UNITED BANK OF INDIA
APPENDIX - 3

APPLICATION FORM FOR TERM LOAN
UNDER EDUCATIONAL LOAN SCHEME ( 2001 )

HEAD OFFICE : CALCUTTA
Place :.....................
Date :.....................
To
United Bank of India, PHOTOGRAPH
_______________________
(Name of the Branch)
I hereby apply for an Educational Loan of Rs................................................................ repayable
in .......................................................... monthly instalments beginning ...................................... years
after the disbursal of the loan to enable me to prosecute higher education in ..........................................

(NOTE : Application form to be read carefully before filling in Application should be submitted in duplicate)
2. BIO-DATA OF THE STUDENT:
(a) Name in full :
(b) Address :
(c) Date of birth and age :
(d) Nationality :
(e) Is the student otherwise
gainfully occupied elsewhere : Yes/No
If yes, please give details :
of present occupation
(f) Marital Status : Married [ ] Unmarried [ ]
If married, number of children, if any
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APPENDIX-3 (CONTD.)
(g) Parents' Name in full :
i) Father :
ii) Mother :
(h) Guardian's name in full
and relationship with :
the student
(i) Address of father/parent/
Guardian with Telephone :
No., if any,
Permanent :
Present :
Full Office Address :
with designation & Telephone No.
3. EDUCATIONAL QUALIFICATIONS
Examination Passed
Institution/University from which passed
Year of Passing
Percentage of marks obtained
Class Obtained
1 2 3 4 5
Mark Sheets of examinations passed as also testimonials from the College last attended to be attached.
4. Particulars of Scholarship/Prizes won for academic distinction:
a) Examination :
b) Nature of Scholarship/ :
Prizes
c) Amount :
d) Duration of Scholarship :
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APPENDIX-3 (CONTD.)
5. Parents'/Guardian's financial
status/family particulars:
a) Occupation (Give full :
particulars)
b) Income per month :
c) If in service, the age :
of retirement
d) Number of dependants :
e) Details of income of :
any other member of
family, if earning
6. Particulars of the course for
which the loan is required :
a) Name of the course :
c) Institution/University :
d) Detailed yearwise breakup of expenses
including fees & other requirement:
i) Fees payable to College/School/Hostel :
ii) Examination/Library/Laboratory Fees :
iii) Purchase of books/equipments/
instruments/uniforms :
v) Caution Deposit/Building Fund/
Refundable Deposit supported :
by Institution Bills/Receipts
v) Travel Expenses/Passage Money for
studies abroad :
vi) Purchase of Computers essential for completion of the course :
vii) Any other expenses required to
complete the course like study :
tours, project work, thesis, etc.
Funds avaiable from own/family :
source including margin
Amount of loan required :
(Rate of conversion of Foreign currency taken is to be indicated here)
TOTAL :
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APPENDIX-3 (CONTD.)
e) Other Particulars :
7. Schedule of Disbursement :
proposed by the applicant
8. i) Expected income per month : Rs.
after completion of course
ii) Anticipated monthly expenses : Rs.
Balance : Rs.
Amount avaiable for : Rs.
repayment of loan
9. In case of students intending to go abroad, details of passport :
Note: i) Permission of the Foreign University accepting the student for environment or letter of admission to the ForeignUniversity to be enclosed.
ii) Permission of the RBI Exchange Control Department should be produced at the time of submission of the application along with the Paasort and Visa of the Student.
10. Any other useful information :
11. Details of documents attached :
a) b)
c) d)
e) f)
12. Details of securities offered :
(where applicable)
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APPENDIX-3 (CONTD.)
13. Particulars about 3rd party as Guarantor:
(in case of 3rd party providing security)
(A declaration by the Guarantor to be submitted as per specimen enclosed along with this application):
a) Name :
b) Residential Address :
with Telephone No.
and office Address :
with Telephone No.
c) Occupation with designation :
and other details
d) Estimated worth :
14. Reference (Name and Address of two Referees
(not related to you):
1.
2.
We hereby give the under taking that the borrower student shall follow all the rules and regulations laid down by the institution where he will be prosecuting studies and shall maintain such dignity and honour, as is expected of a student pursuing higher studies.
We further undertake that if the borrower student studying abroad takes up any part time employment, full particulars of such employment shall be intimated to the bank.
We also hereby undertake that the borrower student should inform the Bank of any financial aid, assistance-ship, scholarship. Sponsorship or any other assistance availed of by him at the time of applying for the loan or thereafter and of any other subsequent change in the financial position during the pendency of the loan.
We further undertake that full details of employment after completion of the course shall be furnished to the Bank by the student borrower.
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APPENDIX-3 (CONTD.)
We certify that to the best of our knowledge and belief, the information furnished herein is true and correct.
We promise to abide by the terms and conditions governing the grant of the Educational Loan by UNITED BANK
OF INDIA. We also undertake to furnish the correct address from time to time.
APPENDIX - 3
UNITED BANK OF INDIA
HEAD OFFICE : CALCUTTA
NAME OF THE BRANCH:_______________________
SIGNATURE OF STUDENT (APPLICANT)
(SIGNATURE OF FATHER/GUARDIAN SIGNATURE OF MOTHER/GUARDIAN)
Particulars about the Guarantor (To be furnished by the Guarantor)
In respect of Educational Loan Proposal
of Shri/Smt. ____________________________
(Name of Student applicant)
1. Name :
2. Address :
3. Age :
4. Occupation :
(Please give details)
5. Approx. Annual Income :
6. Estimated net worth :
indicating inter alia
details of Fixed
Assets and Liabilities,
if any.
Dated: Signature:.........................