O/s Amount of default Rs
The repayment schedule is enclosed to this application Cost of production and profitability statements for the period of repayment: (In Lakhs) Particulars Turnover Raw materials Other expenses / Year 1 Year 2 Year 3 Year 4 Year 5
Enclosures: (1)SSI Registration Certificate (2)PAN / TIN / TNGST /CST (3)Partnership deed (4)Proof of residence (5)Proof of Identity (6)Statement of accounts with present banker (7)Financial statements & IT assessment copies (8)Proof of Date of Birth (9)Lease deed / Rental agreement (10)Quotations for machinery & other assets to be purchased (11)Photograph (12)Assets & liability statements of the applicant (13) Mentor charges letter (14)Copies of orders on hand (15)Site verification form (16)Technical Evaluation form (17)Profitability statement (18)Repayment schedule
YES NOT APPLICABLE NOT APPLICABLE YES YES YES NOT APPLICABLE YES YES YES YES YES YES YES YES YES YES YES