Annexure II

Application for Pradhan Mantri Mudra Yojana Loan up to Rs.50000/-

To Photograph to be
The Branch Manager pasted at the time
Bank of Baroda of signing of the
Branch application in the
designated
branch.

I/We request for a loan of Rs under Pradhan Mantri

Mudra Yojana scheme for the purpose of
.
I/We furnish particular as below:

1. Name of the Applicant

Gender : Male / Female / Not applicable (in case of other than Individual)

2. Constitution Individual/ Joint/ Prop. Concern /Partnership

3. Residential Address

4. Address of Factory/Shop

Address of the Office -------------------------------

5. Whether Belongs to SC/ST/OBC/Minority Community: Yes/ No

If Yes, then Please Select: SC/ ST/ OBC/ Minority Community

6. Telephone No. Residence Factory/Shop Office :

7. E mail Address

8. Mobile No.

9. Aadhar Card No. PAN Card No.

10. Nature of Activity:

11. Date of Establishment

 -2-

12. Name of Proprietor / Partners and Their Addresses:

S.No Name Date of Father/ Spouse Academic Mobile No

Birth Qualification
1.
2.
3.

S.No PAN No. Residential Address Telephone Experience in the

No. line of activity
(Residence) (Years)
1.
2.
3.

13. Existing Banking Relationship of the applicant and their family members:

Account type Name of the Person & A/c No Balance

(SB/CA/ Fixed ) Relation

It is hereby confirmed that our unit has not availed any loan from any other Bank / Financial
Institution in the past and I am not indebted to any other Bank / Financial Institution other
than those mentioned as under:
Details of existing Borrowings of the Applicant and their Family members

Name of the Name of the Type of Purpose Amount Security

Person Bank/Others Facilities Rs. Offered

14. Relationship of Proprietors/ Partners/ Directors with the officials of the Bank/ Director of
the Bank: Please select (Yes/ No)
15. Details of the Existing Assets and Liabilities as at the end of Last Year or Latest date
(please specify):
Liabilities Amount Assets Amount
Rs. Rs.
Capital Stock
Loans from Friends and Receivables
Relatives
Creditors Equipment
Other Liabilities Other Fixed assets
Other Advances and deposits
Total Total
 -3-

16. Details of Loan Requested: Working Capital / Purchase of Assets / Machinery/

Equipment

Working Capital: Basis of Credit Limit applied (Rs. in actual )

Projected
Actual Sales
2013-14 2014-15 Sales Profit Inventory Debtors Creditors

In case of term loan, the details of machinery Required: (Rs. in actual )

Type of machine Purpose for Name of Supplier Total Cost Loan Required
/ Equipment which required of Machine

Repayment period requested for:

17. Status Regarding Statutory Obligations:

Statutory Obligation: Remarks( Any details in Connection with the relevant obligation to be
given)

Whether Complied with (select Yes /No). If not applicable then select N. A. . In case of Yes ,
validity period ,
1. Registration under Shops and Establishment Yes/ No/ NA Valid upto
ACT
2. Registration under MSME (Provisional /Final) Yes/ No/ NA Valid upto
3. Drug License Yes/ No/ NA Valid upto
4. Latest Sales Tax Return Filed Yes/ No/ NA Valid upto
5..Any other Statutory licenses (Please specify) Yes/ No/ NA Valid upto

Declaration:

I/We hereby certify that all information furnished by me/us is true; that I/We have no
borrowing arrangements for the unit except is in the application; that there is no over dues/
statutory dues against me/us/promoters except as indicated in the application; that I/We
shall furnish all other information that may be required connection with my/our application
that this may also be exchanged by you with an agency you may deem fit and you, your
representatives or Reserve Bank of India or Mudra Ltd., or any other agency as authorised
by you, may at any time, inspect/ verify my/our assessment of account etc. in our
factory/business premises as given above.

Signature:

To be signed at the designated branch only’

Date:

Place:
 -4-

CHECK LIST

1. Proof of Identity : Voter’s ID Card / Passport / Driving License / PAN Card / Signature
identification from preset bankers of proprietor, partner or director ( if a company)
2. Proof of residence: Recent telephone bills, electricity bill, property tax receipt
/Passport / voter’s 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. Assets and liabilities statement of applicant /s along with latest income tax returns, if
any.
6. Rent / lease Agreement (if business premises is on rental/ lease basis) and
clearance from pollution control board if applicable.
7. SSI / MSME registration if applicable.
 Annexure III

Application for Pradhan Mantri Mudra Yojana Loan from Rs 50001/- to Rs.10 Lakh

Photograph to be
pasted at the time
of signing of the
application in the
designated
branch.

To
The Branch Manager
Bank of Baroda
Branch

I/We request for a loan of Rs under scheme for

the purpose
I/We furnish our particular as below:
1. Name of the Applicant

Gender : Male / Female / Not applicable (in case of other than Individual)

2. Constitution Individual/ Joint/ Prop. Concern /Partnership Pvt Ltd Co/ Limited Co/ others

3. Residential Address

4. Address of Factory/Shop

Address of the Office -------------------------------

5. Whether Belongs to SC/ST/OBC/Minority Community: Yes/ No

If Yes, then Please Select: SC/ ST/ OBC/ Minority Community

6. Telephone No. Residence Factory/Shop Office :

7. E mail Address

8. Mobile No.

9. Aadhar Card No. PAN Card No.

10. Nature of Activity:

11. Date of Establishment

 -2-

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

S.No Name Date of Father/ Academic Mobile No DIN No.

Birth Spouse Qualification

1.
2.
3.

S.No PAN No. Residential Address Telephone Experience in the

No. line of activity
(Residence) (Years)

1.
2.
3.

13. Names of Associate Concerns and Nature of Association:

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

14. Relationship of Proprietors/ Partners/ Directors with the officials of the Bank/ Director of
the Bank: Please select (Yes/ No)

15. Details of the Existing Assets and Liabilities as at the end of Last Year or Latest date
(please specify): Enclose Financials if available.
Liabilities Amount Assets Amount
Rs. Rs.
Capital Stock
Loans from Friends and Receivables
Relatives
Creditors Equipment
Other Liabilities Other Fixed assets
Other Advances and deposits
Total Total
 -3-

16. Banking/Credit Facilities (Existing) (Rs. in lakh)

Type of Limit (in Outstanding Name of Securities Rate of Repayment

Facilities lakh) as on the Bank Interest Terms
/Branch
Cash
Credit
Term Loan
LC/BG
Others
Saving NA NA NA NA NA
Account
Current NA NA NA NA NA
Account

It is certified that our unit has not availed any loan from any other Bank / Financial Institution
in the past and I am not indebted to any other Bank / Financial Institution other than those
mentioned in column no. 15 above.

17. Details of Loan Requested

Type of Facilities Amount (in lakh) Purpose for which Required

Cash Credit
Term Loan
LC/BG
Others
Total

Working Capital: Basis of Credit Limit applied (Rs. in Lacs)

Projected
Actual Sales
2013-14 2014-15 Sales Profit Inventory Debtors Creditors
after Tax

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

Type of Purpose Name of Total Cost Loan Type of Purpose

machine for which Supplier of Required machine for which
/ required Machine / required
Equipment Equipment

Repayment period requested for:

 -4-

19. Past Performance / Future Estimates

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 lakh Past Year 1 Past Year 2 Present Year Next Year
(Actual) (Actual) (Estimate) (Projection)
Net Sales
Net Profit
Capital (Net
Worth in case of
Companies)

20. Status Regarding Statutory Obligations:

Statutory Obligation: Remarks (Any details in Connection with the relevant obligation to be
given)

Whether Complied with (select Yes /No). If not applicable then select N. A.
1. Registration under Shops and Establishment ACT Yes/ No/ NA Valid upto
2. Registration under MSME (Provisional /Final) Yes/ No/ NA Valid upto
3. Any other License (Please specify) Yes/ No/ NA Valid upto
4. Latest Sales Tax Return Filed Yes/ No/ NA
5.Latest Income Tax Returns Filed Yes/ No/ NA
6.Any other Statutory dues remaining outstanding Yes/ No/ NA
7.Polution Control Yes/ No/ NA Valid upto

Declaration:

I/We hereby certify that all information furnished by me/us is true; that I/We have no
borrowing arrangements for the unit except is in the application; that there is no over dues/
statutory dues against me/us/promoters except as indicated in the application; that I/We
shall furnish all other information that may be required connection with my/our application
that this may also be exchanged by you with an agency you may deem fit and you, your
representatives or Reserve Bank of India or any other agency as authorised by you, may at
any time, inspect/ verify my/our assessment of account etc. in our factory/business premises
as given above.

Signature:

To be signed at the designated branch only’

Date:

Place:
 -5-

CHECK LIST

1. Proof of Identity : Voter’s ID Card / Passport / Driving License / PAN Card / Signature
identification from preset bankers of proprietor, partner of director ( if a company)
2. Proof of residence: Recent telephone bills, electricity bill, property tax receipt
/Passport / voter’s ID Card of Proprietor, partner of Director (if a company)
3. Proof of business Address
4. Applicant should not be defaulter in any Bank/F.I.
5. Last three years (Audited or Unaudited ) Balance Sheets of the units along with
income tax / sales tax returns etc. (Applicable for all cases from Rs. 2 lakh and
above)
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/ Lease Agreement (if business premises on rent/ Lease ) and clearance from
pollution control board if applicable.
9. SSI / MSME registration if applicable.
 Annexure V
Appraisal format for Pradhan Mantri Mudra Yojana
(For proposals for advances up to Rs.50,000/-)
(For Fresh Facilities)

Name of the Account :

Branch :
Region :

Basic Data:

Date of Establishment
Dealing with the Bank since

Location & Contact Detail

Nature of Activity
MSME Segment (Micro/Small/Medium)
RBI defaulters’ list dated-
Whether names of promoters, directors, Yes/No
Company, group concerns figure in Willful defaulters’ list dated- Yes/No
CIBIL dated- Yes/No
Whether eligible to be covered under Yes/No
CGTMSE, if yes then Date of Coverage
Whether promoter / directors of the Yes / No
borrower Company are relatives of any
member of the Bank’s Board/Senior Officer
of the Bank/ Member of any other Bank’s
Board

Background of the firm (In brief):

Name of Partners/Proprietor:
(` in Lac)
Name Designation PAN /ADHAR NO Net Worth As on

Existing funds/capital invested /available with the Applicant:

Existing Banking Relationship of the applicant and their family members:

Account type Name of the Person & A/c No Balance

(SB/CA/ Fixed ) Relation

Loans from other Banks/ Financial Institutions:

Name of the Institution Limit Outstanding Excess / Remark

As on Overdue

Any reschedulement agreed by our bank/ Other financial Institution/ Bank (in last –3- years):
( If yes give details)

Pre Sanction Inspection conducted on by :

Observations :

Introduction of the Applicant to the Bank , if any , By:

( It is not a mandatory for introduction )

Facilities enjoyed by Family members:

Name of the Name of the Type of Purpose Amount Security Remarks

Person Bank/Others Facilities Offered
Rs.

Assessment of Working Capital (Justification for working capital)

Actual Sales during the last year 2014-15

Projected Sales during the current year 2015-16

:
20% of the Projected Sales:

Limit proposed. Rs.

Assessment of Term Loan (Justification for term loan sanction)

Total Cost of Machinery /equipment proposed to be purchased Rs

Less: Margin proposed to be put in by the applicant:
Term Loan proposed

Expected Income from the Activity:

Less Estimated Expenses (including Interest)

Net income available

Less Repayment proposed for installment

Net surplus available for the Applicant

Justification and Recommendations:

(Officer/ Credit Incharge )

Comments of Sanctioning Authority:

SANCTIONED as per the Terms and conditions attached

(Branch Head)
Date:
 Terms and Conditions:
(Please note to incorporate details such as Nature of facility (existing and proposed) security,
margin, interest period etc. and other general terms and condition).

Terms and Conditions:

Nature of Facility Demand loan / Term Loan / Cash Credit / Overdraft

Limit Rs.
Purpose
Margin:

Rate Of Interest: % over Base Rate. Presently chargeable ROI @ % p.a.

Repayment Period: Subject to Annual Review

Repayment Schedule:
Moratorium Period:

Security/Documents: 1.

2.

3.

4.

Insurance
Other Conditions  Bank’s nameplate to be prominently displayed at the place of
Indicative terms are storage of the goods charged to the bank and other business
furnished places of the concern.
(As per Scheme/ Sector  Prescribed undertaking in respect of details of legal heirs,
of Advances, relevant to immovable properties and other matters are to be obtained from
concerned borrower the directors & guarantors.
accounts is to be  Undertaking for CIBIL purpose to be executed .
stipulated.)  Other Usual undertakings are to be executed .
 The representatives of Bank or any other agency can carry out
verification of books of accounts and inspection .
 The Bank is at liberty to change /add any of the terms and
conditions of sanction.
 The ROI & other Charges are subject to change from time to time
based on changes in Base Rate or Bank guidelines or RBI /GOI
guidelines
 Annexure VI

Appraisal format for Pradhan Mantri Mudra Yojana

(For fresh proposals for advances from Rs 50,001 to Rs.10.00 lacs

Name of the Account :

Branch :
Region :

Basic Data:

Asset Classification as at ………………

Bank’s Credit Rating as per ABS as at
…………………..
Constitution
Date of Establishment
Dealing with the Bank since

Location & Contact Registered Office

Detail Works
Key Person
Nature of Activity
Whether names of promoters, directors, RBI defaulters’ list dated- Yes/No
Company, group concerns figure in Willful defaulters’ list dated- Yes/No
ECGC caution list dated- Yes/No
CIBIL dated- Yes/No
Category of Loan – Kishore / Tarun
Whether eligible to be covered under Yes/No
CGTMSE, if yes then Date of Coverage
Whether Take over norms complied
Whether directors of the borrower Company
are relatives of any member of the Bank’s
Board/Senior Officer of the Bank/ Member
of any other Bank’s Board

Facilities and Outstanding:

(Rs. in Lacs)
Sr. No. Nature of Facility Existing Limit Proposed O/s as on Overdue
Limit
Background of the firm (In brief):

Name of Partners/Proprietor:
(` in Lac)
Name Designation PAN /ADHAR NO Net Worth As on

Loans from other Banks/ Financial Institutions:

Name of the Institution Limit Outstanding Excess / Remark

As on Overdue

Deposit Relationship /Ancillary Business: (Loan / advances against same to be also quantified)

Nature of Deposit Average Deposit in Last At Present

12 Months

Any reschedulement agreed by our bank/ Other financial Institution/ Bank (in last –3- years):
( If yes give details)

Facilities enjoyed by Associate/ Sister Concerns :

Name of company/firm Business/ Date of last Commitments with us/other bank

And its Prop./partners Activity review Branch, conduct of account

Pre Sanction Inspection conducted on by :

Any Adverse Observations :

Financial Performance/ Ratios of the Firm/ Company:

Particulars Actual Actual Estimated Projected

Year Ending 31st March 20
Sales
Net Profit After Tax
Depreciation
Net worth
Unsecured Loan
Term Loan
Current Assets
Current Liabilities
Net Current Assets
Fixed Asset
Current Ratio
DE Ratio (TTL/ TNW)
DE Ratio (TOL/TNW)
Profitability Ratio (NP/Sales) %
DSCR

Assessment of Working Capital (Justification for working capital)

Assessment of limit as per 1st Method of Lending is as follows:

(Rs. in Lacs)
Particulars Audited Estimated Projected
Total Current Assets (i)
Less: Current Liabilities
(Other than Bank Borrowings) (ii)
Working Capital Gap (iii)
Actual/projected bank borrowing (iv)
Total Current liabilities ii+iv (v)
25% of Working Capital Gap (vi)
Actual/projected NWC (vii)
Minimum stipulated margin 25% of WC Gap/ Projected
NWC (whichever is higher) (viii)
MPBF iii-vii
Excess borrowings, if any

Assessment of limits as per Turnover Method: (Rs. in Lacs)

Particulars Audited Estimated Projected
Actual/ Projected Turnover (APT)
25% of APT
5% of APT (A)
Net Working Capital (B)
Margin { (A) or (B) whichever is higher}
PBF
In respect of units under Regulatory definition of MSME Act, assessment of WC may be
done on the basis of Turnover Method or First Method of Lending, whichever is higher.
(Rs. in Lacs)
Particulars Estimated Projected
As per Turnover Method (PBF)
As per 1st Method of Lending (PBF)
Assessment of WC may be done on the basis of Turnover
Method or First Method of Lending, whichever is higher

Assessment of Term Loan (Justification for term loan sanction)

Requirement of other facilities (Justification for sanctioning other facility/ies)

Modifications (if any, in the existing terms and conditions with justification)

Confirmation:

Recommendations:

(Officer/manager)
Comments of Sanctioning Authority :

SANCTIONED
(Branch Head )
Date:
 Terms and Conditions:
(Please note to incorporate details such as Nature of facility (existing and proposed) security,
margin, interest period etc. and other general terms and condition).
Terms and Conditions:
Nature of Facility Demand loan / Term Loan / Cash Credit / Overdraft

Limit Rs.
Purpose
Margin:

Rate Of Interest: % over Base Rate . Presently chargeable ROI @ % p.a.

Repayment Period: Subject to Annual Review

Repayment Schedule:
Moratorium Period:
Security/Documents: 1.

2.

3.

4.

Insurance

Other Conditions  Bank’s nameplate to be prominently displayed at the place of

Indicative terms are storage of the goods charged to the bank and other business
furnished places of the concern.
(As per Scheme/ Sector  Prescribed undertaking in respect of details of legal heirs,
of Advances, relevant to immovable properties and other matters are to be obtained
concerned borrower from the directors & guarantors.
accounts is to be  Undertaking for CIBIL purpose be obtained.
stipulated.)  Other Usual undertakings are to be obtained.
 The representatives of Bank or any other agency can carry
out verification of books of accounts and inspection .
 The Bank is at liberty to change /add any of the terms and
conditions of sanction.
 The ROI & other Charges are subject to change from time to ti m
 based on changes in Base Rate or Bank guidelines or RBI /GOI
 guidelines
 Cash Credit (Hypo.) Limit will be availed against paid stock only
 Turnover in the account should commensurate with sales.