Micro Credit Scheme of NSTFDC NSTFDC /MCS -SHG/ANNEXURE 'A' (1) NAME & ADDRESS OF THE SELF HELP GROUP :?? (2) NAME & ADDRESS OF THE FINANCING SCA OF NSTFDC : (3) BACKGROUND OF THE SHG i. Legal Status with Registration, No. of SHG, if any : ii. Total Number of Members of SHG : iii. Date of Start of operations of SHG : iv. Total Share Contribution of Members as on _______ : v. Total Advances as loan to Members as on ________ : vi. Details of loan taken from other sources, if any : (Agency, Amount, Outstanding Balance, Rate of Interest etc.) vii. Rate of Interest charged by the SHG from the Members including on loans availed from other sources : viii. Details of Profitability of the SHG for last three years on the date of close of Financial Year or for a shorter duration as the case may be : Year Net Profit (i) (ii) (iii) 4. PURPOSE OF LOAN ( NAME OF SELF EMPLOYMENT VENTURES/ACTIVITIES] : 5. DETAILS OF MEMBERS EXTENDED THE LOAN BY SHG R LOAN6. SUMMARY OF SECTORWISE /GENDER BASE DATA PROVIDED : Amount Number of Loaners A. Sector : Male Female Male Female i. Agriculture ii. Industrial iii. Service TOTAL ____________ ____________ ____________ ____________ B. Rural/Urban Breakup Male Female Male Female i. Rural ii. Urban TOTAL ___________ ____________ ___________ ____________ Note : Details for the item at S.No. 5 & 6 are to be submitted by the SHGs to the SCAs within 60 days from the date of receipt of funds along with certificate on the lines of format at S. No. 7 hereinafter. Srl No. a) Name, b) Name of Tribe and c) address of the beneficiary. Husband / Father Name Sex M/F Annual Family Income at the time of availing assistance Name of activity for which loan extended . NSTFDCs Share 1 a) b) c) 2 3 7. FUNDS UTILISATION CERTIFICATE: Certified that: a) the financial assistance of Rs..... has been extended to ________(Nos.) eligible persons as per eligibility criteria of NSTFDC. Further, Funds have been utilized for the purpose/ activities stated herein above . b) An amount of Rs. _________________________ has been utilized by the Self Help Group within 30 days from the date of release of funds by the SCA to SHG. Date: ( Signature of the Authorised signatory of the SHG) Name : Designation: (OFFICIAL STAMP) FORMAT OF PROPOSAL AND FUNDS UTILISATION CERTIFICATE FOR MICRO CREDIT FINANCE SCHEME OF NSTFDC TO BE SUBMITTED BY THE SCAS NSTFDC/MCS-SHG/Annexure 'B' (1) NAME & ADDRESS OF THE SELF HELP GROUP :?? (2) NAME & ADDRESS OF THE FINANCING SCA OF NSTFDC : (3) BACKGROUND OF THE SHG i. Legal Status with Registration, No. of SHG, if any : ii. Total Number of Members of SHG : iii. Date of Start of operations of SHG : iv. Total Share Contribution of Members as on _______ : v. Total Advances as loan to Members as on ________ : vi. Details of loan taken from other sources, if any : (Agency, Amount, Outstanding Balance, Rate of Interest etc.) vii. Rate of Interest charged by the SHG from the Members including on loans availed from other sources : viii. Details of Profitability of the SHG for last three years on the date of close of Financial Year or for a shorter duration as the case may be : Year Net Profit (i) (ii) (iii) (4) PURPOSE OF LOAN : (Name of Self Employment Venture/Activities) (5) SUMMARY OF SECTORWISE/GENDER BASE DATA FOR LOAN PROVIDED : Amount Number of Loanees A. Sector : Male Female Male Female i. Agriculture ii. Industrial iii. Service TOTAL _ ___________ ____________ ____________ ____________ B. Rural/Urban Breakup Male Female Male Female i. Rural ii. Urban TOTAL ___________ ____________ ___________ ____________ Note : Details for the item at Srl. No. 5 are to be submitted by the SCA to NSTFDC within 120 days from the date of receipt of funds from NSTFDC along with certificate on the lines of format at S.No. 9 hereinafter. (6) SANCTION/DISBURSEMENT: a. Date & Total Amount of loan sanctioned to the SHG by the SCA: b. Date and amount of loan released by the SCA to SHG : (7). REPAYMENT: a) Moratorium Period for repayment of loan given to SHG : Six Months b) Total Repayment Period fixed for the SHG by the SCA (No. of years) : c) Total No. of Instalments : d) Periodicity of Instalment (Quarterly/Half yearly) : e) Amount and Due date of first/each instalment : f) Amount & date of last instalment :
