FORM S. NO. Annexure - A APPLICATION FORM FEE RS. 200/- Rajasthan Financial Corporation, (MERCHANT BANKING DIVISION) APPLICATION FORM UDYOG BHAWAN TILAK MARG JAIPUR Application for financial assistance to good borrowers (Short Term Loan) Passport Size Photograph Loan Applied for Rs. .......... Duly Signed PART 'A' Basic information about the Unit 1. Name of the Unit : __________________________ 2. Name of key promoters : 1_________________________ 2_________________________ 3_________________________ 3. Address , for Correspondence : __________________________ ___________PIN____________ Factory Site : __________________________ ___________PIN____________ Phone (O) ________ (R)____________ Fax __________________________ 4. (i) Constitution : __________________________ (ii) Date of Incorporation : __________________________ (iii) Date of Commencement of commercial production : __________________________ (iv) Income Tax P. A. No. : __________________________ 5. Size of unit : Medium/S.S.I. 6. Registration No. : __________________________ PART 'B' Financial Information Details of financial assistance from Corp. (a) Loan Sanctioned Date AMT. (i) (ii) (b) Loan Disbursed (i) First (ii) Last (c) Last date of Repayment Loan outstanding/overdues, if any (as on ...............) (Rs. in lacs.) (i) Principal not due : (ii) Principal overdue : (iii) Interest overdue : (iv) Other Money : TOTAL O. S. _____________________ Details of Relief/Waiver etc granted to unit or its sister/associate unit. I Name of Unit II Nature of Relief Refixation / Reshedulement / Waiver of (Pl. Tick) Penal Interest / Writing off as bad debts /Rebate under any scheme of Corp. III Year of Relief : __________________________ IV Amt. Of Relief : __________________________ Names of sister concern(s) Loan Sanctioned Amt. O/s Overdues by RFC (as on...) (as on...) I II Loan Assistance from other Financial Institution/Bank 1. Name and address of the bank/financial : _____________________ institution 2. Amount of term loan/limit : _____________________ 3. Payment behaviour with other instituion : Regular/Satisfactory 4. Whether second charge given to Bank : _____________________ PART 'C' Details of loan assistance applied 1. Amount of loan requested : _____________________ 2. Purpose of loan (Please Tick) : (i) Expansion (ii) Modernisation (iii) Purchase of balancing equipments (iv) Replacement of fixed assets 3. Installed capacity (i) Existing : _____________________ (ii) Proposed after (2) as above : _____________________ 4. Brief details of assets to be acquired under the scheme. S.No. Particulars of Cost of Name of Supplier assets to be assets acquired 1 2 3 4 PART 'D' Performance Analysis (for last 3 years) (1) Cash surplus for last 3 years ----------(Rs. in lacs.) Year Sales and Net Profit Depreciation Cash Surplus Other Income Investment Allowances 1 2 3 4 5 (3 - 4) I II III (2) Payment made to Corporation (in last 3 years). I .................. II .................. III .................. Enclosures with the application: (1) Copy of memorandum and article of association / partnership deed and firm registration. (2) Copy of audited balance sheets and profits and loss accounts for last 3 years. (3) Bio-data of promoter directors/partners, if changed subsequent to sanction of original term loan to the Company/Unit by the Corporation. (4) Application form in duplicate with all relevant papers. (5) Quotations from reputed suppliers for Plant & Machinery proposed to be purchased. (6) Affidavit in prescribed format. (7) Copy of Statement of Loan A/c of pervious assistance (in last 3 years). (8) Details of any change in the Original Promoter's of the unit, if any. PLACE: (Signature of Applicant) DATE: Name: DESIGNATION: Annexure - B FORM NO...... APPLICATION FORM FEE Rs. 200/- Rajasthan Financial Corporation UDHYOG BHAWAN TILAK MARG JAIPUR Application form for sanction of Working Capital Term Loan (Both for WCTL & WCTL to non-assisted units). Loan Applied for Rs ........ 1. Name of the Unit/Co. ............... 2. Address: (a) Registered office/office ............... ............... Tel.No./Fax No. ............... (b) Works ............... ............... Tel.No./Fax No. ............... 3. Name of present Proprietor/Partners/Directors (Submit details as per Annexure 'A') (i) ............... (ii) ............... (iii) ............... 4. (i) Constitution Proprietorship/Partnership/Private Ltd./ Public Ltd. (ii) Status SSI / M. S. I. (iii) Registration ............... 5. Date of incorporation ............... 6. Date of Commencement of Production ............... 7. (a) Line of product ............... (b) Nature of product Perishable / Non Perishable 8. Brief history of Unit (Enclose separate sheet if necessary) .................................... .................................... .................................... .................................... 9. Past financial assistance availed from Corporation: (Rs. in lacs.) Loan Sanctioned Loan Disbursed Loan O/S Amount Date Amount Last date As on.... of disb. PND POD INT. Ist IInd IIIrd __________________________________________________ Total __________________________________________________ 10. Amount paid against principal: A/c Amount Ist Rs............ IInd Rs............ IIIrd Rs............ Total Rs............ 11. Whether Unit/Co availed Working Capital loan under single window scheme of Corporation, if so, give details. (a) Amount of loan sanctioned Rs.........date....... (b) Amount outstanding (as on ..........) Rs........ (c) Amount overdues (as on...........) Rs...... 12. Amount of working capital term Rs............ loan requested. 13. Projected working capital requirements: Rs............ (Please enclose statement of calculations) 14. Projected turnover for next 3 years: alongwith justification Year Projected Sales 1. Rs............ 2. Rs............ 3. Rs............ 15. Whether Working Capital available from bank, if yes, give details as under (i) Name and address of Branch of Bank (ii) Details of various limits sanctioned Limit Margin Outstanding (A) Fund Based Sanctioned % as on (i) C. C. (ii) Book debt (iii) Others (B) Non Fund Based (i) L/C (ii) Bank Guarantee (iii) Others 16. Name and address of the bank through which all the transactions shall be routed. 17. Whether the concern shall repay the working capital facility of Bank on sanction/release of YES/NO funds from Corporation. 18. Market realisable value and Book value of existing fixed assets mortgaged or to be mortgaged with corporation. MRV (Rs. in lacs.) Written down value (as on......) (i) Land------Area ....... ........ (ii) Building-Total constructed area ....... ........ (iii)Plant & Machinery ....... ........ (iv) Other assests ........ ........ Total Rs. ___________ ______________ 19. Details of other marketable security being offered as collateral security. a) Location b) Area c) Total MRV. 20. Whether, any Government enquiry, proceedings or prosecution has been instituted and any litigation is pending against the unit or its proprietor, partners or directors for any offences. - If so, give details. - If not, furnish affidavit to this effect. (as per Annexure 'B') 21. BRIEF DETAILS ABOUT SISTER/ASSOCIATE CONCERN: a) Name & Address of the unit in which ............ promoters are interested and their ............ extent of Interest. ............ b) Nature of activities of sister/associate ............ concern. ............ ............ c) Details of financial assistance if any ............ availed by the Sister/associate concern ............ from the corporation. ............ (Rs. in lacs.) Loan O. S. A/c No. Loan Sanctioned Loan Disb. (As on......) Amount Date Amount PND POD INT I II III Total d) Past performance of sister/associate concern for the last 3 years. Year Sales & other Income Net Profit after Tax Cash Accruals Net Worth 1 2 3 4 5 Enclosures: (i) Statement of working capital calculation as per normal Cycle of operation. (ii) Statement of cost of production for projected turn over. (iii) List of original promoter/partners/directors and changes taken place during the currency of loan and details of approval for Changes granted by Corporation. (iv) Details of promoters in Annexure 'A' (separate form for each partner/director) (v) Affidavit as per Annexure 'B" (vi) Financial ratios as per Annexure 'C' (vii) Financial performance as per Annexure 'D' (viii) Audited copy of Balance Sheet and Profit & Loss Accounts for last 3 years. (ix) Performance letter for payment behaviour from bank mentioning the details of working capital assistance granted by the Bank. (x) Copies of Income Tax assessment order/return filed for last three years of proprietor/partners/directors. CERTIFICATE The information furnished in the above form is true and correct to the best of my knowledge and belief. No material facts have been concealed or falsely stated. Date: Place: 1. ......... 2. ......... . 3. .......... (Signature of Applicant) Annexure-'A' DETAILS ABOUT PROPRIETOR/PARTNERS/DIRECTORS 1. Name : 2. Father's Name : 3. Age : 4. Address: PASSPORT SIZE PHOTOGRAPH DULY SIGNED (i) Present Tel. No. (ii) Permanent Tel. No. 5. Qualifications: (a) Academic (b) Professional/Technical (c) Any training programme 6. Name & Address of the Bank (Where personal account is held) 7. Share holding percentage in unit 8. Details of concern(s) in which he is proprietor/partner/director (following details in respect of each such concern may be given.) (a) Name & address of Concern : (b) Nature of Business : (c) Extent of his interest : (d) Year of establishment : (e) Name & address of the Bank(s) in which account of such concern is operated : (f) Details of financial assistance from RFC/Bank etc. (if any) : 9. Details of income tax/wealth tax for last 3 years (Enclose copies of assessment orders/return filed). (Rs. in lacs.) Assessment Income Income Year assessed tax paid 10. Details of Net Worth 11. Any other details Place: Date: Signature Annexure-'B' (To be submitted on non judicial stamp paper Rs. 10/-duly attested by notary Public.) AFFIDAVIT I_______________________________S/o______________________________ aged__________Years________residing at_____________________________ _____________________Director/Partner/Proprietor of M/s.________________ ______________do hereby state on oath as follows: 1. That I am/we are submitting an application to the Rajasthan Financial Corporation (RFC) for a sanction of Short Term loan/Working Capital loan of Rs. ____________________ (Rupess________________________only) under the Good Borrower Scheme. 2. That my/our unit has been regular in repayment of its dues and has not committed any default (except some technical default) in repayment of the dues to the RFC. 3. That neither my/our concern/company have applied for nor have been granted any reschedulement in the existing loan accounts and have also not been benefited by waiver/rebate in penal interest by the RFC, in last 3 years. 4. That no Govt. enquiry, proceeding or prosecutions has been instituted against my/our Concern/Company or against me/any partner/director of our concern/company for any offence. 5. That no litigation/dispute is pending in any Court relating the payment of dues of any Financial Institution/Bank and also no proceeding have been initiated for economic offences against my/our Concern/Company or against me/any partner/director of our Concern/Company. Place: Dated: DEPONENT I, said _____________________(Proprietor/Partner/Director) do hereby verify on oath that contents of para 1 to 5 of the above Affidavit are true and correct to the best of my Personal knowledge and belief, Nothing has been concealed or falsely stated, so help me GOD. DEPONENT Annexure - C FINANCIAL RATIOS OF M/S....................... Year _________ _________ _________ (i) Debt. Equity Ratio (ii) Current Ratio (iii)Quick Ratio (iv) Inventory Turnover (times) (v) Collection Period (days) (vi)Return on Net Worth (%) Please give reasons: (i) For Current Ratio less than 1:1. (ii) For increase in Collection Period. (iii) For lower turnover of Inventory. Annexure - D - 1 PROFORMA OF SUMMARISED PAST PERFORMANCE OF THE APPLICANT UNIT M/s. ______________________________________________ SUMMARISED PROFIT & LOSS ACCOUNT For the year ended _______ ________ (Rs. in lacs.) _______ Installed Capacity Production (Product wise) Capacity utilised (%) INCOME: Sales Other Income Total Income EXPENDITURE: Excess of opening stock Over closing stock Raw Material Consumed Processing Expenses Stores Consumed Power & Fuel Packing expenses Salary & Wages and Other benefits Repairs & Maintenance Rent, Rates & Taxes Excise Duty Interest Selling expenses Admn. expenses NON CASH EXPENDITURE Depreciation Investment Allowance Amounts written off Net Profit/Loss after tax Cash Accruals Note: Please give reasons for decrease in turn over, profit if any. Annexure - D - 2 PROFORMA OF SUMMARISED PAST PERFORMANCE OF THE APPLICANT/UNIT M/s. ____________________________________________________________ SUMMARISED BALANCE SHEET As at (Rs.in lacs.) Year _______ _______ ______ SOURCES OF FUNDS Shareholders Funds a) Capital b) Reserves and Surplus _______ _______ _______ Total _______ _______ _______ Loan Funds a) Secured loans b) Unsecured Loans (int. bearing) c) Unsecured Loans (int. free) Total _______ _______ _______ APPLICATION OF FUNDS A ->Fixed Assets a) Gross Block b) Less: Depreciation c) Net Block d) Capital work in progress e) Investment B ->Current Assets a) Inventories b) Sundry debtors c) d) Cash and Bank Balances Loans and Advances Total Current Assets _______ _______ _______ _______ _______ _______ C ->Less: Current Liabilities a) b) c) Current Liabilities & Provision Bank borrowing for Working Capital Unsecured Creditors (short Term) Total Current Liabilities _______ _______ _______ _______ _______ _______ D Net Current Assets (B-C) _______ _______ _______ _______ _______ _______ E Net Total Assets (A+D) _______ _______ _______ _______ _______ _______
