ID NO.

11004
(Processing Fees / Upfront Fees are indicated in the Annexure and for the latest fees, the loan applicants may visit the Banks Website WWW.corpbank.com)

CORPORATION BANK Branch UDHANA, SURAT

APPLICATION FOR CREDIT FACILITIES TO MICRO & SMALL ENTERPRISES

To be submitted along with documents as per check list (For Office use only) Date of Receipt of application Received by Acknowledgement issued 1. NAME OF THE ENTERPRISE 2. ADDRESS OF REGD.OFFICE : ________________ : ________________ : Yes / No YASH FASHION 3. ADDRESS OF FACTORY / SHOP

TELEPHONE NOs.(Office) MOBILE NO.

9099975559 BQKPK3349H 4. CONSTITUTION : Proprietary 5. DATE OF ESTABLISHMENT 16.10.2008 6. PERSONAL DETAILS OF PROPRIETOR / PARTNERS / DIRECTORS OF COMPANY : I II III IV Name RAJESHBHAI JAYNTIBHAI KACHHADIYA Fathers / JAYNTIBHAI Husbands B.KACHHADIYA Name Residential Address 166, PunitDham Society, Setelight Road, Mota Varachha, Surat

EMAIL ID: PAN

Date of Birth Gender Occupation Educational Qualification Religion

14/06/1985
[ ] Male [ ] Female [ ] Business 12Th [ ] Male [ ] Female [ ] Male [ ] Female [ ] Male [ ] Female

Marital Status

[ ] Single [ ] Married [ ] Divorcee

[ ] Single [ ] Married [ ] Divorcee

[ ] Single [ ] Married [ ] Divorcee

[ ] Single [ ] Married [ ] Divorcee

No. of Dependents

Children_________ Others___________
[ ] SC [ ] ST [ ] OBC [ ] Minority [ ] Ex.servicemen [] Others

Children_________ Others___________
[ [ [ [ ] SC [ ] ST [ ] OBC ] Minority ] Ex.servicemen ] Others

Children_________ Others___________
[ [ [ [ ] SC [ ] ST [ ] OBC ] Minority ] Ex.servicemen ] Others

Children________ _ Others__________ _
[ ] SC [ ] ST [ ] OBC [ ] Minority [ ] Ex.servicemen [ ] Others

Category

PAN. Passport No. Voter Card No. Experience in the line of activity Annual Income Net worth 7. ACTIVITY

BQKPK3349H
Embroidery Work , Water Jet, Repeir Textile Machinery 2,81,477/18,99,567/-

Existing Embroidery Job-Work on Imported Machine Proposed (#) : Embroidery Job-Work on Imported Machine # If a different activity other than existing activity is proposed. 8. NAMES OF ASSOCIATE CONCERNS AND NATURE OF ASSOCIATION :
NAME OF ASSOCIATE CONCERN ADDRESS OF ASSOCIATE CONCERNS PRESENTLY BANKING WITH NATURE OF ASSOCIATION EXTENT OF INTEREST AS A PROP./PARTNER/ DIRECTOR OR JUST INVETSOR IN ASSOCIATE CONCERN

9. Relationship of Proprietor / Partner / Director Name : with the officials of the Bank / Director of the Bank Relationship : if Any ? 10(a) CREDIT FACILITIES (EXISTING) : Not Applicable Type of Facilities Current Account Cash Credit Term Loan LC / BG Limit Outstanding as on. Presently Banking with Security Lodged Rate of Interest Repayment Terms

If Banking with this Bank, Customer No. be given here. Not Applicable 10(b) It is certified that our unit has not availed any othr Bank / Financial Institution in the past and I/We am/are not indebted to any other Bank / Financial Institution other than those mentioned in 10(a) above.

11. CREDIT FACILITIES (PROPOSED) : Types of Facilities Amount Purpose for (In Lacs) which required

Security offered
PRIMARY SECURITY (Details with approximate Value to be mentioned) Whether Collateral Security offered (Please mention yes or no) (If yes, then provide details in column 12)

Over Draft 24.50 Working Capital N.A. Term Loan N.A. N.A. N.A. LG / BG N.A. N.A. N.A. In case of Term Loan requirement, the details of machinery may given as under :
Type of Machine Purpose for which required Whether imported of indigenous Name of supplier Total cost of machine (in case of imported machine, the breakup of basic cost, freight, insurance and customs duty may be given

Yes N.A. N.A.

Contribution being made by the promoters Loan Required

12.

DETAILS OF COLLATERAL SECURITY OFFERED, IF ANY * (* As per RBI guidelines banks are not to take collateral security for loans upto Rs.5 Lakhs to MSME

Units Owner of the Property : RAJESHBHAI JAYNTIBHAI KACHHADIYA Type of Security Address of Property : Residential Property : R.S. No-130/1, 129/4, 129/3, 129/1+2, 135/1,135/2, & 133 Block No-124, to 128 & 131, 132 T.P.S. No. 18(Mota Varachha) O.P. No-73 to 77, & 80, 81, F.P. No-74, to 78 & 81, 82, Paiky Plot No-166 in Punitdham Society,, Moje- Mota Varachha, TalukaChiryasi, Dist-Surat : : 56.46 Sq. Mt. ie 67.50 Sq. Yard. : 540.00 Sq. Ft. Ground Floor.

Area of Property Land Area Construction Area

Value of the Property : 35,13,000/- (As per Valuation Report from C.C. Mahadevwala) 13. PAST PEORFORMANCE/FUTURE ESTIMATES (Actual performance for two previous years, estimates for current year and projections to be provided for working capital facilities. However, for term loan facilities projections to be provided till the proposed year of repayment of loan ) : PAST YEAR II PAST YEAR I PRESENT YEAR NEXT YEAR (Rs. in lacs) (Actual) (Actual) (Estimates) (Projections) Net Sales N.A. 30.89 Lacs Net Profit N.A 3.41 Capital (Net worth in case of Companies) 14. STATUS REGARDING STATUTORY OBLIGATIONS :
Statutory Obligation Whether Complied with (Write

30.89Lacs 3.51

116.60 5.52

Remarks ( Any details in connections

1. Registration under Shops And Establishment Act. 2. Registration under SSI (Provisional / Final) 3. Drug License 4. Latest Sales Tax Return Filed. 5. Latest Income Tax Returns Filed. 6. Any other statutory dues remaining outstanding

Yes/No.) If not applicable then write N.A. N.A.

with the relevant obligation to be given)

Yes
N.A. N.A.

No/DIC/SRT/EM/Part-1/20650

Yes
N.A.

I / We Certify that all information furnished by me / us I / We Certify that all information furnished by me / us is true; that I /We have no borrowing rangements for the unit except as indicated in the application; that there is no overdues / statutory dues against me / us promoters except as indicated in the application; that no legal action has been / is being taken against me / us / promoters; that I / We shall furnish all other information that may be required by you in connection with my / our application that this may also be exchanged by you with any agency you may deemed fit and you, your representatives, representatives of the Reserve Bank of India or any other agency as authorized by you, may, at any time, inspect / verify my / our assets, books of account etc. in our factory / business premises as given above.

15.

SPACE FOR PHOTO

SPACE FOR PHOTO

SPACE FOR PHOTO

SPACE FOR PHOTO

SIGNATURES OF PROPRIETOR / PARTNER / DIRECTOR WHOSE PHOTO IS AFFIXED ABOVE

SIGNATURES OF PROPRIETOR / PARTNER / DIRECTOR WHOSE PHOTO IS AFFIXED ABOVE

SIGNATURES OF PROPRIETOR / PARTNER / DIRECTOR WHOSE PHOTO IS AFFIXED ABOVE

SIGNATURES OF PROPRIETOR / PARTNER / DIRECTOR WHOSE PHOTO IS AFFIXED ABOVE

Only one photo of proprietor / each Partner / each working Director is required to be affixed. Each photo will be certified / attested by the Branch Team with name and signatures on the photograph with Branch Stamp. The connected staff will put his name below the signatures. 16. Date : 10/05/2012 Place : Surat 17. Particulars of Guarantor/s (Only in case of loans for more than Rs.5.00 Lakh) :

I Name of Guarantor/s Father/Husbands Name Residential Adress

.

II

Phone E-mail

Mobile:

Phone E-mail

Mobile:

Date of Birth Gender Marital Status

[ ] Male [ ] Female [ ] Single [ ] Married [ ] Divorcee

[ ] Male [ ] Female [ ] Single [ ] Married [ ] Divorcee

Educational Qualification Occupation PAN. Passport No. N.A. Voter Card No. Annual Income Net worth I am Willing to stand as Guarantor/s

Photograph of guarantor with signature

Photograph of guarantor with signature

Date : Place :

Signature/s of Guarantor/s