MARGIN MONEY SCHEME THROUGH NATIONALISED PUBLIC SECTOR BANKS/ REGIONAL RURAL BANKS PHOTOGRAPH 1. Name in full (In Block Letter): 2. Fathers / Husband's name : 3. Postal Address including Pin Code : 4. Age & Date of Birth (According to School Certificate): 5. Educational Qualification (S): 6. Technical Qualification(S): 7. Details of Training / Experience : 8. Whether belongs to SC/ ST / OBC/ PH : XSM / Minority Community / Others (Certificate to be attached) 9. No. of Members in the family : 10. No of members working : 11. Village industry activity proposed to be taken up. (Schemes) 12. Products to be manufactured : 13. Details address of the place / area : where unit is proposed to be set up. Contd. 2/ 14. Raw materials required (item wise) : 15. Details regarding availability of : raw materials (Item /Place / Quantity) 16. Sales arrangement Local / Outside : 17. Estimated project cost : (Term Loan) Fixed Capital: Working Capital: 18. details of Own Land/ Own Rented / Lease 19. Name of the nearest Bank Branch i. Free hold Land : ii. Lease hold Land: iii. Rented Premises: (With full address) DECLARATION: I do hereby declare that the information furnished here in are true to the best of my knowledge and belief. If any of the information furnished here in above is found to be incorrect, not only my application will be liable to be rejected but also I shall be liable for panel action as per the laws of the land. Place: Date : Signature of applicant Forwarded By:
