Professionals/Self Employees (category-B) - Loans
Above Rs.25,000/- Interview-cum-Appraisal From
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Application for Equipment Finance/Working Capital
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Personal data
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Name of the Applicant*

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Number of Dependents Belongs to scheduled Cast/Tribe
Age Adults
Children Total Yes No.
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Business Address

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Professional data

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Professional Qualification Date of setting up business/profession

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Past experience

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Factors assuring applicant of successful business

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Past Income & Expenses
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Average monthly Income in the past year Rs.----------------------------------------
Average monthly expenses Rs. ---------------------------------------
Net savings per month (After Tax) Rs.----------------------------------------

Particulars of Income Tax and Sales Tax Assessments

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Equipment/term finance requirement (Proforma Invoices/estimates to be enclosed)

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Purpose for which equipment is required.

Details of equipment required
Item Manufacturer/Supplier Cost
(Rs.)

Total Cost Rs.
Less Applicant’s contribution % Rs.
Bank Loan required Rs.
Working capital requirements
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Need for working capital, give details

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Amount of working capital required Rs.
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Less Applicant’s contribution % Rs.
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Bank Loan required Rs.
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*If the applicant is a partnership firm, data on each partner to be furnished.
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Anticipated Income & Expenses
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Anticipated monthly income Rs. (A)
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Anticipated monthly expenses Rs. (B)
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Net surplus (After Tax) Rs. (C)
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Basis for anticipation of monthly income

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Break-up of expenses (anticipated)

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Repayment Programme
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Start up period and its necessity
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Repayment schedule
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Facility No. of Installments Amt. of Installment
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Term loan
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Working capital
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Total monthly repayment obligations
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Towards Bank Rs.
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Total
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Security
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Other Remarks

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Date :
Place :
Name of Official
Interviewing applicant Signature of applicant
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Remarks of the bank

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Facilities Recommended/Sanctioned with stipulations, if any

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Recommended Recommended/Sanctioned

Date : Date :
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