LOAN APPLICATION FORM For financing of loan under the M.M.L. Programme/National scheme of liberation & rehabilitation of scavengers & their dependants of the Orissa Scheduled Caste & Scheduled Tribe Development Finance Co-Operative Corporation Ltd, Bhubaneswar. (Kindly tick mark the programme for which the loan application is sponsored.) To The Branch Manager/Secretary........Bank/Samity.......... 1. Name, Father's Name, Address of applicant and age. 2. Whether the applicant is Small farmer/ Marginal farmer/Agricultural Labour/Landless Tenants/Liberated Scavengers or their dependants etc.? (B.D.O./Sub-Collector/Executive Officer, Urban local Body/ D.M., OSFDC will mention the category and the identification number) (For urban area a certificate of Annual family income to be attached. No income certificate is needed for liberated Scavengers & their dependants.) 3. Whether the applicant is SC/ST, if so to which sub-caste/Sub Tribe the applicant belongs (Certificate to this effect form Collector/S.D..O./Tahasildar/D.W.O./B.D.O. of the concerned area should be attached) 4. Present Occupation: 5. (a) Name of the Scheme/Project for the purpose of loan. (b) Unit cost of the Project/Scheme Rs. (c) Amount of Bank loan Rs.....Margin money loan Rs..... Subsidy Rs..... 6. His capacity, past experience and educational qualification to utilize the loan for his economic benefit. 7. Whether he is a member of the Co-operative society or share holder of a registered Unit. If so name of the society/unit and Membership No., Registration No. 8. Whether he has borrowed any amount form any source. If so the address of financing agency and the amount of loan outstanding details of Security offered, Rate of interest. 9. Size and particulars of land holdings, if any, in the name of the applicant and his family members. The details of such holdings to be furnished. 10. Size of applicant's family Adults Children Total 11. Present income per annum and source of income. 12. Expenditure per annum. (minimum amount required for subsistence) I/We certify that all information furnished by me/us are true, that I/We have no borrowing arrangements for the unit with any bank that no legal action has been/is being taken against me/us, that I/We shall furnish all other information that may be required by you in connection with nay agency you may deem fit and that you/your representatives of the Reserve Bank of India or any other agency(s) authorized by you may at any time inspect/verify our assets books of account, etc. Our factory and business premises. Date: Place: Signature of the Applicant/Borrower. Ref. No.......... Date.......... Certified that the applicant fulfill the eligibility criteria fixed by the Orissa Scheduled Caste & Scheduled Tribe Development Finance Co-Operative Corporation Ltd. And that the particulars/data furnished in the application form are correct to the best of my knowledge and belief. The total cost of the Scheme/Project would be Rs......out of which Bank Loan is Rs......M.M. loan Rs......& Subsidy.......... Date: Place: Signature of the Sponsoring Authority (Designation)
