Vidya Lakshmi Common Education Loan Application Form

Student ID 878204

Application ID 406026

Bank Name State Bank of India

Bank Scheme Name SBI STUDENT LOAN SCHEME

Preferred Bank IFSC Code SBIN0017083

Preferred Bank Branch Name SARBUJJILI

Date of Application 01-Jan-2019

1. Personal Information

Field Name Student Parent / Husband Co-obligant / Guarantor

Title Mr. Mr.

First Name CHINTADA CHINTADA

Middle Name

Last Name CHANDRASEKHAR MADHAVA RAO

Father’s /Husband’s First Name CHINTADA CHINTADA

Father’s /Husband’s Middle Name

Father’s /Husband’s Last Name MADHAVA RAO NARSIHAPPADU

Date of Birth 18/07/1996 10/12/1965

Category OBC OBC

Sex Male Male

Marital Status Single Married

Educational Qualification B.tech Degree

Marks obtained in Highest

91.2 0.0 0.0
qualification %

Occupation Student Farmer/Agriculturist

Income from all sources (Rs) 40000.00

PAN No.# BHWPC8793A AFUPC0906J

State Andhra Pradesh Andhra Pradesh

Address Line 1 1-81 1-81

Address Line 2

Village / Area/ Locality main Steet, Turakapeta Main street,Turakapeta

Block/Taluka /Sub-district/Town Srikakulam Srikakulam

PIN 532458 532458

Contact No. 9966274917 9493907379

e-mail Id chandrasekhar110036@gmail.com chandrasekhar110036@gmail.com

Present Banker Details

Branch IFSC SBIN0020149 SBIN0017083

Banker STATE BANK OF INDIA STATE BANK OF INDIA

Bank Branch N I T BR SARUBUJJILI

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Account Type Savings Account Savings Account

SB / OD A/c No. 35755278082 20313398326

Direct/Indirect liability details (Rs)

2. Whether related to Chairman /Directors / employee of our Bank or any other Banks. No

If yes, details of relationship

3. Particulars of course, for which loan is required.

Whether under: Merit / Management Quota Merit

Name of the Institution NATIONAL INSTITUTE OF TECHNOLOGY, WARANGAL

Name of the Course M.TECH(CIVIL ENGINEERING(CE))

Duration of the Course 02 (Years) 00 (Months)

Date of Commencement 30/07/2018 Date of Completion 29/05/2020

Cost of Finance Details

4. Cost of Course / Source of Finance: (All amounts are in (Rs))

Particulars Year 1 Year 2 Year 3 Year 4 Year 5 Year 6 Total

Tuition fees 70000 70000 140000.00

Exam fees 1000 0 1000.00

Books Stationery 750 5700 6450.00

Equipment/Computer 16300 0 16300.00

Hostel Expenses 0 0

Sundries/Travel 500 0 500.00

TOTAL 88550 75700 164250.00

Own Source / Scholarship 0 0

Loan Required 88550 75700 164250.00

5.Details of securities offered

6.Prospects of earning after completion of the course

No. of Installments Amount (Rs) p.m.

Repayment proposed
0.00

7.Uploaded Documents:

Marksheet

Proof Of Admission to the course

Schedule Of Expenses for the course, as given by institution

Undertaking letter in the absence of PAN & Aadhaar

Applicant Photo

Parent Photo

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I / We declare that all the particulars and information given in the application form are true, correct and complete and binding on me / us. Further,
the above particulars shall form the basis of any loan Bank may decide to sanction to me / us. The loan amount will be used for the purpose for
which it is granted.

Signature of the Signature of the Signature of the

Student Parent/Guardian Co-obligant/Guarantor

Place:

Date:

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For office use

Credit Report No. Date : Customer ID/Application ID:

Details of security including

Rate of Repayment Whether eligible under CSIS
Nature of limit Amount (Rs.) Margin(Rs.) Personal Guarantee/Co-
Interest* conditions Scheme / (Yes/No)
obligation.

Other terms and conditions:

The Bank may revoke in part or in full or withdraw/stop financial assistance at any stage by giving reasonable notice to the borrower. Credit
facilities sanctioned are to be availed within 6 months from the date of this letter, failing which; the limits will automatically stand cancelled.

Manager/Senior Manager / Accepted all the terms and

Chief Manager /Asst Gen Manager conditions of sanction Borrower/s

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