Sbi Bank

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Before.............................................................................

, Notary Public, Purulia

AFFIDAVIT

I, BISWANATH GORAIN , Son of Senapati Gorain, aged about 46 years, (Date


of Birth 05/03/1972, Place of Birth Chitmu ), by occupation, Business, Telephone/ Mobile No.
9933951151, Resident of Vill. & P.O.:Chiotmu, P.S.:Kotshila, Dist.: PURULIA, do hereby solemnly
affirm and declare on oath as follows :-

1. That may business place is Vill+P.O- Chitmu, P.S- kotshila, Dist- Purulia.
2. That educational qualification is VIII Pass.
3. That my occupation is business.
4. That no. of my family members are Three and no. of dependents are Three.
5. That the State Bank of India, a bank established under State Bank of India Act, 1955 having
its Branch at Kotshila( hereinafter referred to as Bank) has at my request granted/and/or
agreed to grant credit facility(ies)to me Dipankar Gorain (name of the borrower), inter alia,
against my guarantee and hence, this affidavit are my statement /details of Assets &
Liablities as on _________________(give here date of swearing the affidavit).

2. That following are my statement/details of assets & liabilities as on ______________ (give


here date of swearing the affidavit)
Contd..................P/2
- : 2 : -

a. DETAILS OF IMMOVABLE PROPERTY(IES)


Place(s) Ancestral or self If Extent of Market value in Whether Whether
Where acquired/ encumbered,, land in Rupees any case agricultural
land(s)or belonging in towhat acres /suit non-
building(s) individual extent before any agricultural
is/are name/in joint competent and
situated names(if Court whether
ancestral/in authority comes in
joint in respect ceiling area
names,specify of the
share thereof) immovable
property is
pending

Place
Village
Taluka
Police station
Registration
Sub-District
District
Survey No.
Plot No.
Door No.
Name of street
Ward No.
Holding No.
Mouza
Khatina No.
Bounded by
North
South
East
West

TOTAL

Contd.................P/3
- : 3 : -
b. LIQUID ASSETS

Particulars Description Amount If encumbered to what extent

Cash

Bank balance

c . GOVERNMENT SECURITIES :
(PLEASE GIVE FULL DETAILS)

d .SHARES :
(PLEASE GIVE FULL DETAILS)

e . LIFE INSURANCE POLICIES :


( PLEASE FURNISH THE SURRENDER VALUE)

POLICY NOS:

f . JEWELLERY :

g . INVESTMENT IN BUSINESS IN :
ASSOCIATE FIRM IF ANY

h . INCOME PER MONTH :

i. LIABILITIES :
PARTICULARS: i ) BORROWING FROM BANKS
ii )BORROWING FROM MARKET
iii)BORROWING FROM OTHER SOURCES
iv) ASSUMED INDIRECT LIABILITY

Contd.................P/4
- : 4 : -

7. That I undertake and declare further to notify to the State Bank of India, Kotshila Branch,
any change, whether by way of increase or diminution, in the assets liabilities as detailed above
every year.

8. That the Statements/declaration made in this affidavit in paragraphs 1 to 3 above are true
to my knowledge.

Deponent
Date :

Deponent in identified

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