SME CITY CREDIT CENTRE
APPLICATION FOR DOCTOR (+) PLUS

Personal Detai ls
1
Name of the unit
Individual Partnership
2
Constitution
Company Trust
Pin Number
Telephone / Mobile
3
Business address
E Mail
Pin Number 1
Telephone /Mobile
Residence address
E Mail
4 Registration No. of Medical
Practitioner
Own Own
(not
mortgaged)
5
Owning a House
Not owning
Academic Qualifications Graduate (MBBS/BMS/OTHER) Studying MDS.
6 (Medical Fields) PG Specialisation
Doctor
Employed
7
Spouse Detail
Not working
8
Income Assessed under IT
Yes
No
9
Taken Life Insurance Policy
Yes
No
SC / ST Minority
Community
Male Female
10
Whether belongs to
Ex-service man
11 Banking with SBI New connection
Details of Deposit A/c. Since
Loan A/c Since
Loans Repaid
BUSINESS DETAILS
12 Description of Activity
Over 10 years
5-10 years
3-5 years
13
Experience in respect of medical
practice
Less than 3 years
Owned / leased 5 years
Owned but mortgaged
14
Premises where practice is done
Rented Rented
15. PROJECT DETAILS (Rs /in lacs)
Cost of Project Amount Means of Finance Amount
Fixed Assets Working Capital
Deposit Term Loan
Current Assets Other
Total Total
16. TRACK RECORD (Rs /in lacs)
Years 2005-2006 2006-2007 2007-2008 2008-2009 2009-2010
Income
Operating Profit
(pre tax)
17 TOL/TNW
(quasi equity to be added to TNW
and reduced from TOL)
DSCR
18 Amount of Loan Required
Upto 3 years
3-5 years
19 Repayment Period
5-10 years
20 Collateral Value of the property
(TDR or cash equivalent is
offered as security VIZ. RBI
Relief Bond, NSC etc multiply
cash equivalent by 2 and add to
the collateral at value)
% of the loan
21 I / We certify that (i) all information furnished by me/us is true, correct and complete;
(ii) I/We have no borrowing arrangement for the unit with any Bank as except
indicated in the application; (iii) there are no over dues/statutory dues against me/us;
(iv) no legal action has been taken against me/us; (v) I/We shall furnish all other
information that may be required by Bank in connection with my application; (vi) the
information may also be exchanged by you with any agency you may deem fit; (vii)
you/your representatives or 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; (viii) you may take appropriate safeguards/action for recovery of
Bank's dues including publication of defaulters name in web site/submission to RBI;
(ix) I/We further agree that my/our loan shall be governed by the rules of State bank
of India which may be in force from time to time.
Place: Mumbai
Date: - Signature of Borrower