Form_A

APPLICATION FOR LOAN UP TO RS.5.00 LAKH UNDER ANGEL FUND SCHEME

1 Name of the Applicant (Block letters)


:
2 Office operating Address

:
3 Address of Factory/Shop

:
4 Whether belongs to SC/ST/OBC/Minority
Community?
If Yes, then please select: SC/ ST/ OBC/ Minority
Community and attach the certificate from the
competent authority
: Yes/No
5 Mobile No :
6 PAN Card No. ( if applicable) :
7 Place where loan is required . District .. Block.


8 Branch where loan is required

:
9 Promoters details :

Name Residential
Address
Date of
Birth
Father/ Spouse Academic
Qualification
Contact No






10 Details of the Scheme /activity
A. Name of the activity /Scheme and purpose :
B. Approximate value of the proposed
scheme/projects
:
11 Whether undergone any skill development training
under Industries & Commerce department/
DI&CC/ Other Govt. Department/ Organization /
any other experience and training undergone
If yes, please attach the copy of the
certificate/document.
: Yes/No
12 In case of term loan requirements, the details of
machinery ( whether applicable) may be given as
under ( for new unit)
:

Type of
machine/equipment
Purpose for
which
required
Whether
imported or
indigenous
Name of
machines/s
Contribution
being made by
the promoter
Loan
required



13 Address and Identity proof
(a) ID Proof (Any of the following):
(Voters Identity Card/ PAN Card/ Driving
Licence/ J ob Card/ Aadhaar Card/ Identity Card
(subject to the satisfaction of bank)
:
ID Proof No :
(b) Address Proof (Any of following)
(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 )
:
Address Proof No: ( Consumer account
No/License No/Card no, etc.)
:
Additional information for existing unit :
14 License/Registration if any :

( select Yes/No), if Not Applicable then select NA
1 Trade License Yes/No/NA
2 DICC Registration certificate (provisional/Final) Yes/No/NA

15 Banking/Credit facilities for existing unit (in Rs.
lakh)
:

Type of
facilities
Limit (in
lakh)
Outstanding
as on
Presently
banking with
Securities Rate of
interest
Repayment
terms
Current
account

Cash Credit


Term Loan



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


Date:-

Place :- Signature/thumb impression of borrower



PLEASE NOTE THE FOLLOWING

1.Following are the documents shall be submitted along with the application:

1 Application in the prescribed format ( as per Form-A)
2 Two copies of Passport size photo graph ( black & white)
3 Entrepreneurs Memorandum Part-I ( EM part-I)/EM-II , as applicable.
4 Scheme /project Report of the proposed activity.
5 Identity Proof:- as indicated in the application form
6 Address Proof : As indicated in the application form
7 Trade license if any
8 Certificate of training , if any
9 Certificate of OBC/SC/ST/Physically challange, if any
10 Any other documents likely to be provided by the applicant.

2.Eligibility :
(1) Any prospective / existing entrepreneur
(2) Existing Artisans having traditional skill
(3) Only individuals shall be eligible to avail the loan under the said scheme.
( Note : Group activities / partnership firms/NGO /Cooperative society shall not be eligible under the
scheme. Beneficiary of PMEGP or erstwhile PMRY beneficiaries or any other Government self
employment scheme shall not be eligible to get the benefit under the scheme. Also a defaulter of any
Government/PSU/Financial Institute shall not be eligible to get the benefit of the scheme.)

3.Partner Bank:
Assam Gramin Vikash Bank.
4.Preference:
Preference shall be given as follows:
(1) Applicant/s having skill development training arranged by the Industries & Commerce
Department or other Govt. departments / Organizations. They should have to produce certificate in this
regard.
(2) Applicant/s belonging to women, weaker section, like SC/ST or Physically challenges..
(3) Existing units which goes for modernization & diversification or technology upgradation.
5.Other terms of the scheme:
i Maximum loan amount is Rs.5 lakh
ii Any Micro unit ( new or existing) which has come into existence after announcement of
the scheme will be eligible.
iii Own equity : in case of new unit : 15% and in case of existing unit : 20%
iv Loan Amount: Incase of new unit :85% and in case of existing unit : 80%
v Rate of Interest is 5% pa with interest free moratorium period of 10 months.
vi Loan to be repaid within 7 years.
vii Unit who repay their dues before time will be given cash incentive on interest @1%.
viii Default in repayment will charge penalty of 2% over the prescribed rate of interest.

Note:
A. Further details may be obtained from the General Manager , District Industries & Commerce
Centre (DICC) of the concerned district.
B. Application may be submitted directly to the concern General Manager of District Industries &
Commerce Centre (GM, DICC) of the district.