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LOAN APPLICATION FORM
1
Name of the Applicant
*
:
2
Full Office Address
*
:
2.1
Telephone Number
*
:
2.2
Email Id
:
3
Full Factory Address
*
:
3.1
Telephone Number
:
3.2
Email Id
:
3.3
District of the factory
*
:
Please Select District
Alipurduar
Bankura
Birbhum
Cooch Behar
Dakshin Dinajpur
Darjeeling
Hooghly
Howrah
Jalpaiguri
Jhargram
Kalimpong
Kolkata
Malda
Murshidabad
Nadia
North 24 Parganas
Paschim Bardhaman
Paschim Medinipur
Purba Bardhaman
Purba Medinipur
Purulia
South 24 Parganas
Uttar Dinajpur
3.4
Constitution
*
:
Please Select Constitution
PARTNERSHIP
CO-OPERATIVE
LLP (LIMT LIAB PARTNERSHIP)
PROPRITORSHIP
SOCIETY
LIMITED COMPANY
PRIVATE LIMITED COMPANY
UNKNOWN CONSTITUTION
3.5
PAN
:
3.6
GST
:
3.7
Nature of project site
*
:
Please Select Nature of project site
Rented
Leasehold
Freehold
4
Name of the CEO/key person of the applicant concern
*
:
4.1
Mobile Number
*
:
4.2
Email Id
*
:
4.3
PAN Number
*
:
4.4
Aadhaar Number
*
:
4.5
Date Of Birth
*
:
5
Proposed line of activity for which the loan is being sought for
*
:
6
Amount of Loan Requirement
*
:
₹
7
Project Cost
*
:
₹
8
Capital Cost
*
:
₹
9
Working capital requirement
*
:
₹
10
Total capital outlay
*
:
₹
11
All Documents Upload
(Only 5 MB PDF File Allow)
*
:
I/We confirm that all the information and/or documents submitted by me/us in connection with my/our loan proposal are true and genuine and I/We understand that the loan proposal would be processed on such information and/or documents or may be rejected if any of these is found false/incorrect and, in that case, I /We shall not claim refund of the processing fee from the Corporation.
Date
*
:
Partially filled up application and/or application without the requisite fees shall not be accepted. Please obtain acknowledgement of receipt on a photocopy of this form.
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Employee
Loanee
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