State Bank of India

Small Scale Industries
Application Form For credit facilities of over Rs. 10 lacs & up to Rs. 50 lacs

1. Name of the Unit:
(In block letters)
1.2 Constitution: (Proprietary / Partnership Firm /
(Please strike out whichever is not Private Limited Company /
applicable) Public Limited Company /
Co-operative Society)
1.3 Name of the business house / group :
(if any)
2.1 Registration No. :
(As given by the District Industries
Centre / Directorate of Industries)
2.2 Date of Incorporation /
Commencement of Business:
3 Business Address with Telephone / Telex Number
3.1 Registered Office:
3.2 Administrative Office:
3.3 Factory:
4. Background of the (Please furnish background for
Proprietor / Partners / Directors each person as per the
Appendix I)
5. Brief description of the Industrial activity
5.1 Existing
5.2 Proposed
6. How the Activity was financed so far:
(to be filled in case of existing unit only)
Source of Funds (*) Security Rate of
Int.
Repayment
Per month
Present O/s. (in
000s of Rs.)
Amount of
Default (if any)
(*) Indicate sources of funds with name & address, e.g. banks/ financial institutions /
others specify)
State Bank of India
7. Past performance for last three years (to be filled by existing unit only)
(in 000s of Rs.)
Particulars 20__ 20__ 20__
Turnover
Net Profit
Retained Profit
Monthly Turnover for last twelve months
Jan Feb Mar Apr May Jun
Jul Aug Sep Oct Nov Dec
8. Arrears in Statutory payments (if any)
a) Income tax
b) Sales tax
c) Provident Fund
d) Employees State Insurance Corporation
e) Others (specify)
9. If the unit is an ancillary unit, the undertaking to which it is catering and its
address
10. Name of the associate concern(s), if any
10.1 Nature of association and amount invested
10.2 Nature of activity
10.3 Items traded / manufactured
10.4 Turnover and profit during preceding three years.
State Bank of India
11. Employment Present Proposed
Executives
Supervisory
Administrative / Office Staff
Skilled Labour
Unskilled Labour
12. Technical Feasibility ________________
12.1 Name of the product(s), including Bye-products & its (their) use
12.2 Manufacturing Process, in brief (Indicate to the extent possible, stage-wise
capacity data, yield/ conversion data, material f low, etc.
12.3 Capacity: (No . of Units / Quantity in kg. / Volume in litre per annum)
Capacity for each
product
Licensed Installed Operating
Number of working days in a month and Number of shifts in a day:
12. 4 Locational advantages of existing and /or proposed premises and with
reference to
i) absence of civic restrictions
ii) proximity to the source of raw materials
iii) market for the product
iv) availability of
a) power
b) water
c) labour
d) transport
v) whether clearance has been
obtained from the pollution control authority?
12. 5 Land & Building
Area / Plinth Area (in sq. meters) Value (in 000s of Rs.)
Existing Proposed Existing Proposed
Factory Land
Factory
building
Ancillary
building
Open Storage
Space
State Bank of India
12.6 Type of soil and load bearing capacity (enclose test report)
Enclosures:
a) certified photo copy of sale / lease deed
b) certified photo copy of the Govt. order converting the land into
industrial land, if applicable
c) locational map
d) certified photo copy of the site plan of the land and blueprints of the
buildings duly approved by Corporation / Municipality / Panchayat.
12.7 Particulars of Machinery & other assets : As per Appendix II
12.8 Necessity & purpose for the proposed investment / addition to factory premises /
machinery (in case where such investment is intended) for achievement of the
anticipated turnover.
12.9 Raw Materials / Components
(Please mention about the imported and indigenous items separately)
Name / Brief description of the items
(A) (B) ( C) (D)
Quantity
Required
Sources of Supply
Minimum Purchase
Quantity
Lead / Procurement Time
Available throughout the
year
If answer to the above is
no, then no. of months it is
available
(enclose proforma invoices in respect of each item, if available)
13. Utilities
(Give comments on requirement, availability adequacy, qualitative aspects, etc.)
a) Power
Contracted Load
Connected Load
State Bank of India
Future power consumption
(in no. of units) per month
(Enclose certified Xerox copy of sanction for power connection)
b) Water
c) Fuel
d) Others (specify)
14. Economic Feasibility
Marketing (mention separately for each product)
14.1 Whether the product is reserved exclusively for the SSI sector?
14.2 Name of the Major customers
14.3 Region / Area where the product is / will be sold
14.4 Extent of competition & No. of Units engaged in similar line in the area
14.5 How does the unit meet / propose to meet the competition?
(comment on the competitive advantages enjoyed by the unit)
14.5.1 In price and quality, how does the unit’s product compare with those of its
competitors?
14.5.2 Is the Unit selling direct to its customers? If so please furnish details like sales
force, showrooms, depots, etc.
14.5.3 If a selling / distribution agency has been appointed, its name, period of contract,
commission payable, period by which the bills will be paid by it etc. (enclose
copies of agreement, wherever such agreement has been entered into)
14.6 Nature and volume of orders / enquiries on hand
(certified Xerox copies to be furnished)
State Bank of India
14.7 If the Unit is export oriented, please furnish exporter code no., if allotted,
And relevant details as under in the preceding three years:-
Code No.:
Name of the product
exported
Name of the Country where
Exported
F.O.B Value in US $
15. Cost of Project
(Please furnish estimates of cost of project under the following heads, Indicate the
basis for arriving at the cost of project)
(In 000s of Rs.)
Sr.
No.
Particulars Already
Incurred
To be incurred Total Cost
A Land including
development
B Building & Other Civil
Works
C Plant & Machinery
1) indigenous
2) Imported
D Essential Tools, Spares &
Accessories
E Testing Equipment
F Miscellaneous Fixed
Assets
G Erection / Installation
Charges
H Preliminary Expenses
I Pre-Operative Expenses
J Provision for
Contingencies
1. Buildings
2. Plant & Machinery
3. Other Fixed Assets
K Margin for Working
Capital Required
L Total
State Bank of India
16. Means of Financing
(Please furnish details of sources of finance for meeting the cost under the
following heads)
(In 000s of Rs.)
Sr.
No.
Particulars Amount
Already Raised
Amount
Proposed to be
Raised
Total
A Capital (specify resources
contributing capital)
B Reserves
C Term Loans
(give full particulars
D Unsecured Loans and
Deposits
(indicate sources, rate of
interest, repayment period,
etc.)
E Deferred Payment
Arrangements including
Suppliers Credit
F Subsidy
Central Govt.
State Govt.
G Seed Capital
(indicate sources)
H Internal Cash Accruals
I Other Sources (specify)
J Total
16.1 In case internal accruals are taken as source of finance, explain the basis for
estimation of internal accruals by means of a statement.
16.2 Indicate sources from which expenditure already incurred has been financed
16.3 Promoter’s contribution to the project as % of the total cost
(Please furnish list of persons / firms who would be contributing to promoter’s
share of the capital and the respective amounts and their relationships)
State Bank of India
17. Schedule of Implementation
Please indicate the progress made so far in the implementation of the project and
furnish the schedule of implementation as follows
Date of Expected date of
commencement completion
a) Acquisition of Land
b) Development of Land
c) Civil works for
Factory building
Machinery Foundation
Administrative Building
d) Plant & Machinery
Imported
Indigenous
e) Arrangement for power
f) Arrangement for water
g) Erection of equipment
h) Commissioning
i) Initial Procurement of Raw
Material
j) Trial Runs
k) Commercial Production
18. Future Projections
(To be given for the next three years)
Please furnish data on projected profitability as per Appendix III
Please furnish data on projected cash flow statement as per
Appendix IV.
Percentage of Cash Sales in Total Sales ____%
Period in which payment is received in respect of credit sales
___ days
Average credit available on purchases
____ days
19. Working Capital Required for the Anticipated Turnover:
(Please furnish data as per Appendix VI)
20. Repayment Programmes:
State Bank of India
21. Details of Securities to be offered
21.1 Primary
(Working capital and term loan
securities to be indicated separately)
21.2 Collateral, if any, (give full details)
21.3 Details of guarantor(s)
21.3.1 Name
21.3.2 Residential Address
21.3.3 Occupation
(if in service, name, & address of
his / her employer)
21.3.4 Details of Movable & Immovable
Property (ies) Owned by him / her &
Other dependent family members
21.3.5 Details of any similar guarantee, if
Any, given to other institutions
I / We certify that all information furnished by me / us is true; That I / We have no
borrowing arrangements for the Units with any bank except as indicated in the
application; that there is no over dues / statutory dues against me / us / promoters except
State Bank of India
as indicated in the application; that no legal action has been / is being taken against me /
us / promoters; that I / We shall furnish all other information that may be required by you
in connection with my / our application; that this may also be exchanged by you with any
agency you may deem fit and you, your representatives, representatives of the Reserve
Bank of India / National Bank of Agriculture & Rural Development / Small Industries
Development Bank of India / Deposit Insurance and Credit Guarantee Corporation of any
other agency as authorized by you, may at any time, inspect / verify my / our assets,
books of accounts, etc., in our factory / business premises as given above.
Date __________________
Place Signature of the Borrower
(Name & Designation)
Encl.: Certified Xerox copies of
a) Balance Sheets with Trading and Profit & Loss Account for the last three
years.
b) Memorandum and Articles of Association, Certificate for Commencement
of Business.
c) Income Tax, Wealth Tax Returns and assessment orders for the last
Three years, for the unit as well as proprietors / partners / Directors
d) Sales Tax Returns for the last three years.
Forms as per Appendix – SSI-I to Appendix – SSI- VI given hereafter should also be
submitted along with the application for advances above Rs. 10 lacs,