UTTARA BANK LIMITED .............................

BRANCH

New Renewal Renewal with Enhancement Resched lin! Othe"s

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CREDIT APPLICATION FORM For Financing Small Medium Corporate Others Enterprise Enterprise (Large) Enterprise

PART A
(To be filled in by the Applicant !orro"er)

#e"$ice C%nce"n T"adin! C%nce"n Man &act "in! C%nce"n

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The #elationship Manager ''''''( !ranch )ttara !an* Limited '''''(( +,( +.( -ame of the Applicant !orro"er Address & a) !usiness /resent b) $istance from the branch c) /ermanent Address of o"ner of the firm & & & -ot more than ((((((((( 0ilometer( &

$ate of re%uest&

3.

(a) -ame of the o"ner(s) (1ndi2idual /roprietor /artners $irectors Others) : SL( -o( +,( +.( (b) $etails of the family members( (Father Mother Spouses) : SL( -o( #elation -ame of the person Age "ith the /ersons o"ner +,( +.( (c) 8ho "ill run the business in absence of the borro"er : -ame 3 residential address "ith Father4s Mother5s 6usband4s name 3 phone no( Share 6olding in 7
/ersonal -et 8orth in Ta*a (supported by papers)

Age

/osition

Engaged "ith the

business /rofession

Educational 9ualification

+:(

Account -o( "ith date of opening& (Current Sa2ings CC O$ etc() : -ature Sl( -o( -ame Style of the Account of the Account +,( +.(

Account -o(

Opening $ate

'#I(NAT)RE OF T*E APPLICANT+

,-.

Cate!%". %& A//licant 0 1%""%we" : 'Please tick+ /roprietorship /artnership /ri2ate Ltd( Co( /ublic Ltd( Co Corporation
Co; operati2e society

Other

+<(

'a+ Date %& Esta2lishment 0 C%mmencement %& 1 siness : Sl( -o +,( +.( +?( +:( 1tems
(supported by papers)

-umbers

1ssue date

1ssued by

=alidity

#emar*s

Trade Licence Ta> 1dentification 1mport #egistration E>port #egistration

(b) /artnership $eed ( 1n case of partnership firm) & #egistered ( enclosed) (c) Memorandum 3 Articles of Association 3 Certificate of 1ncorporation (1n case of Limited Company) & (enclosed) 3. Date %& &i"st limit sancti%ned 4 /"esent limit 'i& an. + : (a) "ith our !an* -ature of Loan First sanctioned limit /resent a2ailing limit (b) 8ith other !an* First sanctioned limit /resent a2ailing Limit +@( 'a+ In$estment in 2 siness : 'As /e" 1alance #heet+ 1tems Current year A( Capital a) AuthoriBed Capital (1ncase of Limited T*( Company) b) /aid )p Capital (1n case of Limited Company) c) Total Capital Funds including reser2es (1ncase of Limited Company) d) 1n2estment (For other than Limited Company) !( Total Fi>ed Assets T*( Less& Land 3 !uilding T*( -et /osition T*( /roAected year (!orro"er Code (((((((((((((((() -ature of Loan Security 6eld

Limit

$ate of Sanction

=alidity

(supported by papers)
Limit $ate of Sanction =alidity

T*( T*(

(b) -o( of "or*er engaged employed& ( )se separate sheet C if necessary) Sl( -o( -ame of the Employees $uty +,( +.(

E>perience

'#I(NAT)RE OF T*E APPLICANT+

'#I(NAT)RE OF T*E APPLICANT+

+D(

-ature and details of business & (/lease tic*) (a) -ature of business&;
8holesaler #etailer Manufacturer 1mporter E>porter #endering ser2ice Contractor Supplier 3 1ndentor Others

(b) 1tems of business&

,+(

!ac*ground and !usiness E>perience "ith training of the applicant borro"er & ( )se separate sheet C if necessary)

(a)Family !ac*ground
of the business& (b) Applicant4s Educational 9ualification (c) !usiness E>perience (d) Training of the Applicant (if any) ,,(

& & & &

Encumbered unencumbered $etails of loan liabilities

,.(

/articulars of Assets and liabilities in /ersonal -ame of the o"ner (s) & ( )se separate sheet C if necessary) /resent Location /articulars Mar*et =alue $escription Land !uilding $eposit "ith the ban* Stoc*s Shares $ebentures Sanchayapatras Others -ames of Sister Concern Allied Concern Subsidiaries Affiliates & -ame and Address -ames and #esidential of the company Firm Address of O"ners -ames of /re2ious 3 /resent !an*ers & (a) Facilities Sought & Sl -o( -ature of Facilities Amount , . (b) =alue of collateral security as per Engineer4s Sur2eyor4s 2aluation) Mar*et =alue(

-ature of !usiness

7 of Share 6olding

,?( ,:(

/urpose

Security Offered

Tenor =alidity #epayment Terms

Forced Sale =alue $istress =alue

(d)

$istance of the security location from the branch(

& -ot more than '''(( *ilometer(

'#I(NAT)RE OF T*E APPLICANT+

5-.

1ORRO6ER7# 1A#IC FACT #*EET $ate of #e%uest& (((((((((((((((((((((((((((( Add"ess Fa> E e;mail address Ta> 1$ -o( (if any): Father4s -ational 1$ Card E (if any):

'i+ 1ORRO6ER7# PROFILE : Name /hone E Off & #es & -ational 1$ Card E (if any): Father4s -ame 'ii+ 'a+ REFERENCE# 'AT LEA#T T6O+ : Name /hone E Off & #es & -ational 1$ Card E (if any): 'ii+ '2+ Name /hone E Off & #es & -ational 1$ Card E (if any):

Add"ess Fa> E e F mail Address Ta> 1$ -o( (if any):

Add"ess Fa> E e F mail Address Ta> 1$ -o( (if any):

'iii+ NAT)RE OF 1)#INE## 0 PROFE##ION: 1ndustrial Commercial Agricultural 'i$+ E8I#TIN( LIMIT# AND #TAT)# : Amount Fund !ased -on F Fund !ased '$+ RE9)E#TED LIMIT#: Amount Fund !ased -on F Fund !ased (2i) $etails of payment schedule if term loan sought( (2ii) Latest 1ncome Ta> 8ealth Ta> Form to be submitted by the borro"er E>piry $ate #egular

Ser2ices

Any other

Status Amount O2erdue (if any)

Amount #escheduled restructured (if any)

Tenor

I ce"ti&. and nde"take that the In&%"mati%n & "nished a2%$e is t" e t% the 2est %& m. kn%wled!e

APPLICANT7# #I(NAT)RE 4 #EAL