8/13/2019 Copy of Application Form
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TELEPHONE
NOs. (Office)
Mobile No.
BANK OF BARODA
APPLICATION FORM FOR MSEs
To be submie! "lo#$ %i& !ocume#s "s 'e &ec&eclis
(Fo Office*se)
+) NAME OF THE ENTERPRISE M,s A#i m"ei#$ P-.L!
) RE/D. OFFICE ADDRESS0
1) ADDRESS OF FACTOR2, SHOP0
3) 4HETHER BELON/S TO
SC,ST,OBC,MINORIT2COMM*NIT2
EMAIL ADDRESS0
PAN CARD NO.
5) CONSTIT*TION0 P6T.LTD
7 ) DATE OF +889
ESTABLISHMENT0
9) NAME OF PROPRIETOR,PARTNERS,DIRECTORS OF COMPAN2 AND THEIR
ADDRESSES0
NAME A/E ACADEMIC
:*ALIFICATIONS
RESIDENTIAL ADDRESS TELEPHONE
NO. (Resi!.,
Mobile
E;PERIENCE
IN THE LINE
OF ACTI6IT2
+
[email protected]
AABCA9306M
16, Tip Top la!a "#$ oint AMBA%&'((010
16, Tip Top la!a "#$ oint AMBA%&'((010
).A
mailto:[email protected]:[email protected]
8/13/2019 Copy of Application Form
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PAST PERFORMANCE,F*T*RE ESTIMATES (Acu"l 'efom"#ce fo %o 'e-ious
=e"s? esim"es
fo cue# =e" "#! 'oecio#s fo #e =e" o be 'o-i!e! fo %oi#$ c"'i"l
f"ciliies. Ho%e-e fo
em lo"# f"ciliies 'oecio#s o be 'o-i!e! ill &e 'o'ose! =e"
of e'"=me# of lo"#)0
(Rs. i# l"cs)PAST
2EAR II
(Acu"l)
PAST 2EAR I
(Acu"l)
PRESENT
2EAR
(Esim"es)
NE;T 2EAR
(Poecio#s)
NE;T 2EAR
(Poecio#s)
Ne S"les
Ne Pofi
C"'i"l (Ne %o& i#
c"se of com'"#ies)
I# c"se of em lo"# euieme#s? &e !e"ils of m"c&i#e= m"=
be $i-e# "s u#!e0
T='e of
M"c&i#e
Pu'ose
fo %&ic&
euie!
4&e&e
im'oe! o
i#!i$e#ous
N"me of
su''lie
To"l cos of m"c&i#e (i#
c"se of im'oe! m"c&i#e?
&e be"u' of b"sic cos?
fei$&? i#su"#ce "#!
cusoms !u= m"= be
$i-e#)
Co#ibuio#
bei#$ m"!e b=
&e 'omoes
Lo"#
euie!
+) De"ils of Coll"e"l Secui= offee!? if "#=? i#clu!i#$ 1! '"=
$u""#ee G
(G As 'e RBI $ui!eli#es b"#s "e #o o "e coll"e"l secui= fo lo"#s
u'o Rs. +@ l"&so MSME
*#is)
S. No. Desci'io# of &e Secui= O%#e! b= A''o. -"lue
+1)
+3) S"us e$"!i#$ S"uo= Obli$"io#s0
S"uo= Obli$"io# 4&e&e Com'lie! %i&
(4ie 2es , No). If No
Rem"s (A#= !e"ils i# co##ecio# %i&
&e ele-"# obli$"io# o be $i-e#)
+. Re$is"io# u#!e S&o's "#!
Es"blis&me# Ac
. Re$is"io# u#!e SSI
(Po-isio#"l , Fi#"l)
1. Du$ Lice#se
3. L"es S"les " eu# file!
5. L"es I#come " eu#s file!
7. A#= o&e s"uo= !ues
em"i#i#$ ous"#!i#$
3
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+5)
*AC+ $-
$T$
*AC+ $-
$T$
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+7) D"e0 Pl"ce0
I,4e ceif= &" "ll i#fom"io# fu#is&e! b= me,us is ue
&" I,4e &"-e #o boo%i#$
""#$eme#s fo &e u#i ece' "s i#!ic"e! i# &e "''lic"io#
&" &eeis #o o-e!ues ,s"uo=
!ues "$"i#s me,us,'omoes ece' "s i#!ic"e! i# &e "''lic"io#
&" #o le$"l "cio# &"s bee#,is
bei#$ "e# "$"i#s me,us,'omoes &" I,4e s&"ll fu#is&
"ll o&e i#fom"io# &" m"= be
euie! b= =ou i# co##ecio# %i& m=,ou "''lic"io# &"
&is m"= "lso be ec&"#$e! b= =ou
%i& "#= "$e#c= =ou m"= !eeme! fi "#! =ou? =ou e'ese#"i-es?
e'ese#"i-es of &e
Rese-e B"# of I#!i" o "#= o&e "$e#c= "s "u&oise! b= =ou?
m"=? " "#= ime?
i#s'ec,-eif= m=,ou "sses? boos of "ccou# ec. I# ou
f"co=,busi#ess 'emises "s$i-e# "bo-e.
8/13/2019 Copy of Application Form
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'CHECK LIST (TO BE /I6EN TO THE NE4 C*STOMERS B2 BRANCH) OF
DATATO BE KEPT READ2 B2
THE C*STOMER
+ Poof of i!e#i= 6oeJs ID C"! , P"ss'o ,!i-i#$ lice#ce , PAN C"!
, si$#"ue i!e#ific"io#fom 'ese#
b"#es of 'o'ieo? '"#e o Dieco (if " com'"#=).
Poof of esi!e#ce Rece# ele'&o#e bills? elecici= bill? 'o'e=
" ecei' , '"ss'o , -oeJs ID C"! of
'o'ieo? '"#e o Dieco (if " com'"#=).
1 Poof of busi#ess "!!ess
3 Poof of Mi#oi=
5 L"s &ee =e"s b"l"#ce s&ees of &e u#is "lo#$%i&
i#come " ,s"les " eu#s ec. (A''lic"ble fo "ll
c"ses fom Rs. l"cs "#! "bo-e).
Ho%e-e? fo c"ses belo% fu#! b"se! limis of Rs.5 l"cs if "u!ie!
b"l"#ce s&ees "e #o "-"il"ble? &e#
u#"u!ie! b"l"#ce s&ees "e "lso "cce'"ble "s 'e e"#i#sucio#s
of &e b"#. Fo c"ses of Rs.5 l"cs "#!
"bo-e? &e "u!ie! b"l"#ce s&ees "e#ecess"=.
7 Memo"#!um "#! "icles of "ssoci"io# of &e
Com'"#=,P"#es&i' Dee! of '"#es ec.
9 Asses "#! li"biliies s"eme# of 'omoes "#! $u""#os "lo#$%i&
l"es i#come " eu#s.
Re# A$eeme# (if busi#ess 'emises o# e#) "#! cle""#ce fom
'olluio# co#ol bo"! if"''lic"ble.
8 SSI e$is"io# if "''lic"ble.
+@ Poece! b"l"#ce s&ees fo &e #e %o =e"s i# c"se of
%oi#$ c"'i"l limis "#! fo &e 'eio! of &e lo"# i#
c"se of em lo"#. (Fo "ll c"ses of Rs.l"cs "#! "bo-e)
++ I# c"se of "eo-e of "!-"#ces? s"#cio# lees of f"ciliies bei#$
"-"ile! fom eisi#$ b"#es,Fi#"#ci"l
I#siuio#s "lo#$%i& !e"ile! ems "#!co#!iio#s.
+ Pofile of &e u#i (i#clu!es #"mes of 'omoes? o&e !iecos
i# &e com'"#=? &e "ci-i= bei#$
u#!e"e#?"!!esses of "ll offices "#! 'l"#s? s&"e&ol!i#$
'"e# ec. (APPLICABLE FOR CASES 4ITHE;POS*RE ABO6E Rs.5 LACS).
+1 L"s &ee =e"s b"l"#ce s&ees of &eAssoci"e,/ou'
Com'"#ies (If "#=). (APPLICABLE FOR CASES 4ITH
E;POS*RE ABO6E Rs.5 LACS).
+3 Poec e'o (fo &e 'o'ose! 'oec if em fu#!i#$ is euie!)
co#"i#i#$ !e"ils of &e m"c&i#e= o be
"cuie!? fom %&om o be "cuie!? 'ice? #"mes of
su''lies?fi#"#ci"l !e"ils lie c"'"ci= of m"c&i#es?
c"'"ci= uilis"io# "ssume!? 'o!ucio#? s"les? 'oece! 'ofi "#! loss
"#! b"l"#ce s&ees fo &e #e 9o
=e"s ill &e 'o'ose! lo"# is o be '"i!? &e !e"ils of
l"bou? s"ff o be &ie!?b"sis of "ssum'io# of suc&
fi#"#ci"l !e"ils ec. (APPLICABLE FOR CASES 4ITH E;POS*REABO6E
Rs.5 LACS).
+5 Re-ie% of "ccou# co#"i#i#$ mo#&%ise s"les (u"#i= "#!
-"lue bo&)? 'o!ucio# (u"#i= "#! -"lue)?
im'oe! "% m"ei"l(u"#i= "#! -"lue)? i#!i$e#ous "% m"ei"l (u"#i=
"#! -"lue)? -"lue of socs i#
'ocess? fi#is&e! $oo!s (u"#i= "#! -"lue)? !ebos? ce!ios?
b"#s ous"#!i#$s fo %oi#$ c"'i"l
limis? em lo"# limis? bills !iscou#e!. (APPLICABLE FOR CASES4ITH
E;POS*RE ABO6E Rs.5 LACS).
+7 P&ooco'ies of le"se !ee!s,ile !ee!s of "ll &e 'o'eies
bei#$ offee! "s 'im"= "#! coll"e"lsecuiies.
+9 Posiio# of "ccou#s fom &e eisi#$ b"#es "#! co#fim"io#
"bou &e "sse bei#$ S"#!"! %i&&em (I# c"se
of "eo-e).
+ M"#uf"cui#$ 'ocess if "''lic"ble? m"o 'ofile of eecui-es i#
&e com'"#=? "#= ieu's? !e"ils "bou "%
m"ei"l use! "#! &ei su''lies? !e"ils "bou &e bu=es?
!e"ils "bou m"o com'eios "#! &e com'"#=s
se#$& "#! %ee#esses "scom'"e!o &ei com'eios ec.
(APPLICABLE FOR CASES 4ITH E;POS*RE
ABO6E Rs.5 LACS).
(T&e c&ec lis is o#l= i#!ic"i-e "#! #o e&"usi-e "#!
!e'e#!i#$ u'o# &e loc"l euieme#s " !iffee#
