¶ãñÍã¶ãÊã Íãñ¡¿ãîÊ¡ ‡ãŠãÔ›áÔã ¹ãŠãƒ¶ãòÔ㠆⡠¡ñÌãÊã¹ã½ãò› ‡ãŠã¹ããóÀñÍã¶ã

NATIONAL SCHEDULED CASTES FINANCE & DEVELOPMENT CORPORATION

(¼ããÀ¦ã ÔãÀ‡ãŠãÀ ‡ãŠã „¹ã‰ãŠ½ã/A Govt. of India Undertaking)
14Ìããé ½ãâãä•ãÊã, ‡ãŠãñÀ 1&2, Ô‡ãŠãñ¹ã ½ããè¶ããÀ, Êãà½ããè ¶ãØãÀ ãä•ãÊãã ‡ãòŠ³, ãäªÊÊããè-110092
14th Floor, Core:1&2, SCOPE Minar, Laxmi Nagar District Centre, Delhi-110092

¹ããÔã¹ããñ›Ã ‚ãã‡ãŠãÀ ‡ãŠã ¹ãŠãñ›ãñ

Passport Size Photo

Íãõàããä¥ã‡ãŠ ¨ãɥ㠂ããÌãñª¶ã ¹ãƹã¨ã

EDUCATIONAL LOAN APPLICATION FORMAT
(‡ãñŠÌãÊã À㕾ã Þãõ¶ãñÊããƒãä•ãâØã †•ãòÔããè ‡ãñŠ ½ã㣾ã½ã Ôãñ ¹ãÆÔ¦ãì¦ã ‡ãŠÀ¶ãñ ‡ãñŠ ãäÊã†)
(To be submitted through State Channelising Agency only)
I. ̾ããä‡ã‹Øã¦ã ãäÌãÌãÀ¥ã/PERSONAL DATA:
1. ‚ããÌãñª‡ãŠ ‡ãŠã ¹ãîÀã ¶ãã½ã (ºãü¡ñ ‚ãàãÀãò ½ãñ)
Full Name of the Applicant (In capital
letters)
2. ãä¹ã¦ãã/¹ããÊã‡ãŠ ‡ãŠã ¶ãã½ã/Father/Guardian's
Name
3. •ã¶½ã ¦ããÀãèŒã/Date of Birth
4. •ãããä¦ã ‚ããõÀ „¹ã•ãããä¦ã/Caste & Sub Caste
5. ÌãããäÓãÇ㊠¹ãããäÀÌãããäÀ‡ãŠ ‚ãã¾ã/Annual Family
Income
6. Ô©ãã¾ããè ¹ã¦ãã ‚ããõÀ ãä¹ã¶ã ‡ãŠãñ¡
Permanent Address with PIN Code
7. ¹ã¨ããÞããÀ ‡ãŠã ¹ã¦ãã ‚ããõÀ ãä¹ã¶ã ‡ãŠãñ¡
Address for Correspondence with PIN
Code
8. Ìãõ£ã ¹ããÀ¹ã¨ã Ôãâ. ‚ããõÀ ‚ãÌããä£ã Ôã½ããã书㠇ãŠãè ¦ããÀãèŒã
(ãäÌãªñÍã ½ãò ‚㣾ã¾ã¶ã ‡ãñŠ ãäÊã†)
Valid Passport No. & Expiry Date
(For study Abroad)
9. Ìãõ£ã Ìããè•ãã/¹ãÀãä½ã› Ôãâ. ‚ããõÀ ‚ãÌããä£ã Ôã½ããã书㠇ãŠãè
¦ããÀãèŒã
(ãäÌãªñÍã ½ãò ‚㣾ã¾ã¶ã ‡ãñŠ ãäÊã†)
Valid Visa/Permit No. & Expiry Date
(If any for study abroad)
10. Ôãâ¹ã‡ãÊ ¶ãâºãÀ (½ããñºããƒÊã/ãä¶ãÌããÔã)
Contact No.(Mobile/Residence)
II.
¹ãÀãèàãã ÔãâÔ©ãã¶ã/ãäÌãÍÌããäÌã²ããÊã¾ã •ãÖãú Ôãñ „¦¦ããè¥ãà ÌãÓãà ‚ã‡ãŠãò ‡ãŠã ¹ãÆãä¦ãÍã¦ã/ØãÆñ¡
Examination ¹ãÀãèàãã ¹ããÔã ‡ãŠãè Year of Percentage of marks/grade
Institution/University passing
from which passed
(1) (2) (3) (5)
1.
†Ôã†Ôã†ÊãÔããè/SSLC
2. 10+2
3.
Ô¶ãã¦ã‡ãŠ/Graduation
4. ¹ãÀãÔ¶ãã¦ã‡ãŠ/P.G.
5.‚㶾㠇ãŠãñƒÃ/ Any
other (‡ãðŠ¹ã¾ãã
„ãäÊÊããäŒã¦ã ‡ãŠÀò)/
(please specify)
III. ½ãã¦ãã-ãä¹ã¦ãã ¹ããÊã‡ãŠ ‡ãŠã ãäÌãÌãÀ¥ã/PARTICULARS OF PARENTS/GUARDIAN:
a) ¹ãîÀã ¶ãã½ã/Full Name
b) Ô©ãã¾ããè ¹ã¦ãã: ãä¶ãÌããÔã
Permanent Address: Residence
c) ¹ã¦ãã: ‡ãŠã¾ãÃÔ©ãÊã
Address: Place of work
d) ¹ãŠãñ¶ã ¶ãâ. (ãä¶ãÌããÔã) ‚ããõÀ ‡ãŠã¾ããÃÊã¾ã
Phone Number : (Res.) & Office
e) ‚ãã¾ãì/Age
IV. ¹ã㟿ã‰ãŠ½ã ‡ãŠãè •ãã¶ã‡ãŠãÀãè (ãä•ãÔã‡ãñŠ ãäÊㆠÍãõàããä¥ã‡ãŠ ¨ãɥ㠇ãŠãè ½ããâØã ‡ãŠãè)
COURSE DETAILS: (For which Educational Loan sought)
1. ¹ãî¥ãÇãŠããäÊã‡ãŠ ̾ããÌãÔãããä¾ã‡ãŠ/¦ã‡ãŠ¶ããè‡ãŠãè ¹ã㟿ã‰ãŠ½ã ãä•ãÔã‡ãñŠ
ãäÊㆠ¨ãɥ㠇ãŠãè ‚ããÌã;ã‡ãŠ¦ãã Öõ
Name of the Fulltime Professional/Technical Course
for which Loan is required
2. ¹ã㟿ã‰ãŠ½ã ‡ãŠãè ‚ãÌããä£ã/Duration of the Course
3. ‡ãŠãùÊãñ•ã/ÔãâÔ©ãã¶ã/ãäÌãÍÌããäÌã²ããÊã¾ã ‡ãŠã ¶ãã½ã
(Ôãâºã®/½ã㶾ã¦ãã ¹ãÆ㹦ã)
Name of the College/Institute/
University (Affiliation/Recognition)
4. ¹ãÆÌãñÍã ¹ãÀãèàãã, ¾ããäª ‡ãŠãñƒÃ Öõ, „¦¦ããè¥ãÃ/
Entrance exam, if any, qualified
5. Íãõàããä¥ã‡ãŠ ÔãâÔ©ãã¶ã ´ãÀã „¹ãÊ㺣㠇ãŠÀㆠ•ãã ÀÖñ
ãä¶ã¾ããñ•ã¶ã, ¾ããäª ‡ãŠãñƒÃ Öõ, ‡ãŠã º¾ããõÀã
Details of placement to be provided
by the Educational Institute, if any
 (ÀããäÍã Á¹ã¾ããò ½ãò/Amount in Rs.)
V. ‚㣾ã¾ã¶ã ‡ãŠã ‡ãìŠÊã ŒãÞãÃ*/TOTAL STUDY EXPENSES*:
ÌãÓãÃ-ÌããÀ ‚ã©ãÌãã Ôã¨ã-ÌããÀ/YEAR-WISE OR SEMESTER- 1 2 3 4 ‡ãìŠÊã
WISE TOTAL
1. ¹ãÆÌãñÍã ÍãìʇãŠ/Admission Fees & Tuition Fee
2. ¹ãìÔ¦ã‡ãòŠ, ÊãñŒã¶ã Ôãã½ãØãÆãè, ‚ããõÀ ¹ã㟿ã‰ãŠ½ã ‡ãñŠ ãäÊã†
‚ã¹ãñãäàã¦ã ‚㶾㠄¹ã‡ãŠÀ¥ã/Books, Stationery and
other instruments required for the course
3. ¹ãÀãèàãã ÍãìʇãŠ/Examination Fee
4 ¼ããñ•ã¶ã ‚ããõÀ ‚ããÌããÔã ÍãìʇãŠ/Boarding and Lodging
Expenses
5. ½ãð¦¾ãì ‚ã©ãÌãã Ô©ãã¾ããè ãäÌã‡ãŠÊããØãâ¦ãã ‡ãñŠ ½ãã½ãÊãñ ½ãò ¨ãɥ㠇ãŠãè
ÔãìÀàãã ‡ãñŠ ãäÊㆠ¨ãÉ¥ããè ‡ãŠãñ ºããèãä½ã¦ã ‡ãŠÀ¶ãñ Öñ¦ãì ºããè½ãã
ãä¹ãÆãä½ã¾ã½ã/Insurance premium for policy for
insuring loanees against loan in case of death or
permanent disability
6. ãäÌãªñÍ㠂㣾ã¾ã¶ã ‡ãñŠ ãäÊㆠ¾ãã¨ãã ̾ã¾ã/½ããØãà ̾ã¾ã/Travel
Expenses/Passage Money for studying abroad.
7. ÔãìÀàãã ÀããäÍã, ãäÌã‡ãŠãÔã ãä¶ããä£ã, ƒ¦¾ãããäª/Caution Money,
Development Fund etc.
8. ‡ãìŠÊã/TOTAL

*‚㣾ã¾ã¶ã ‡ãŠã ‡ãìŠÊã ŒãÞãà ‡ãŠãùÊãñ•ã/ÔãâÔ©ãã¶ã ´ãÀã ¹ãƽãããä¥ã¦ã ãä‡ãŠ¾ãã •ãã†ý ¾ããäª ‚ã¹ãñãäàã¦ã Öõ ‚ãÊãØã Ôãñ ‡ãŠãØã•ã ÊãØãã†â /
Total study expenses are to be certified by the college/institute† If required use separate sheet.

(ÀããäÍã Á¹ã¾ããò ½ãò/Amount in Rs.)

VII. ãäÌ㦦㠇ãŠã Ôãã£ã¶ã/MEANS OF FINANCE:
ÀããäÍã/Amount ¹ãÆãä¦ãÍã¦ã/%AGE
1. ¹ãÆÌã¦ãÇ㊠‡ãŠã ‚ãâÍãªã¶ã/Promoters Contribution
2. †¶ã†Ôㆹ㊡ãèÔããè Ôãñ ¨ãÉ¥ã/Loan from NSFDC
3. À㕾ã Þãõ¶ãñÊããƒãä•ãâØã †•ãòÔããè Ôãñ ¨ãÉ¥ã/Loan from State
Channelising Agency
4. ÔããäºÔã¡ãè /Subsidy
5. ‚㶾ã, ¾ããäª ‡ãŠãñƒÃ Öõ/Others, if any
Total
VIII. ‚㶾ã ãäÌãÌãÀ¥ã/OTHER DETAILS:

ÔããÀ¦ã : ºã¦ãã†â ãä‡ãŠ ¹ã㟿ã‰ãŠ½ã ‡ãñŠ ¹ãîÀã Öãñ¶ãñ ¹ãÀ ¾ãÖ ‚ãã¹ã‡ãŠãè ‚ãã•ããèãäÌã‡ãŠã ‚ã•ãö㠇ãŠãè Ôãâ¼ããÌã¶ãã ‡ãŠãñ ºãü¤ã¶ãñ ½ãò ÔãÖã¾ã‡ãŠ ÀÖñØããýState in
brief how the completion of the course is going to help for improving your prospects of earning your
livelihood.
__________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
1. ¹ãÆãä¦ã½ããÖ Ôãâ¼ãããäÌã¦ã ‚ãã¾ã/Expected income per month : Á./Rs.________________
2. ¹ãƦ¾ãããäÍã¦ã ½ãããäÔã‡ãŠ ‚ãã¾ã/Anticipated monthly expenses : Á./Rs. _______________
3. ¨ãɥ㠇ãŠãè Þãì‡ãŠãõ¦ããè ‡ãñŠ ãäÊㆠ„¹ãÊ㺣ã ÀããäÍã/Amount available for Repayment of Loan Á./Rs..______________
 ¹ãƽãã¥ã ¹ã¨ã/ CERTIFICATE
½ãö ¹ãƽãããä¥ã¦ã ‡ãŠÀ¦ãã Öîú ãä‡ãŠ ½ãñÀñ ÔãÌããó¦¦ã½ã —ãã¶ã ‚ããõÀ ãäÌãÍÌããÔã Ôãñ, ƒÔã½ãò ¹ãÆÔ¦ãì¦ã ‡ãŠãè ØãƒÃ Ôã¼ããè ÔãîÞã¶ãã†â „ãäÞã¦ã
‚ããõÀ ÔãÖãè Ööý ½ãö ¨ãɥ㠽ãâ•ãîÀãè ‡ãŠãñ ÍãããäÔã¦ã ‡ãŠÀ¶ãñ ÌããÊãñ ãä¶ã½¶ããäÊããäŒã¦ã ãä¶ãºãâ£ã¶ããò ‚ããõÀ Íã¦ããô ‡ãŠã ¹ããÊã¶ã ‡ãŠÀ¶ãñ ‚ããõÀ ¨ãÉ¥ã
‡ãŠã „¹ã¾ããñØã ãä•ãÔã „ÿñ;㠇ãñŠ ãäÊㆠ¨ãɥ㠽ãâ•ãîÀ Öì‚ãã Öõ „Ôããè ‡ãñŠ ãäÊㆠ‡ãŠÀ¶ãñ ‡ãŠã ÌãÞã¶ã ªñ¦ãã Öùîâý
I certify that, to the best of my knowledge and belief, the information furnished herein is
true and correct. I promise to abide by the following terms and conditions governing the
sanction of loan and to utilize the loan for the purpose for which it is sanctioned.

¨ãɥ㠇ãñŠ ãä¶ãºãâ£ã¶ã †Ìãâ Íã¦ãó/Terms and conditions of loan :-

(‡ãŠ) ¨ãÉ¥ããè ãä‡ãŠÔããè ‚ãÌãõ£ã ‡ãŠã¾ãà ½ãò ¼ããØã ¶ãÖãé ÊãñØãã, ¹ãŠÊãÔÌã¹㠄Ôãñ ‚ã¹ã¶ãñ ‚㣾ã¾ã¶ã ‡ãŠãñ ¹ãîÀã ‡ãŠÀ¶ãñ Ôãñ ÌãâãäÞã¦ã Öãñ¶ãã
ÖãñØãã †Ìãâ „Ôãñ Íãõàããä¥ã‡ãŠ ÔãâÔ©ãã¶ã ´ãÀã ãä¶ã£ããÃãäÀ¦ã Ôã¼ããè ãä¶ã¾ã½ã ‚ããõÀ ãäÌããä¶ã¾ã½ããò ‡ãŠã ¹ããÊã¶ã ‡ãŠÀ¶ãã ÖãñØããý
(a) The borrower would not participate in any unlawful activity, which would debar him
from perusing his/her studies and follow all the rules and regulations laid down by the
educational institution.
(Œã) ¨ãÉ¥ããè, ¨ãɥ㠂ãÌããä£ã ‡ãñŠ ªãõÀã¶ã ‚ãããä©ãÇ㊠‚ããõÀ ãäÌ㦦ããè¾ã ªñ¾ã¦ãã ½ãò Íãããä½ãÊã ¶ãÖãèâ ÖãñØããý
(b) The borrower would not enter into a pecuniary obligation or financial liability during the
currency of the loan.
(Øã) ¨ãÉ¥ããè, ¹ã㟿ã‰ãŠ½ã ¹ãîÀã Öãñ¶ãñ ‡ãñŠ ºã㪠„¹ã¾ãì‡ã‹¦ã Àãñ•ãØããÀ ¹ãã¶ãñ ‡ãŠãè ‡ãŠãñãäÍãÍã ‡ ãŠÀòØãòý •ãõÔãñ Öãè ÌãÖ Àãñ•ãØããÀ ¹ãã
Êãñ¦ãñ Öö, Ìãñ †ñÔãñ Àãñ•ãØããÀ ‡ãŠã ‚ãã¾ã Ôããä֦㠹ãîÀã ãäÌãÌãÀ¥ã À㕾ã Þãõ¶ãñÊããƒãä•ãâØã †•ãòÔããè ‡ãŠãñ ¹ãÆÔ¦ãì¦ã ‡ãŠÀòØãòý
(c) The borrower would strive to secure a suitable employment after the completion of the
course. As soon as he/she secures employment, he/she would furnish full particulars of
such employment, including income therefrom to SCA.
(Üã) ¾ããäª ¨ãÉ¥ããè ‚ãâÍã ‡ãŠããäÊã‡ãŠ ¶ããõ‡ãŠÀãè ‡ãŠÀ ÀÖã Öõ, ÌãÖ ÔãâÔ ©ãã¶ã ‡ãñŠ ¹ãÆ£ãã¶ã ‡ãñŠ ÖÔ¦ããàãÀ Ôãñ ¹ãƽãã¥ã-¹ã¨ã ¹ãÆÔ¦ãì¦ã ‡ãŠÀñ
ãä‡ ãŠ ƒÔã ¶ããõ‡ãŠÀãè Ôãñ „Ôã‡ãñŠ ‚㣾ã¾ã¶ã ¹ãÀ ‡ãŠãñƒÃ ¹ãƼããÌã ¶ãÖãé ¹ãü¡ñØããý
(d) If the borrower is taking up a part-time employment, he/she would produce a certificate
from the head of the Institution to the effect that the employment will not effect his/her
studies.

(Üã) ¨ãÉ¥ããè À㕾ã Þãõ¶ãñÊããƒãä•ãâØã †•ãòÔããè ‡ãŠãñ Ôã½ã¾ã-Ôã½ã¾ã ¹ãÀ ¹ã¦ãñ ½ãò ¹ããäÀÌã¦ãöã, ¾ããäª ‡ãŠãñƒÃ Öõ, ÔãîãäÞã¦ã ‡ãŠÀ¦ãã ÀÖñØããý
(e) The borrower would keep SCA informed, from time to time about change of address, if
any.

(¡:) ¨ãÉ¥ããè À㕾ã Þãõ¶ãñÊããƒãä•ãâØã †•ãòÔããè ‡ãŠãè ¹ãîÌãà ‚ã¶ãì½ããä¦ã ‡ãñŠ ãäºã¶ã㠂㣾ã¾ã¶ã ‡ãŠã ¹ã㟿ã‰ãŠ½ã ‚ã©ãÌãã Ô©ãã¶ã,
Íãõàããä¥ã‡ãŠ ÔãâÔ©ãã¶ã ½ãò ¹ããäÀÌã¦ãö㠶ãÖãé ‡ãŠÀñØããý
(f) The borrower would not, without SCA written prior permission, change the course of
studies or the place of study or the educational institution.

(Þã) ¨ãÉ¥ããè ¹ãƦ¾ãñ‡ãŠ ‚ãÌããä£ã/Ôã¨ã ‡ãŠãè Ôã½ããã书㠇ãñŠ ºã㪠‚ãâ‡ãŠ ÔãîÞããè À㕾ã Þãõ¶ãñÊããƒãä•ãâØã †•ãòÔããè ‡ãŠãñ †¶ã†Ôㆹ㊡ãèÔããè
‡ãŠãñ ‚ããØãñ ¹ãÆÔ¦ãì¦ã ‡ãŠÀ¶ãñ ‡ãñŠ ãäÊㆠªñØããý
(g) The borrower would furnish the copy of mark sheet after every term/semester to the
SCA for further submission to NSFDC.

(œ) ¨ãÉ¥ããè ÜããñÓã¥ãã ‡ãŠÀ¦ãã Öõ ãä‡ãŠ

(h) The borrower hereby declares that
 (i) ¹ã㟿ã‰ãŠ½ã ãä•ãÔã‡ãñŠ ãäÊㆠ¨ãɥ㠇 ãŠã ‚ããÌãñª¶ã ãä‡ãŠ¾ãã •ãã ÀÖã Öõ, „Ôã‡ãñŠ ãäÊㆠ‡ãŠãñƒÃ ãäÍãàãã ¨ãÉ¥ã ãä‡ãŠÔããè
‚㶾㠺ãö‡ãŠ/ÔãâÔ©ãã¶ã Ôãñ ¹ãƪã¶ã ¶ãÖãé ãä‡ãŠ¾ãã Øã¾ãã Öõý
No Education Loan has been granted by any other Bank/Institute for the Course
for which loan is being applied for.

(ii) ¹ã㟿ã‰ãŠ½ã ãä•ãÔã‡ãñŠ ãäÊㆠ¨ãɥ㠽ããâØãã •ãã ÀÖã Öõ „Ôã‡ãñŠ ãäÊㆠãä‡ãŠÔããè ÔãÀ‡ãŠãÀãè †•ãòÔããè/‡ãŠãñƒÃ ‚㶾ã Õããñ¦ã
Ôãñ ‡ãŠãñƒÃ œã¨ãÌãðã䦦ã/Íãìʇ㊠½ãìãä‡ã‹¦ã ¶ ãÖãé „¹ãÊ㺣ã Öõý
No Scholarship/freeship is available for the course for which loan is sought
from any Govt. Agency/any other source.

½ãã¦ãã-ãä¹ã¦ãã/¹ããÊã‡ãŠ ‡ãñŠ ÖÔ ¦ããàãÀ ‚ããÌãñª‡ãŠ ‡ãñŠ ÖÔ¦ããàãÀ

Signature of Parent/Guardian Signature of Applicant

Ô©ãã¶ã/Place :
ãä ª¶ããâ‡ãŠ/Date :