Sui Appln

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Chapter - 36 Stand Up India (SUI) Scheme

ANNEXURE - II

(To be submitted along with documents as per the check list )

Enterprise Name Name of the Branch Category


SC /ST/Woman

Name of the Applicant /


Enterprise

Partner- Ltd.
Constitution Proprietary Pvt. Ltd. Any Others (specify)
ship Company

Business Address
State PIN Code
Business Premises Rented Owned
Telephone No. Mobile No. 91
E-mail:
Business Activity Proposed
Date of Commencement(DD/MM/YYYY)
Whether the Unit is Registered Yes No
If Registered (Please mention: Registration no. And
the Act under which registered )
Udyog Aadhar Registration No. **
** Not Mandatory

Social Category SC ST Minority


Community
If Minority Community Buddhists Muslims Christians Sikhs Jains Zoroastrians

addresses:

S.No Name Date of Sex Residential Academic Experience


Birth Address with in the line of
Mobile No. activity (Years)
1.
2.

Part – 5 696
Chapter - 36 Stand Up India (SUI) Scheme

S.No Id proof Id proof Address Address PAN Card/DIN Relationship with the
no. proof proof no. No.
bank if any
1.
2.

Names of Address of Presently Nature of Extent of Interest as a Prop./


Associate Associate Banking with Association Partner/ Director or Just Investor
Concern Concern Concern in Associate Concern

Type of Facilities Banks Name and Limit Availed Outstanding


Branch As on ……
Savings Account N. A.
Current Account N. A.
Term Loan
If banking with this bank, customer ID to be given here:

the past and I/we am/are not indebted to any other Bank / Financial Institution other than those
mentioned in column no. E above.

Type of Facilities Amount Purpose for which Security Offered


Required
Primary Security Whether Collateral
(Details with Security Offered
approx. value to be (If, yes, then
mentioned) provide details on
column I) (Yes/No)
Cash Credit**
Term Loan
LC/BG
Total
** Mandatory Fields

Part – 5 697
Chapter - 36 Stand Up India (SUI) Scheme

Cash Credit Projected


Sales Working Inventory Debtors Creditors Promoter’s Limits
Cycle in Contribution
Months

under:

Type of machine Purpose Name of Total Cost of Contribution Loan Required


/ Equipment for which Supplier Machine being made by the (Rs.)
required promoters(Rs.)

Total

Repayment period with Moratorium period requested for

working capital facilities. However for term loan facilities projections to be provided till the proposed
year of repayment of loan)
Current Year First Year Second Year Third Year (Projection)
(Estimate) (Projection) (Projection)
Net Sales

Capital (Net
Worth in case of
Companies)

Whether Remarks
Complied with (Any details in connection
Statutory Obligations (select Yes/No) withthe relevant
If not applicable obligation to be given )
then select N. A.
1. Registration under Shops and Establishment Act
2. Registration under MSME (Provisional /Final)
3. Drug License
4. Latest Sales Tax Return Filed
5.Latest Income Tax Returns Filed
6.Any other Statutory dues remaining outstanding

Part – 5 698
Chapter - 36 Stand Up India (SUI) Scheme

I/We hereby certify that all information furnished by me/us is true, correct and complete. I/We have no
borrowing arrangements for the unit except as indicated in the application form. There is/are no overdue
/ statutory due owed by me/us. I/We shall furnish all other information that may be required by Bank
in connection with my/our application. The information may also be exchanged by you with any agency

by you, may at any time, inspect/ verify my/our assets, books of accounts etc. in our factory/business
premises as given above. You may take appropriate safeguards/action for recovery of bank’s dues.

Space for Photo Space for Photo Space for Photo

(Signatures of Proprietor/
partner/ director whose

Date:___________________

Place:___________________

Part – 5 699

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