Vidya Lakshmi Common Education Loan Application Form

Student ID 1086725

Application ID 538644

Bank Name Bank of Baroda

Bank Scheme Name BARODA SCHOLAR

Preferred Bank IFSC Code BARB0DHARAM

Preferred Bank Branch Name DHARAMPETH

Date of Application 12-Jul-2019

1. Personal Information

Field Name Student Parent / Husband Co-obligant / Guarantor

Title Ms. Dr. Dr.

First Name Ashwini Meenakshi Meenakshi

Middle Name Deorao

Last Name Jadhav Rathod Rathod

Father’s /Husband’s First Name Pradeep Deorao Deorao

Father’s /Husband’s Middle Name

Father’s /Husband’s Last Name Jadhav Rathod Rathod

Date of Birth 23/02/1996 31/08/1970 31/08/1970

Category Others Others Others

Sex Female Female Female

Marital Status Single Divorced Divorced

Educational Qualification Bachelor in Physiotherapy M. B. B. S., M.D. MBBS, MD

Marks obtained in Highest

67.5 69.0 0.0
qualification %

Occupation Student Professional Doctor Professional Doctor

Income from all sources (Rs) 1.00 1.00 1500000.00

PAN No.# BBNPJ9765N ADOPR5962R

State Maharashtra Maharashtra Maharashtra

ESIS hospital, Plot no. P16, quarter

Address Line 1 Plot no. 324/B, Ganesh Vandan apt Plot no. 324/B, Ganesh Vandan apt
E2, Naregaon road

Address Line 2 Ganesh nagar, Nagpur Ganesh Nagar, Nagpur

Village / Area/ Locality Nagpur Nagpur Aurangabad

Block/Taluka /Sub-district/Town Nagpur Nagpur Aurangabad

PIN 440009 440009 431001

Contact No. 9545499239 9823199596 9823199596

e-mail Id rathodashwini23@gmail.com Dr.meenakshirathod@gmail.com Dr.meenakshirathod@gmail.com

Present Banker Details

Branch IFSC SBIN0003462 PUNB0272300 PUNB0272300

Banker STATE BANK OF INDIA PUNJAB NATIONAL BANK PUNJAB NATIONAL BANK

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Bank Branch MEDICAL COLLEGE NAGPUR HANUMAN NAGAR NAGPUR HANUMAN NAGAR

Account Type Savings Account Savings Account Savings Account

SB / OD A/c No. 33379481916 2723001300001786 2723001300001786

Direct/Indirect liability details (Rs) NIL 6000000 6000000

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 Manchester Metropolitan University

Name of the Course MSc. Advanced Physiotherapy

Duration of the Course 01 (Years) 03 (Months)

Date of Commencement 30/09/2019 Date of Completion 11/12/2020

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 1683500 0 1683500.00

Exam fees 0 0

Books Stationery 0 0

Equipment/Computer 0 0

Hostel Expenses 1385475 0 1385475.00

Sundries/Travel 0 0

TOTAL 3068975 0 3068975.00

Own Source / Scholarship 500000 0 500000.00

Loan Required 2568975 0 2568975.00

5.Details of securities offered Flat no. 324/B, Ganesh Vandan Apartment, Ganesh Nagar, Nagpu

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

Proof of Income

ITAO / IT Return (latest)

Undertaking letter in the absence of PAN & Aadhaar

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Applicant Photo

Parent Photo

Co-obligant / Guarantor Photo

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:

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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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