Application ID: (For office use)

APPLICATION FORM FOR FINANCIAL ASSISTANCE UNDER PRIME MINISTERS

EMPLOYMENT GENERATION PROGRAMME (PMEGP)
12 Name of the project / business activity proposed :

13 Amount of loan required (in Rs.)

Capital Expenditure Loan
Working
Building Type Workshed Machinery/ Pre
Capital /
Building Equipment/ Operative
Cash Credit Total
etc. Furniture Cost
Limit
Rented 0 0 0 0 0
Details of earlier or current Loan/Grant and subsidy availed from
14 Central/State Govt. Scheme/ or any other Similar Scheme.
Activity of the Project with Address Amount Year of Sanction

I certify that all information furnished by me is true; and that I and any of my dependent have not
borrowed any money under subsidy linked scheme from any Central / State Government or bank for
establishing any such project

Place:
Date: Signature of the Applicant

For Official Use only: (Rejected / to be placed before District Task force Committee)
Reason (if Rejected):

Place: Signature, Name & Designation of Officer

Date:
 NOTE

Own contribution must be invested 5% for SC/ST/OBC/PHC/woman/ Ex-serviceman/ North

East Reason/Hill Boarder Area and 10% for General
Total Project Cost should not exceed 25 lakhs for Manufacturing unit and 10 lakhs for
service unit.
Applicant will not be entitled for additional Margin Money(Subsidy) in case of Own
Contribution over and above the prescribed limit.
VIIIth pass for Manufacturing Unit above Rs.10 lakhs project cost and under Service Sector
above Rs.5 lakhs
Application should be submitted complete in all respect along with attested copies of the
following documents:
1. Certificate of qualification-academic and technical (if project cost above 5 lakhs under
service industry or above 10 lakhs under Manufacturing industry)
2. Relevant Certificate for SC/ST/OBC/Minority/Ex-Servicemen/PHC
3. if Entrepreneur Development programme(EDP) training undergone (at least for two weeks)
then submit photocopy of the certificate
 DATA INPUT SHEET

Preference for sponsoring agency of the project to Bank: (mark )

KVIC KVIB DIC RURAL URBAN
1.1 Name of the Applicant/Institution

1.2

2 Gender Male Female

3 Address of the Proposed location of Unit: Rural Urban

Taluk/Block:
District: Pin:
State:
Email: Mobile:

4 Qualification
Academic Technical
12th Pass

5 Whether the applicant belongs to (mark )

Ex- Hill
SC ST OBC PHC Service Minority Boarder General
man Area

Manu-
Whether the

Service
6 facturing
Unit
project (mark ) Unit
8 Name of the project / business activity proposed :

Legal Status:

Land ###

BUILDING DETAILS
Particulars Area Rate/Sq.ft Amount in Rs.
0.00
0.00
0.00
0.00
0.00
0.00
0.00

MACHINERY DETAILS
Particulars Qty. Rate Amount in Rs.
0.00
0.00
0.00 Male
0.00
0.00
0.00 KVIC
0.00
0.00 DIC
0.00
0.00
0.00 Rura
0.00

Total 0.00 No

d. Preliminary & Pre-operative Cost : SC

e. Furniture & Fixtures :

f. Contingency/Others/Miscellaneous

Working Capital : 0.00

 Manu

Means of Financing ###

Own Contribution : 10%

Bank Finance : 90%
Margin Money (Govt. Subsidy) : 25%

DETAILS OF SALES Own

Rate/ Qantity Amount in Rs.
Particulars of Products
Unit
0.00
0.00
0.00
0.00
0.00
0.00
0.00

Total 0.00

RAW MATERIALS
Particulars Unit Rate/Unit Reqd. Unit Amount In Rs.
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
Total 0.00

WAGES
No. of Wages Per Month Amount in Rs.
Particulars
Worker Total Month 12
0.00
0.00
0.00
0.00
0.00
0.00
0.00
Total 0 0.00

SALARY DETAILS
No. of Wages Per Month Amount in Rs.
Particulars
Staff Total Month 12
0.00
0.00
0.00
0.00
0.00
Total 0 0.00

WORKING CAPITAL ESTIMATE

Element of Working Capital No. of Days

Stock in process

Finished goods

Receivable by

POWER ESTIMATE
Power Requirement

Repair and Maintanance Rs. 0.00

Power and Fuel Rs. 0.00

Other Overhead Expenses Rs. 0.00

Telephone Expenses Rs. 0.00

Stationery & Postage Rs. 0.00

Advertisement & Publicity Rs. 0.00

Building Rent Rs.

Other Miscelleneous Expenditure Rs. 0.00

Rate of Interest

Depreciation
On Building
On Machinery

INTRODUCTION

ABOUT THE PROMOTER

 PROJECT AT A GLANCE - TOP SHEET
1 Name of the Entreprenuer 0

2 Constitution (legal Status) Individual

3 Father's/Spouce's Name 0

4 Unit Address : 0
0
Taluk/Block: 0
District : 0
Pin: 0 State: 0
E-Mail : 0
Mobile 0
5 Product and By Product

6 Cost of Project : Rs. 0

Name of the project / business 0
activity proposed :
7 Means of Finance
Term Loan Rs. 0.0
KVIC Margin Money Rs. 0.00
Own Capital Rs. 0.00

8 Debt Service :
Coverage Ratio

9 Pay Back Period : 5 Years

10 Project : 0 Months
Implementation
Period

11 Break Even Point :

12 Employment : 0

13 Power Requirement : 0

14 Major Raw materials : ,,

15 Estimated Annual : Rs. 0.00

Sales Turnover

PMEGP Project Report Page 10

 DETAILED PROJECT REPORT
1 INTRODUCTION :

2 ABOUT THE PROMOTER :

3 COST OF PROJECT
A. Fixed Capital Investment
a. Land : 0 Own

b. Workshed Area Sq.ft Rate in Rs. Amt. In Rs.

0 0 0.00 0.00
0 0 0.00 0.00
0 0 0.00 0.00
0 0 0.00 0.00
0 0 0.00 0.00
0 0 0.00 0.00
0 0 0.00 0.00
Total 0.00
#REF!
C. Machinery Qty. Rate Amount in Rs.
0 0 0.00 0.00
0 0 0.00 0.00
0 0 0.00 0.00
0 0 0.00 0.00
0 0 0.00 0.00
0 0 0.00 0.00
0 0 0.00 0.00
0 0 0.00 0.00
0 0 0.00 0.00
0 0 0.00 0.00
0 0 0.00 0.00
0 0 0.00 0.00
Total 0.00

PMEGP Project Report Page 11

 d. Preliminary & Pre-operative Cost : Rs. 0.00

e. Furniture & Fixtures : Rs. 0.00

f. Contingency/Others/Miscellaneous Rs. 0.00

Total Capital Expenditure : Rs. 0.00

Working Capital : Rs. 0.00

Total Cost Project : Rs. 0.00

3.1 Means of Financing :

Own Contribution 10% Rs. 0.00

Bank Finance : 90%

Term Loan Rs. 0.00
Working Capital Rs. 0.00

Total Rs. 0.00

Margin Money (Govt. Subsidy) From KVIC 25% Rs. 0.00

Margin Money Subsidy received From KVIC will be kept in term deposit as per norms of
PMEGP in the name of Beneficiary for three years in the financing branch.

3.2 STATEMENT SHOWING THE REPAYMENT OF TERM LOAN & WORKING CAPITAL :
TERM LOAN

Interest @
Year Opening Balance Installment Closing Balance
0.00%
1st 0 0 0 0
2nd 0 0 0 0
3rd 0 0 0 0
4th 0 0 0 0
5th 0 0 0 0
6th 0 0 0 0
7th 0 0 0 0
8th 0 0 0 0

WORKING CAPITAL

Interest @
Year Opening Balance Installment Closing Balance
0.00%
1st 0 0 0 0
2nd 0 0 0 0
3rd 0 0 0 0
4th 0 0 0 0
5th 0 0 0 0
6th 0 0 0 0
7th 0 0 0 0
8th 0 0 0 0

PMEGP Project Report Page 12

3.3 STATEMENT SHOWING THE DEPRECIATION ON FIXED ASSETS:
WORKSHED @ 0.00%
Particulars 1st Year 2nd Year 3rd Year 4th Year 5th Year
Opening Balance 0 0 0 0 0
Depreciation 0 0 0 0 0
Closing Balance 0 0 0 0 0
MACHINERY @ 0.00%
Opening Balance 0 0 0 0 0
Depreciation 0 0 0 0 0
Closing Balance 0 0 0 0 0
TOTAL DEPRECIATION
Workshed 0 0 0 0 0
Machinery 0 0 0 0 0
Total 0 0 0 0 0

4 Schedule of Sales Realization :

4.1 Details of Sales
Rate/ No. of Amount in Rs.
Particulars of Product Pair/Unit Pair/Unit
0
0 0.00 0 0.00
0 0.00 0 0.00
0 0.00 0 0.00
0 0.00 0 0.00
0 0.00 0 0.00
0 0.00 0 0.00
0 0.00 0 0.00
Total 0.00

4.2 Capacity Utilization of Sales

Particulars 1st Year 2nd Year 3rd Year 4th Year 5th Year

Capacity Utilization 70% 80% 90% 90% 90%

Sales / Receipts 0 0 0 0 0

5 Rawmaterials :
Particulars Unit Rate/unit Reqd.Unit Amount in Rs.
0 0 0.00 0 0.00
0 0 0.00 0 0.00
0 0 0.00 0 0.00
0 0 0.00 0 0.00
0 0 0.00 0 0.00
0 0 0.00 0 0.00
0 0 0.00 0 0.00
0 0 0.00 0 0.00
0 0 0.00 0 0.00
Total 0.00
5.1 Wages :
No. of Wages Amount in Rs.
Particulars Worker Per Month (Per Annum)
0 0 0.00 0.00
0 0 0.00 0.00
0 0 0.00 0.00
0 0 0.00 0.00
0 0 0.00 0.00
0 0 0.00 0.00
0 0 0.00 0.00
Total 0 0.00

PMEGP Project Report Page 13

5.2 Repairs and Maintenance : Rs. 0.00

PMEGP Project Report Page 14

5.3 Power and Fuel : Rs. 0.00

5.4 Other Overhead Expenses : Rs. 0.00

6 Administrative Expenses :
6.1 Salary
0 0 0.00 0.00
0 0 0.00 0.00
0 0 0.00 0.00
0 0.00 0.00
0 0.00 0.00
Total 0 0.00

6.2 Telephone Expenses 0.00

6.4 Stationery & Postage 0.00

6.5 Advertisement & Publicity 0.00

6.6 Workshed Rent 0.00

6.7 Other Miscellaneous Expenses 0.00

Total 0.00
7 Capacity Utilization of Manufacturing & Administrative Expenses :
Particulars 1st Year 2nd Year 3rd Year 4th Year 5th Year
Capacity Utilization 70% 80% 90% 90% 90%
Manufacturing Expenses
Rawmaterials 0 0 0 0 0
Wages 0 0 0 0 0
Repairs & Maintenance 0 0 0 0 0
Power & Fuel 0 0 0 0 0
Other Overhead Expenses 0 0 0 0 0
Administrative Expenses
Salary 0 0 0 0 0
Postage Telephone Expenses 0 0 0 0 0
Stationery & Postage 0 0 0 0 0
Advertisement & Publicity 0 0 0 0 0
Workshed Rent 0 0 0 0 0
Other Miscellaneous Expenses 0 0 0 0 0
Total: 0 0 0 0 0
8 Assessment of Working Capital :
Particulars Amount in Rs.
Sale 0.00

Manufacturing Expenses
Raw Material 0.00
Wages 0.00
Repair & Maintenance 0.00
Power & Fuel 0.00
Other Overhead Expenses 0.00

Production Cost 0.00

Administrative Cost 0.00
Manufacturing Cost 0.00

PMEGP Project Report Page 15

 Working Capital Estimate :
Element of Working Capital No of Days Basis Amount in Rs.
0 0 Material Cost 0.00

Stock in process 0 Production Cost 0.00

Finished goods 0 Manufacturing Cost 0.00

Receivable by 0 Manufacturing Cost 0.00

Total Working Capital Requirement Per Cycle 0.00

9 Financial Analysis
9.1 Projected Profit & Loss Account :
Particulars 0 Year 1st Year 2nd Year 3rd Year 4th Year
Sales / Receipts 0 0 0 0
0 0 0 0
Manufacturing Expenses
Rawmaterials 0 0 0 0
Wages 0 0 0 0
Repairs & Maintenance 0 0 0 0
Power & Fuel 0 0 0 0
Other Overhead Expenses 0 0 0 0
Depreciation 0 0 0 0
Production Cost 0 0 0 0
Administrative Expenses
Salary 0 0 0 0
Postage Telephone Expenses 0 0 0 0
Stationery & Postage 0 0 0 0
Advertisement & Publicity 0 0 0 0
Workshed Rent 0 0 0 0
Other Miscellaneous Expenses 0 0 0 0
Administrative Cost 0 0 0 0
Interest on Bank credit @ 0%
Term Loan 0 0 0 0
Working Capital Loan 0 0 0 0
Cost of Sale 0 0 0 0
Net Profit Before Tax 0 0 0 0
Less Tax 0.00 0.00 0.00 0.00
Net Profit 0 0 0 0

9.2 CALCULATION OF DEBT SERVICE CREDIT RATIO (D.S.C.R) :

Particulars 0 Year 1st Year 2nd Year 3rd Year 4th Year
Net Profit 0 0 0 0
Add :
Depreciation 0 0 0 0
TOTAL - A 0 0 0 0
Payments :
On Term Loan :
Interest 0 0 0 0
Installment 0 0 0 0
On Working Capital
Interest 0 0 0 0
TOTAL - B 0 0 0 0
D.S.C.R = A/B
#DIV/0! #DIV/0! #DIV/0! #DIV/0!
Average D.S.C.R

PMEGP Project Report Page 16

9.3 PROJECTED BALANCE SHEET :
Particulars 0 Year 1st Year 2nd Year 3rd Year 4th Year
LIABILITIES :
Promoters Capital 0 0 0 0
Profit 0 0 0 0
Term Loan 0 0 0 0
Working Capital Loan 0 0 0 0
Current Liabilities 0 0 0 0
Sundry Creditors 0 0 0 0
0 0 0 0
ASSETS :
Gross Fixed Assets : 0 0 0 0
Less : Depreciation 0 0 0 0
Net Fixed Assets 0 0 0 0
Preliminary & Pre-Op. Expenses 0 0 0 0
Current Assets 0 0 0 0
Cash in Bank/Hand 0 0 0 0
Total 0 0 0 0

9.4 CASH FLOW STATEMENT :

Particulars 0 Year 1st Year 2nd Year 3rd Year 4th Year
Net Profit 0 0 0 0
Add : Depreciation 0 0 0 0
Term Loan 0 0 0 0
Working Capital Loan 0 0 0 0
Promoters Capital 0 0 0 0
Total 0 0 0 0

Total Fixed Capital Invested 0

Repayment of Term Loan 0 0 0 0

Repayment of WC Loan 0 0 0 0
Current Assets 0 0 0 0
Total 0 0 0 0

Opening Balance 0 0 0 0
Surplus 0 0 0 0
Closing Balance 0 0 0 0

9.5 BREAK EVEN POINT AND RATIO ANALYSIS :

Particulars 0 Year 1st Year 2nd Year 3rd Year 4th Year
Fixed Cost 0 0 0 0
Variable Cost 0 0 0 0
Total Cost 0 0 0 0

Sales 0 0 0 0

Contribution (Sales-VC) 0 0 0 0

B.E.P in % #DIV/0! #DIV/0! #DIV/0! #DIV/0!

Break Even Sales in Rs. #DIV/0! #DIV/0! #DIV/0! #DIV/0!

Break Even Units #DIV/0! #DIV/0! #DIV/0! #DIV/0!

Current Ratio #DIV/0! #DIV/0! #DIV/0! #DIV/0!

PMEGP Project Report Page 17

 Net Profit Ratio #DIV/0! #DIV/0! #DIV/0! #DIV/0!

PMEGP Project Report Page 18

 This Project Report has been prepared based on the data furnished by the entrepreneur whose details are
given in the application.
Place :
Date:
Prepared by :
Full Name :

Signature of the Beneficiary

PMEGP Project Report Page 19

 PROJECT REPORT FOR

Affix latest
attested
Photograph

1 Name of the Entreprenuer 0

1
2 Constitution (legal Status) Individual

3 Father's/Spouce's Name #REF!

5 Unit Address : 0
0
Taluk/Block: 0
District : 0
Pin: 0 State: #REF!
Phone #REF!
E-Mail #REF!

6 Background of the Proprietor/Partners/Directors : Furnished detailed information in the DPR

7 Name of Business House/Group if any :

8 Details Other Companies/Units in the group :

Other Companies / Units in the Group (Rs. in Lakhs)
Name & Address Business Equity Reserves Loans Turnover *P.B.T **P.A.T
of Company / Unit

* Profit Before Tax ** Profit After Tax

`

8.1 How the activity was financed so far : ( To be filled up in case of existining unit Only )
*Source of Funds Security Rate of Repayment per Present O/s Amount of Default
Interest Month ( Rs. in '000 ) (if any)

8.2 If the Unit is an ancillary one, undertaking to

which it is catering and its address :
8.3 Employment : Present Proposed
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
Total 0

9 Project Details for Proposed New Unit : Copy of detailed project report is enclosed.
a Expansion / Mordenisation :

b Setting up of New unit :

c Activity for proposed new unit :

d Product / Item proposed to undertake :

9.1 Capacity (Furnish the details of Installed capacity & production : (No. in Units/ Qty. in Kg./Volume in liter per annum)
Capacity is arrived at on the basis of Days working on shift basis
Product & Present Installed Maximum Prod. Proposed Installed Maximum Prod.
By-product if any Capacity Achieved Capacity of 1st Year envisaged
70.00% 0

9.3 State the manufacturing process in brief :

9.4 Has the proposed process ever been tried in the
country or newly adopted? :

9.5 Technical Arrangements :

9.6 Describe arrangement for Key Official

for managing the proposed unit :
Technical Manpower

Administrative Manpower

Accounting personnel

9.7 Particulars of Land Existing Proposed

Location of the Land :
Area of Land
Status of the Land
Nature of Land
Availability of Water :

9.8 Particulars of Building Existing Proposed

(Enclose the plan & Estimation for the proposed Building) Area Value in Rs. Status Area Value Status
Factory Building :

Ancillary Building

Storage

Total 0.00 0.00

9.9 Plant and Machinery Existing (Value in Rs.) Proposed (Value in Rs.)
Indigenous 0.00

Imported

(Enclose the plan layout of the existing plant and machinery )

9.10 Rawmaterials / Components
Req. of Raw material/Components/Chemicals Qty. in Nos./Kgs./Ton Rate/Nos./Kgs/Tons Value in Rs.

Total 0.00

9.11 Utilities (Furnish details on requirement, availability, adequacy, qualitative aspects etc..)
Particulars of Utilities Contracted Load Connected Load Further requirement
in HP/KW/W in HP/KW/W in HP/KW/W
Power

Water

Fuel

Others (Specify)
9.12 Environment Aspect of the Project :

9.13 Requirement of Manpower for the Project :

Particulars of Manpower Total Requirement Salary/Wages per month Cost per Annum
0 0 0.00 0.00
0 0 0.00 0.00
0 0 0.00 0.00
0 0 0.00 0.00
0 0 0.00 0.00
0 0 0.00 0.00
0 0 0.00 0.00
0 0 0.00 0.00
0 0 0.00 0.00
0 0 0.00 0.00
0 0 0.00 0.00
0 0 0.00 0.00
Total 0 0.00

9.14 Schedule of Implementation : BAR CHART

Activities Date of Commencement Expected Date of Completion
a. Acquisition of Land
b. Development of Land
c. Civil Works for Factory / Building
Machinery / Foundation etc..
d. Plant & Machinery
Imported
Indigenous
e. Arrangement for power
f. Arrangement for water
g. Errection of equipment
h. Commissioning
I. Procurement of Raw materials/Chemicals
j. Trail Runs
k. Commercial Production
10 Cost of Project :
(Rs. in '000)
Sr.No. Particulars Already Incurred To be Incurred Total Cost
A Land including Development 0.00 0.00

B Building & Other Civil Works 0.00 0.00

C Plant and Machinery

1. Indigenous 0.00 0.00
2. Imported 0.00

D Furniture & Fixture 0.00 0.00

E Testing equipment 0.00

F Miscellaneous Fixed Assets 0.00

G Errection & Installation Charges 0.00

H Contingency 0.00 0.00

I Preliminary & Pre-Op. Cost 0.00 0.00

J Provision for
1. Buildings 0.00
2. Plant & Machinery 0.00
3. Other Fixed Assets 0.00

K Working Capital for one 0.00 0.00

Operating Cycle

L Total 0.00 0.00 0.00

 11 Means of Financing :
(Rs. in '000)
Sr.No. Particulars Amount already Amount Proposed Total
Raised to be Raised
A Equity / Promoters Contribution 0.00 0.00

B Reserves 0.00

C Term Loans 0.00 0.00

D Unsecured Loans and Deposits 0.00

(Indicate sources, roi, repayment etc)

E Deferred Payment 0.00

Arrangements including Suppliers credit

F Subsidy
Central Government 0.00 0.00
State Government 0.00

G Seed Capital 0.00

H Internal Cash Accruals 0.00

I Other Sources (Specify) 0.00

J Total 0.00 0.00 0.00

11.1 In case internal accruals are taken as

source of finance explain the basis of
estimation of internal accruals :

11.2 Indicate source from which expenditure

already incurred has been financed :

11.3 % of Promoters contribution of the :

total cost of project
 12 Marketing & Selling Arrangements of the Product :

13 Projected Profitability : Projected Profitability Statement given in the

Detailed Project Report.

14 Projected Cash flow Statement : Projected Cash flow Statement given in the
Detailed Project Report.

% of Cash Sales in Total Sales :

Period in which payment is received Days

in respect of Credit Sales

Average Credit Available on Purchase : Days

15 Working Capital Required for the : Rs. 0.00

anticipated turnover

16 Repayment Programme : Detailed Repayment programme for Term loan and

Working capital loan have been given in the DPR.

17 Details of Securities to be Offered :

17.1 Primary ( Furnish details for term loan and : :

working capital loan separately )
17.2 Collateral, if any (Details) :

17.3 Details of Guarantor(s) :

1. Name
2. Residential Address :

3. Occupation :
4. Details of movable & immovable
properties owned by him /her/other
family members

5 Details of any other similar guarantees:

if any, given to other institutions

18 Government Consents :
(Give deatails of various licenses / consents required to be obtained from various authorities for the proposed project)

19 DECLARATION

I / We hereby declare that the information given herein before and the statements and other
papers enclosed are, to the best of our knowledge and belief, true and correct in all particulars

Date : 0 Signature of the Borrower

Place : 0 Name & Designation (In case of Regd. Inst.)
 Project Report on

Prepared By:
#REF!
Khadi & V.I. Commission
#REF!
#REF!
#REF! State: #REF!
e-Mail:
Ph. No.: Fax: