Application Form for Cent Sahyog (For Loans above Rs.10 Lakhs)
1 Name of Unit
Names of Directors/ Partners/Promoters, with worth
& Director’s Identification No. (DIN)
PAN No./s of Directors/ Partners/Promoters
Category of Unit Micro/Small
Manufacturing / Service
Constitution
Incorporation/ Commencement details
Group
Business Address
City Pin- Code:
State
Telephone Nos.
Name & Address of bankers to the company &
details of credit facility, if any
2 Personal Details of Key Person/ Sole Applicant
Name of the key promoter
Date of Birth
Qualification (mention if Professional)
Mailing Address
Pin Code :
Telephone Nos.
PAN No. of the Applicant
3. Business Details
Business/ Line of Activity
4. Project Details
Item Project Cost
(Rs. in Lacs)
Item Source of Funds
(Rs. in Lacs)
Land & Improvements Applicant’s
Investment
Building & Structures Bank Loan
Machinery & Equipment Loans from Friends &
Relatives
Other Capital
Cost(Specify)
Others
Working Capital
Total Total
5. Miscellaneous Details
Amount of Loan Required
Repayment Period for Term Loan
Marketing Arrangement
I declare that the information furnished is true & correct.
Yours faithfully,
(Authorised signatory)
Please attach :
Brief detail of the Project
For existing Units – Balance Sheets for the past 2 years along with estimated & projected Balance
Sheets
Please attach certified copy for Board resolution, authorizing the company officials to sign, execute and
accept documents on behalf of the company.
Copy of SSI Registration Certificate / Application for New Units
Photographs – 2
Proof of Address & Photo Identity for KYC compliance
Pan Card
Pollution Control Certificate, wherever applicable
Asset / Liability Statement