Request Letter - Client Letter Head

[On the Letterhead of Borrower]
Application form for Emergency Credit Line Guarantee Scheme 1.0 extension
Date [●]
I. Introduction
i. All applicants, which expression shall, as the subject or context may admit or require, mean any or each of
the Applicant(s) (‘Applicant’), who wish to avail of financial assistance detailed below (the ‘Facility’) from
ICICI Bank Limited (‘ICICI Bank’) for any purpose specified below (the ‘Purpose’) in this Application
Form (hereinafter ‘Application Form’) under Emergency Credit Line Guarantee Scheme 1.0 (‘ECLGS 1.0
extension.
ii. The Applicant's request for the Facility vide this Application Form and the sanction of the same by ICICI
Bank and/or disbursement of the Facility shall be subject to terms hereof
II. Details of Applicant (To be filled in by the customer)
Name: M/s Kolkata Marine & Engineering Services Pvt. Ltd.
Applicant(s) Constitution: Private Limited Company

Details (Proprietorship Firm/Partnership Firm/ Private Limited Company/ Public Limited Company)
Registered Office: P28, Kasba Industrial Estate, Kolkata - 700107
Auto Dealership/Aviation / Building Materials (tiles) / Cement / Corporate Retail

Outlets / Construction / Consumer Durables / FMCG / Gems & Jewellery / Hotel /
Industry
Restaurants / Iron & Steel Manufacturing / Logistics / Mining / Power / Plastic
(Please tick Products Manufacturing / Tourism /Logistics / Real Estate (residential / commercial)
whichever is / Textiles / Trading – Wholesale /
applicable)
Others _____________(Please specify)
III. Details of the Facility (To be filled in by the customer)
Amount
Rs. 90,00,000.00
Requested for
Purpose For meeting working capital

Type of Facility Working Capital Term Loan and/or
Requested for in the form of [●]
III. Other Details (To be filled in by the customer)
1. Valid GSTN Number (Certificate enclosed) :

19AADCK6706D1ZN____________________
Note: ‘Not Applicable’ to be mentioned in case entity is exempted.
2. PAN : AADCK6706D____________________
3. Total Turnover of the Company as on Fy 2019-20 and 2020-21 (in Cr.) :
____________________
4. PAT of the Company as on FY 2019-20 and 2020-21 (in Cr.) : ____________________ 1
5. Total No. of Employees : ___________750
a. Permanent : ___________750
b. Contractual : ___________
6. I/ We have availed following loans for domestic and overseas borrowing from commercial banks,
NBFCs and FIs. 2
Name of the Bank /

Financial Institution
Data at March 31, 2021

Sanction Sanction
Particulars Facility wise Overdue status
date amount
outstanding
FB facilities
NFB facilities
Derivatives
Total
Sr. No. Particulars (for particular institution) Details
1 Requests for ECLGS facilities if any, with other FI’s
2 Main and allied activities with locations
3 Any statutory auditors comment/pending

litigations/other derogatory remarks
1
Retain if applicable
2
Institution wise details to be filled in individual tables.
7. Detail of Partners / Directors of the firm as follows:-
S Name of Partner / Director/ Date of Address Pan No

No Proprietor/ Individual Birth
1 SANDIP SEN 28.10.1952 CL63, SECTOR-II, AIUPS5139E

C.K. MARKET, KOL-
700091
2 SWATI SEN 10.08.1956 CL63, SECTOR-II, ALPPS7997E
C.K. MARKET, KOL-
700091
3 SOUMYA SEN 21.01.1983 CL63, SECTOR-II, ATDPS4087M
C.K. MARKET, KOL-
700091
IV. Customer Declarations
1. I/ We understand that Government of India through Ministry of Finance and Department of Financial
Services has launched the ‘Emergency Credit Line Guarantee Scheme dated May 23, 2020 (“the
Scheme”) which is modified, amended or updated by the Government from time to time.
2. I / We are fully aware that mere submission of relevant documents and this Application Form does not
guarantee sanction of additional credit under this ECLGS 1.0 extension and that ICICI Bank shall
sanction the same if all the necessary norms are met.
3. I/We hereby agree that grant of the facility under ECLGS 1.0 extension is subject to the me/us
fulfilling the following requirements –
(i) I/we is/are registered under GST or exempted under GST.

(ii) Overall fund based outstanding credit with all banks/NBFCs/financial institutions as on
February 29, 2020 or March 31, 2021 is upto Rs. 50 crores
(iii) The overdues if any, across all banks/NBFCs/financial institutions as on February 29, 2020
and March 31,2021 do not exceed 60 (sixty days).
(iv) Issuance of guarantee by NCGTC.
4. I/ We shall provide proof / execute any documents as may be required by ICICI Bank to prove /
substantiate the abovementioned information.
5. Except to the extent disclosed to ICICI Bank, no director or a relative /near relation (as specified by
RBI) of a director of a banking company (including ICICI Bank) or a relative /near relation (as specified
by RBI) of a senior officer of ICICI Bank (as specified by RBI) is: The Applicants or a partner of our
concern, or a trustee, member, director, employee or our concern, or of our subsidiary, or our holding
company, or a guarantor on my/our behalf, or holds substantial interest in our concern or my/our subsidiary
or holding company.
Details of any such relation as referred to above: ___________________
6. In case of any claim/s received by ICICI Bank from Government of India, Ministry of Finance, towards
false representations / misrepresentation or discrepancy in the documents submitted for the purpose of
availing the ECLGS 1.0 extension , I/ We hereby undertake to indemnify ICICI Bank to full extent without
any delay or demur. In the event of the me/ us availing the ECLGS 1.0 and/ or any benefits under ECLGS
1.0 extension wrongly due to non-eligibility or for any other reasons whatsoever, I/ We authorize ICICI
Bank to reject our application.
7. I/We hereby confirm there is no change in Proprietor/Partners/Directors/Constitution.

8.
9. I/We confirm and declare that all the particulars and information and details given by me/us in this
Application Form are true, correct, complete and up-to-date in all respects and that I/we have not withheld
any information whatsoever. I/We undertake to inform ICICI Bank of any changes to such particulars,
information and details immediately. In case of any of the information provided by me/us is found to be
false or untrue or misleading or misrepresenting, I/we are aware that I/we may be held liable for it.
10.
11. I/We confirm and understand that all future communications by ICICI Bank in respect of my application
shall be done through physical letter or SMS / e-mail to my/our mobile number / e-mail ID provided by
me/us hereinabove.
12.
13. I/We agree and undertake to submit all physical documents as may be required by ICICI Bank for
processing of my/our application and I/we further agree and confirm that my/our failure to submit all
physical documents within 30 (thirty) days from the date when requested by ICICI Bank will render this
application null and void.
14.
15. I hereby authorise the bank to share information with other institutions, if required.
16.
17. I/We agree and understand that the Facility under ECLGS 1.0 extension shall be governed by and subject
to additional terms and conditions as may be communicated by ICICI Bank, which will be binding upon
me/us.
18.
19. I/We agree and confirm that ICICI Bank reserves the right, at any time, with or without previous notice, to
add, modify, alter, change or vary the terms of the Facility in accordance with guidelines of ECLGS 1.0
extension or any regulatory guidelines and notifications and ICICI Bank’s internal policy on the Facility.
For Kolkata Marine & Engineering Services Pvt. Ltd. __________________

(Firm/ Company name)
Signed & Stamped

Authorised Signatory/ies
(Proprietor/Partner/Director)
Place: KOLKATA
Date: 28.01.2022

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[On the Letterhead of Borrower]

II. Details of Applicant (To be filled in by the customer)

Name: M/s Kolkata Marine & Engineering Services Pvt. Ltd.

Applicant(s) Constitution: Private Limited Company

Registered Office: P28, Kasba Industrial Estate, Kolkata - 700107

Auto Dealership/Aviation / Building Materials (tiles) / Cement / Corporate Retail

III. Details of the Facility (To be filled in by the customer)

Purpose For meeting working capital

III. Other Details (To be filled in by the customer)

1. Valid GSTN Number (Certificate enclosed) :

Note: ‘Not Applicable’ to be mentioned in case entity is exempted.

Name of the Bank /

Data at March 31, 2021

Sr. No. Particulars (for particular institution) Details

1 Requests for ECLGS facilities if any, with other FI’s

2 Main and allied activities with locations

3 Any statutory auditors comment/pending

S Name of Partner / Director/ Date of Address Pan No

1 SANDIP SEN 28.10.1952 CL63, SECTOR-II, AIUPS5139E

IV. Customer Declarations

(i) I/we is/are registered under GST or exempted under GST.

7. I/We hereby confirm there is no change in Proprietor/Partners/Directors/Constitution.

For Kolkata Marine & Engineering Services Pvt. Ltd. __________________

Signed & Stamped

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