SME CITY CREDIT CENTRE
APPLICATION FOR DOCTOR (+) PLUS
Personal Details
1
Name of the unit
2
Constitution
3
Individual
Partnership
Company
Trust
Business address
Pin Number
Telephone / Mobile
E Mail
Residence address
Pin Number
Telephone /Mobile
E Mail
4
Registration No. of Medical
Practitioner
5
Owning a House
Own
1
Own
(not
mortgaged)
Not owning
Academic Qualifications
Graduate (MBBS/BMS/OTHER) Studying MDS.
6
(Medical Fields)
PG
Doctor
7
Spouse Detail
Employed
Not working
8
Income Assessed under IT
Yes
No
9
Taken Life Insurance Policy
Yes
No
SC / ST
10
Whether belongs to
Minority
Community
Female
Male
Specialisation
Ex-service man
11
Banking with SBI
Details of Deposit A/c.
Loan A/c
Loans Repaid
New connection
Since
Since
BUSINESS DETAILS
12 Description of Activity
13 Experience in respect of medical
practice
14
Premises where practice is done
15. PROJECT DETAILS
Cost of Project
Fixed Assets
Deposit
Current Assets
Total
16. TRACK RECORD
Years
Income
Operating Profit
(pre tax)
17
Amount
Over 10 years
5-10 years
3-5 years
Less than 3 years
Owned / leased 5 years
Owned but mortgaged
Rented
Means of Finance
Working Capital
Term Loan
Other
Rented
(Rs /in lacs)
Amount
Total
(Rs /in lacs)
2005-2006 2006-2007 2007-2008 2008-2009 2009-2010
TOL/TNW
(quasi equity to be added to TNW
and reduced from TOL)
DSCR
18
19
Amount of Loan Required
Repayment Period
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
% of the loan
the collateral at value)
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.
21
Upto 3 years
3-5 years
5-10 years
Place: Mumbai
Date: -
Signature of Borrower