Pondicherry Industrial Promotion Development And
Investment Corporation Ltd.
Regd. Office : 60, ROMAIN ROLLAND STREET , PONDICHERRY-605001
APPLICATION FOR LOAN
(TRANSPORT INDUSTRY)
LOAN FOR Rs.-----------------------
1. a)
Full name of the Applicant
:
b)
Age
:
c)
Whether belongs to S.C / S.T (if so ,
caste certificate should be enclosed)
:
d)
Father’s / Husband’s Name
:
e)
Address
:
f)
Date of establishment / incorporation /
Registered Office
:
Constitution ( whether Private Limited /
Public Limited Registered Co-operative
Society / Sole Proprietorship / Joint Hindu
Family / Partnership )
:
h)
Registered Office
:
i)
Name(s) and address[es] of Proprietor /
Partner / Directors
:
Whether any one in (I) related to any of the
Directors of PIPDIC
:
g)
J)
2. Enclosed herewith are the following documents
For your persual ;
a)
b)
c)
:
A copy of the Partnership Deed and a
Copy of the Registration Certificate with
The Registrar of Firms
:
A copy of the Memorandum and Articles
Of Association , Bye-laws of the society
Together with a copy of certificate of
Registration.
:
Copies of audited Balance Sheet and Profit
and loss Accounts of the concern for
previous three years [ in the case of
existing concern only].
:
3. a)
b)
c)
Brief history of the concern [indicate the
experience of the applicant in the business
if no experience , whether he would
associate employ experienced personnel.
:
The name and address of other concern
and their Bankers name , and address
wherein the Proprietor / partners/Directors
are interested [ enclose the Profit and Loss
account and Balance Sheet for last 3 years)
:
Following details in respect of Proprietor /
Partner /Director (a Separate sheet may
be enclosed)
:
(i)
Wealth and property
:
(ii)
Income
:
(iii)
Liability
:
(iv)
Amount of wealth tax and income
tax paid for the last 3 years
:
4.
Purpose of the loan
5.
Particulars of vehicle(s) proposed to be acquired
a)
b)
c)
d)
e)
f)
g)
6.
Name of the manufacture , type and make
Specification , model , capacity , etc.
Cost of chasis (quotations should be
produced in proof thereof
Others costs, i,e Body Building , one
spare tyre , insurance, etc.
Initial working capital
Total cost
Place of Registration
Mode of Finance :
a) by way of capital
b) by way of loan from PIPDIC
c) Others (specify source , rate of interest,
etc )
:
:
:
:
:
:
:
:
Rs.
Rs.
Rs.
Total Rs.
7.
8.
Proposed terms of repayment of loan (indicate
the period within which the loan will be repaid
and state by what instalments you propose to
repay the principal amount)
:
Security for loan (the loan will be secure
by the hypothecation of vehicle(s) that is /are
owned and that will be acquired from the
loan from the Corporation)
:
9.
10.
Details in respect of the property which can
be given collateral security for the loan
a) Location and details of the property
b) The present value of the property
(original Title deed and encumbrance
certificate for a period 30 years in
respect of property should be enclosed)
:
Particulars of guarantor , if any
:
a)
b)
c)
d)
:
:
:
e)
f)
11.
12.
13.
14.
:
:
Name
Age
Father’s Name
Profession or occupation ( Income certificate
Should be enclosed)
Permanent address
Net means
:
:
:
Whether permission and licences from the
authorities concernced have been obtained to
operate the vehicle(s) including routes , etc., if so
please furnish the details.
:
Please state if there is any pending ligitation either
by or against the concern
:
a)
Banker’s opinion and A/C . No. Name of the
Bank and address (Please authorise your bank
to furnish information as per form given in
Scheduled ‘C’ under a copy to the corporation) :
b) References from two persons ….Give their
names , occupation and address.
:
Earning
capacity
Schedule ‘D’)
:
(Please
complete
the
Estimated Income
Rs.
Operating Expenses
Rs.
-----------------------------------------------Rs.
Add : Depreciation
Rs.
Interest charges
15
16.
17.
Rs.
Management Remuneration
Rs.
-------------------------------------------------
Net profit before taxation
Rs.
-------------------------------------------------
Please state if you made any application to or
availed of any loan from any other institution
and / or Government . If any such application
was made and rejected , please state the reasons
given , if any for such rejection
:
In the case of existing concerns , details regarding
existing vehicles and the area of operation
(No. of routes ) may be furnished
:
General :
A]
Position regarding income-tax assessment ;
[Please state the last year in respect of which
income tax assessment has been completed and
the amount of income-tax and Corporation
taxes demanded and paid advance tax paid f
or subsequent year , etc )
:
b] Position regarding necessary licenses from
authorities to operate the vehicles
c]
:
Whether any of the existing vehicles owned
have been hypothecated/ mortgaged or taken
on hire purchase basis. If so , please give full
particulars such as name of the institution ,
amount borrowed , rate of interest, present
outstanding , margin period , nature of charge ,
etc., [Please furnish copies of Registration
books , permits from R . T . O . etc. ]
:
d] Position regarding registration of vehicles as
“Public Transport Carrier “ and registration of
charge on the vehicle with the Regional
Transport Authority.
:
I/We hereby certify that the answers given above are in every respect true and correct and that we have not
withheld any information likely to affect acceptance of this proposal and that the properties mentioned
herein are our exclusive properties and will not in any way be transferred or alienated until the obligations
arising out of the agreement are fulfilled.
Place:
Date:
Signature
Name of Applicant
SCHEDULE “A”
PARTICULARS OF VEHICLE(S) ALREADY IN POSSESSION
--------------------------------------------------------------------------------------------------------------------------------Chassis No.
Whether
Make and name of
Engine No
Date of purchase
Cost
purchased
Manufacture
Registration
Rs.
new or
No. and place
second hand
----------------------------------------------------------------------------------------------------------------------------- ----
Area of operation
--------------------------------------------------------------------------------------------------------------------PARTICULARS OF INSURANCE
--------------------------------------------------------------------------------------------------------------------Name of
Amount
Vehicle
Risks
Insurance
insured
Date of expiry
covered
company
(in force)
of policy
---------------------------------------------------------------------------------------------------------------------
--------------------------------------------------------------------------------------------------------------------SCHEDULED “B”
PARTICULARS OF VEHICLE(S) TO BE PURCHASED
--------------------------------------------------------------------------------------------------------------------Cost of
Other costs e . g .Body
Make and
chassis
building, one tyre ,
Total Cost
Manufacturer
Rs.
insurance etc., Rs.
Rs.
---------------------------------------------------------------------------------------------------------------------
Area of operation
SCHEDULE “C”
Place:
Date:
The Manager /Agent
(Name and address of the Banker to be inserted here)
Dear Sir,
We hereby authorise you to furnish to The Pondicherry Industrial Promotion Development
And Investment Corporation Limited to whom we are making an application for financial
assistance , our affairs or any matter relating thereto and to disclose such information as they may
require of you
Yours faithfully,
Signature of Applicant.
SCHEDULE “D”
PROFORMA OF INCOME AND EXPENDITURE
A.
INCOME :
1. Expected running K . M . per day
2. Number of plying days per annum
3. Total plying distance per annum
4. Rate of hire charges assumed
5. Total income expected per year
B.
:
:
:
Rs.
Rs.
EXPENDITURE :
1.
Operating expenditure
:
2.
Cost of Petrol / Diesel per litre
Rs.
3. Total Petrol / Diesel required per annum
@ K .M . per litre
:
4.
Cost of litres of Petrol or Diesel
:
5.
Cost of Engine oil per annum
:
6.
Services and Maintenance
[ % on the cost of the vehicle ]
:
7.
Salaries and Batta to Driver and Cleaners
Post
No.
Registration Charges
Salary per
Month
Salary per
Annum
:
---------------------------------------------Total “X”
----------------------------------------------
C.
OTHER EXPENSES
1.
Insurance
:
2.
Interest
:
3.
Road taxes
:
4.
Depreciation @ 20% of the cost the
vehicle
:
--------------------------------------------------------Total “Y”
--------------------------------------------------------Total Expenditure[ X + Y ] :
Operating Profit [A-B]
LESS : Taxes
ADD ; Deprecation
Net Cash available
:
:
--------------------------------------------------------:
--------------------------------------------------------:
---------------------------------------------------------
Pondicherry Industrial Promotion Development and
Investment Corporation Limited,
60, Romain Rolland Street , P .B . No .190, Pondicherry-605 001.
Sir / Madam ,
With reference to your loan application filed with us for financial assistance for
purchase one new Tourist Taxi / Auto Rickshaw / Lorry / Van / Stage Carrier , you are requested
to kindly furnish the following particulars at an early date so as to enable us to process your loan
application :1.
Valid permit from Transport Department in respect of vehicle proposed to be purchased.
2.
Quotation in respect of vehicle proposed.
3.
Three quotations in respect of body building for the vehicle from standard body builders.
4.
Three quotations in respect of Tarpaulin from standard suppliers.
5.
Three quotations in respect of extra tyres.
6.
Copy of the Birth , Nativity , Nationality Certificate and Ration Card.
7.
Affidavits in respect of the permit , Nationality and clearance of finance institutions /
income tax and wealth tax as per Enclosures –I,II ,III respectively.
8.
Copy of the Driving Lincense , if any.
9.
Bio-data of the promater , in detail ( age, father’s name , educational qualification , present
occupation , experience , if any ,details of family members and property of self and family
members).
10. Banker ‘s name , address and Account Number of self / partners.
11. The name and address of other concerns wherein the promoter / partners are interest . If so,
Last three years balance sheet (audited) and bankers details with account Number.
12. Details of property being given as collateral security for the loan :a)
Location and details of the property.
b)
The present value of the property .(to be obtained from Revenue Department to be
produced).
c)
Original titie deed and encumbrance certificate for the last 30 years and copy of
antecedent document of the property.
13. Details of the other existing vehicles , if any on the promoters name and on the family
members name (Model , Registration Number , are of operation , year of purchase and
details of loan obtained from any institution / bank if any ).
In addition to the above you are also requested to pay a sum of Rs.--------------(I . e.0.25% of the loan proposed ) towards investigation fee.
Enclosure – 1 ( to be typed in Rs. 15.00 stamp paper)
AFFIDAVIT
I,----------------------------------------residing at ------------------------------------------- do solemly and
Sincerely affirm and state on oath as follows:
I am given a permit No--------------------dated---------------------------------issued by state Transport
Authority in respect of Lorry / Taxi ?auto (as applicable)
I have not produced any vehicle against the above permit and the permit valid up to ---------------I am not having any other public carrier or stage carrier permit in my name or in the concerns
where I am interested as partner or Director.
Solemnly and sincerely affirmed at Pondicherry on this the date -------------------------- of
the contents of this affidavit having been first truly and audibly read over and explained to
deponent in tamil who is not well acquintained in english and admitted by him to be correct and
signed in my presence.
Signature
(Dependent)
Signature
Signed before me
NOTARY.
--------------------------------------------------------------------------------------------------------------------Enclosure-II (to be typed on Rs. 5.00 stamp paper)
AFFIDAVIT
I,--------------------------------------S/o. / W/o.-------------------------------------residing at ------------------------------------ be do hereby solemnly and sincerely affirm and state on oath as follows :
I do hereby declare that I am an Indian National and that I have not opted or intend to opt to any
other nationality.
Solemnly and sincerely affirmed at Pondicherry on the ------------------------------- contents of this
affidavit having been first truly and audibly read over and explained to deponent in tamil who is
not well acqintained in English and admitted by him to be correct and signed in my presence.
Signature
(Dependent)
Signature
Signed before me
NOTARY
---------------------------------------------------------------------------------------------------------------------
Enclosure-II (to be typed on Rs. 5.00 stamp paper)
AFFIDAVIT
I , ----------------------------------S/o. aged about -------------------------------years proprietor / partner
of ----------------------------------------- residing at --------------------------------do hereby solemnly
and sincerely affirm as follows :
I am not in default to any financial institutions / banks in payment of their dues. I am also not in
default to Govt. in respect of statutory dues including income tax and wealth tax.
Solemnly and sincerely affirmed at Pondicherry on this day of -----------------------------------------the content of this affidavit having been first truly and audibly read over and explained to the
deponent in Tamil who is not well acquintained in English and admitted by him to be correct and
signed in my presence.
Signature
(Desonent)
Signature
Signed before me
NOTARY PUBLIC
---------------------------------------------------------------------------------------------------------------------