jk"Vªh; efgyk dks"k (Rashtriya Mahila Kosh) Format for loan application for Loan from R.M.K. under the Main Loan Scheme and Loan Promotion Scheme 1. Organisation Directory (i) Name of the Organisation (ii) Address (iii) State (iv) District (v) Block (vi) Phone No. (with STD code) (vii) Fax No. (if any) (viii) Nearest Railway Station (ix) Registration No. of the Organisation (x) Date of Registration (xi) Date of Renewal, if any (xii) Area of operation (xiii) Name of the Bank of Organisation (xiv) Account No. (xv) Name and Designation of Chief Functionary 2. Details of Socio -economic Development Programmes implemented by the organisation during last 3 years (yearwise). Year Name of the Programme Funded by Amount received Achievements (1) (2) (3) (4) (5) Note Please enclose a copy of your annual reports of last three years. For office use only Codes State Distt. Block Organisation 3. Experience of the organisation in CREDIT Activity during last three years (Yearwise) (Amount in Rs.) Years Activities for which loan given No. of SHGs No. of Borrowers Amount of loan disbursed Amount which was due for recovery i.e. Demand Amount Actually Recovered Per cent age of recovery to Demand 7/6 Source of fund 1 2 3 4 5 6 7 8 9 4. Experience of the organisation in thrift/savings and formation of SHGs. Please give details as below (Position as on ----------------------------) (Amount in Rs.) Sl.No. Name & Address of SHG Date of formation No. of Members Savings Mobllised Loan given out of saving Amount Recovered Amount of loan outsanding 1 2 3 4 5 6 7 8 Total 5. Proposed lending programme in the current year (Amount in Rs.) Sl. No. Category of loan Name of Activities No. of SHGs No. of Borrowers Average amount of loan per beneficiary Total Amount Requirement 1 2 3 4 5 6 (5x6) ST MT Total 6. Sources available with the organisation (Amount in Rs.) Sl. No. Source Balance at the beginning of year Amount expected during the current year Total Amount (1) (2) (3) (4) (5) 1 Own Sources 2 Savings of SHGs/ Members 3 Recovery of loans from SHGs/ Members 4 Other sources such as grants/ donations, etc. 5. Borrowings (other than this application of RKM) 6. Total 7. Financial Assistance required from RKM (i.e. Para 5-6) (Amount in Rs.) Sl. No. Category of Loan Name of Activities No. of SHGs No. of Borrowers Average amount of loan per beneficiary Amount required (1) (2) (3) (4) (5) (6) (7) ST MT Total 8. Financial position of the organisation as per Balance Sheet (As on..................) (I) Fixed Assets Rs....................... (iii) Borrowings Rs.................. (ii) Current Assets Rs....................... (Details of borrowings if any, may be given in the proforma below) (iv) Other liabilities Rs....................... Name of the lending Institution Date Amount Outstanding Amount Borrowed Balance of Borrowings Repaid (1) (2) (3) (4) (5) 9. Organisational seup and Training (i) Details of staff No. of staff with the organisation Trained Untrained Total (1) (2) (3) (4) Office/ Supervisory staff Field/ Extension staff Total (ii) Details of arrangements available with the organisation for training of staff/ SHGs 10. Check List (Please enclose the following) Sl. No. Details of enclosures Yes/No Annexure No. (1) (2) (3) (4) (i) Attested Copy of the original Registration Certificate/Renewals. (ii) Attested Copy of Memorandum of Association/Bye-laws (iii) Indicate the provision to borrow from outside agency (Pl. give para/page no. of bye-laws.) (iv) Main objectives/purpose / background of forming organisation- a brief note (v) Bio-data of the chief functionary (vi) Composition of the current Management Committee with name, Designation and address of the members. (With relevant copy of resolution of general body). (vii) Copy of audited accounts and Balance-sheet of the organisation for the last three years. (viii) Copy of resolution passed by Management Committee seeking loan (amount Rs.------------------------------) from RMK (ix) Copies of Annual Reports of last three years. (x) Copies of testimonials received from funding agencies/Govt. Departments etc. if any DECLARATION I ------------------------------------(full name with designation) certify that the facts and figures furnished in the application form and the annexures are correct and tally with the records of our organisation. (Signature with official stamp) Name & Designation of Chief Executive Place Date Encls-------------------SheetsApplication form for interest free loan for the purpose of promotion and development of self help groups (SHGs). Application Form 1 Name of NGO Date of Regn. 2 Full Adress 3. Main objectives 4. Whether the NGO collaborating with RMK 5. Description of main activities of NGO during the last two years. (i) Detail of (Please attach rules if any formed experience for compulsory saving and loans etc.) (ii) No. of SHGs No. of members formed. No. of Total Total Total Groups thrift loans loans collected issued recovered (a) One year old (b) Less than one year (c) In progress (under formulation) 6. No. of extension staff available with NGO for promoting groups-(Indicate their experience) 7. Financial resoruces available to NGO from itself or donors for the purpose of promotion and development of SHGs. (i) Amount available Amount Year for which ( internally) availing (ii) From others Name of donor 8. Details of SHGs programme to be taken up under RMK scheme (only realistic programme to be given) Year No. of SHGs Expected No. Estimated Amt. of to be promoted of members Amt. of lending to saving to be made be generated 1st year 2nd year 3. rd year 9. Amount to Interest Free Loan required by NGO Year Amount Required (Please give your Estimates as per Norms given in the scheme) 10 Please attach a copy of each of the following (i) Buy-laws of your organisation (ii) Copy of resolution of seeking assistance by way of Interest Free Loan from RMK. (iii) Audited Balance Sheet and Audit Report of the last 2 years. (iv) Copy of Annual Report of NGO for the last 2 years 11 Any other information which the NGO would like to present. 12 We undertake to abide by the terms and conditions of the RMK scheme for providing interest free loans to NGOs for the purpose of promotion and development of SHGs and will also execute necessary agreement/other undertakings prescribed/ to be prescribed by RMK. Signature Authorised Officer of NGO
