H.O.

: 7 Bhikhaiji, Cama Place, New Delhi

BO: __________ Date: ____________

Provisional Acknowledgement

Received application for credit facility of Rs.
______________________. A system generated
acknowledgment shall be sent to you through email and
SMS on registered email and mobile phone containing user
ID and password through which you can track the status
of your application by logging on our corporate website
www.pnbindia.in.



Signature of Branch Official



























PNB-1166/2013

APPLICATION FOR MICRO, SMALL & MEDIUM ENTERPRISES
(MSME) FOR LOANS UP TO Rs.100 LAKH

To be submitted along with documents as per the checklist


2. Regd. Office
Address*





3. Address of the factory
/Shop/Business*





Telephone No.*
E-mail ID*
Mobile No.*
PAN Card No.

4. Whether applicant belongs to
SC/ST/OBC/Minority
Community etc*.
SC ST OBC Minority General

5.
Constitution Proprietary Partnership Pvt. Ltd. Ltd. Company Co-op.society
Any Others
(Specify)

6. Date of Establishment*

7. State*: City where loan
is required*:
District:
Branch where loan is required:


8. Name of Proprietors/Partners/Directors Of Company and their Addresses:*
S
No.
Name
Date of
Birth
Father/Spouse
Academic
qualification
Mobile No.
1.



2.

3.



1. Name of the Unit /
Applicant *

2

8. Name of Proprietors/Partners/Directors Of Company and their Addresses:*
S
No.
PAN No. Residential Address
Telephone
No.
Experience in the line of
activity (Years)
1.



2.

3.


9. Line of activity*
Existing :
Proposed (#)
# if a different activity other than existing activity.

10. Name of Associate Concerns and Nature of Association:

Name of the Associate
concerns
Addresses of the
Associate Concerns
Presently
Banking
with
Nature of
Association
Extent of Interest
as a Prop./Partner
Director/or Just
investor in
Associate concern




11. Relationship of Proprietor/Partner/Director with the officials of the
Bank/Director of the Bank: Please select (Yes/No)


12(a). Banking/Credit Facilities (Existing) (Rs. In Lakh)

Type of
facilities
Limits
(in
lakhs)
Outstandin
g as on

Presently
banking with
Security
lodged
ROI
Repayment
terms

Current
Account

Cash
Credit

Term
Loan


LC/BG


Others


Total

If Banking with PNB, customer ID to be given,
12(b). It is certified that our unit has not availed any loan from any other Bank/Financial Institution
in the past and I am no indebted to any other Bank/Financial Institution other than those
mentioned in 12(a) above.
3

13. Credit Facilities (proposed)*
Type of
Facilities
Amt.
(In lakh)
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 in
column 15) Yes/No
Cash Credit**
Term Loan
LC/BG
Others
Total

**Basis of Cash Credit Limit applied
Cash
Credit
Projected
Sales Working
Cycle in
months
Inventory Debtors Creditors Other
current
assets
Promoters
Contribution

*Mandatory Fields

14. In case of term loan requirements, details of proposed machinery/Equipments may be given as
under:-
Type of
Machine/
Equipments
Purpose for
which
required
Whether
imported
or
indigeno
us
Name of supplier Total cost of
machine (in
case if
imported
machine, the
break-up of
basic cost ,
freight,
insurance
and customs
duty may be
given)
Contributio
n being
made by
the
promoters
Loan
required




Total


Note: In case of more machinery, details of machinery/Equipments may be attached as per
Annexure.
4
15. Details of collateral security offered, if any including 3rd party guarantee:-
(* As per RBI guidelines banks are not to take collateral security for loans upto Rs. 10
Lakh to MSME Units)
(a) Guarantee if offered:-
S.
No
.
Name of
Guarantor
Address Relation
with
borrower
Net
worth
Telephone
No.
Mobile
No.
PAN No. Loan
s if
any




(b) Other Collateral Security:-
S.
No.
Name of Owner of
Collateral
Collateral Security
Nature Details Area Valuation (Rs.
In Lakh)



16. 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 loon facilities projections to be provided till the proposed year of repayment
of loan on separate sheet)
Amount in Lakh
Past Year II
(Actual)
Past Year I
(Actual)
Present Year
(Estimates)
Next Year
(Projections)
Net Sales
Net Profit
Capital (Net Worth in case
of companies)


17. Status regarding statutory obligations:
Statutory Obligations: Remarks (Any details in connection with the relevant obligation to be
given)

Whether complied with). Select Yes/No/NA whichever is applicable.
1. Registration under shops and Establishment Act Yes / No / NA
2. Registration under SSI/MSME (Provisional/Final)
Yes / No / NA
3. Drug License (if applicable) Yes / No / NA
4. Latest Sales/VAT Tax Return Filed
Yes / No / NA
5. Latest Income Tax return filed
Yes / No / NA
6. Any other statutory dues remaining outstanding
Yes / No / NA
7. Any other specify
Yes / No / NA

5

18.
ID Proof
Passport: Voter Identity: PAN Card: Driving Licence:
Aadhaar Card: Identiy Card: Job Card:
18 (a).
ID Proof No.


19.
Address
Proof

Electricity
Bill:
Telephone Bill: Bank Account Statement of
any other bank:
Letter from reputed
employer:
Letter from recognized public
authority verifying the address of
the customer to the satisfaction of
the bank:
Ration
Card:
19 (a).
Address Proof No.


20.
SPACE FOR THE PHOTO SPACE FOR THE PHOTO
SPACE FOR THE
PHOTO

SIGNATURE SIGNATURE SIGNATURE
Only one photo of proprietor/each partner/each working Director is required to be
affixed.


I/We certify that all information furnished by me/us is true; that I/We have no borrowing
arrangements for the unit except as is in the application; that there is no overdue/statutory dues
against me/us/promoters except as indicated in the application; that I/We shall furnish all other
information that may be required in connection with my/our application that this may also be
exchanged by you with any agency you may deemed fit and you, your representatives,
representatives of the Reserve Bank of India 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 premised as
given above.

Date..
Place.


Signature of Applicant

For Branch use:

1. Application received and entered.
2. Acknowledgment given to applicant.
3. Photo & Signature of applicant should be attested/verified by Branch official.


Signature of Branch Official
6

CHECK LIST OF DOCUMENTS TO BE SUBMITTED BY THE CUSTOMER

1) Proof of identity Voters ID Card/Passport/Driving License/PAN Card/signature identification
from present bankers of proprietor, partner or Director (if a company).
2) Proof of residence Recent telephone bills, electricity bills, property tax
receipt/Passport/voters ID Card of proprietor, partner or Director (if a company)
3) Proof of business address
4) Applicant should not be defaulter in any Bank/F.I.
5) Last three years balance sheets of the units along with income tax/sales tax returns etc.
(Applicable for all cases from Rs.2 lakhs and above). However, for cases below fund based
limits of Rs.25 lakhs if audited balance sheets are not available then un-audited balance
sheets are also acceptable as per extant instructions of the bank.
6) Memorandum and articles of Association of the Company/Partnership Deed of partners etc.
7) Assets and liabilities statement of promoters and guarantors along with latest income tax
returns.
8) Rent Agreement (if business premises on rent) and clearance from pollution control board if
applicable.
9) SSI /MSME registration if applicable.
10) Projected balance sheets for the next two years in case of working capital limits and for the
period of the loan in case of term loan (For all cases of Rs.2 lakhs and above)
11) In case of takeover of advances, sanction letters of facilities being availed from existing
bankers/Financial Institutions along-with detailed terms and conditions.
12) Photocopies of lease deeds/title deeds of all the properties being offered as primary and
collateral securities.
13) Position of accounts from the existing bankers and confirmation about the asset being
Standard with them (In case of takeover).

For Cases With Exposure Above Rs. 25 Lakhs

14) The audited balance sheets are necessary.
15) Profile of the unit (includes names of promoters, other directors in the company, the activity
being undertaken, addresses of all offices and plants, shareholding pattern etc.
16) Last three years balance sheets of the Associate/Group Companies (If any).
17) Project report (for the proposed project if term funding is required) containing details of the
machinery to be acquired, from whom to be acquired, price, names of suppliers, financial
details like capacity of machines, capacity utilization assumed, production, sales, projected
profit and loss and balance sheets for the next 7 to 8 years till the propose loan is to be paid,
the details of labour, staff to be hired, basis of assumption of such financial details etc.
18) Review of account containing month-wise sales (quantity and value both), production (quantity
and value), imported raw material (quantity and value), indigenous raw material (quantity and
value), value of stocks in process, finished goods (quantity and value), debtors, creditors,
banks outstanding for working capital limits , term loan limits ,bills discounted.
19) Manufacturing process if applicable, major profile of executives in the company, any tie-ups,
and details about raw material used and their suppliers, (details about the buyers, details
about major competitors and the companys strength and weakness as compared to their
competitors etc.

(The Check is list is only indicative and not exhaustive and depending upon the local
requirements at different places addition could be made as per necessity).