Vidya Lakshmi Common Education Loan Application Form

1. Personal Information

Field Name Student Parent / Husband Co-obligant / Guarantor

Title Mr. Mr.

First Name Darshan Pareshkumar

Middle Name Pareshkumar Dhansukhlal

Last Name Nakawala Nakawala

Father’s /Husband’s First Name Pareshkumar Dhansukhlal

Father’s /Husband’s Middle Name Dhansukhlal Gulabdas

Father’s /Husband’s Last Name Nakawala Nakawala

Date of Birth 14/07/1998 24/10/1973

Category OBC OBC

Sex Male Male

Marital Status Single Married

Bachelor of engineering in civil

Educational Qualification
engineering

Marks obtained in Highest

77.2 0.0 0.0
qualification %

Occupation Student Business

Income from all sources (Rs) 427078.00 427078.00

PAN No.# BICPN5129C ACEPN0436H

State Gujarat Gujarat

4/502, ghanchi sheri, begampura, 4/502, ghanchi sheri, begampura,

Address Line 1
surat-3 surat-3

Address Line 2

Village / Area/ Locality Surat Surat

Block/Taluka /Sub-district/Town Surat Surat

PIN 395003 395003

Contact No. 9099889656 9016396893

e-mail Id darshannakawala050@gmail.com Pareshnakawala9@gmail.com

Present Banker Details

Branch IFSC SBIN0003320 SBIN0003320

Banker STATE BANK OF INDIA STATE BANK OF INDIA

Bank Branch SVRCET SURAT SVRCET SURAT

Account Type Savings Account Savings Account

SB / OD A/c No. 35023799744 20057756982

Direct/Indirect liability details (Rs)

2. Whether related to Chairman /Directors / employee of our Bank or any other Banks. No

If yes, details of relationship

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3. Particulars of course, for which loan is required.

Whether under: Merit / Management Quota Merit

Name of the Institution Institute of Law Nirma University of Science & Technology Ahmedabad

Name of the Course M.tech CASAD

Duration of the Course 02 (Years) 00 (Months)

Date of Commencement 16/07/2019 Date of Completion 15/07/2021

Cost of Finance Details

4. Cost of Course / Source of Finance: (All amounts are in (Rs))

Particulars Year 1 Year 2 Year 3 Year 4 Year 5 Year 6 Total

Tuition fees 242000 242000 484000.00

Exam fees 11000 11000 22000.00

Books Stationery 0 0

Equipment/Computer 0 0

Hostel Expenses 121000 121000 242000.00

Sundries/Travel 0 0

TOTAL 374000 374000 748000.00

Own Source / Scholarship 0 0

Loan Required 374000 374000 748000.00

5.Details of securities offered 1000

6.Prospects of earning after completion of the course

No. of Installments Amount (Rs) p.m.

Repayment proposed
84 10000.00

7.Uploaded Documents:

Marksheet

Proof Of Admission to the course

Schedule Of Expenses for the course, as given by institution

Proof of Income

ITAO / IT Return (latest)

Applicant Photo

Parent Photo

I / We declare that all the particulars and information given in the application form are true, correct and complete and binding on me / us. Further,
the above particulars shall form the basis of any loan Bank may decide to sanction to me / us. The loan amount will be used for the purpose for
which it is granted.

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 Signature of the Signature of the Signature of the
Student Parent/Guardian Co-obligant/Guarantor

Place:

Date:

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For office use

Credit Report No. Date : Customer ID/Application ID:

Details of security including

Rate of Repayment Whether eligible under CSIS
Nature of limit Amount (Rs.) Margin(Rs.) Personal Guarantee/Co-
Interest* conditions Scheme / (Yes/No)
obligation.

Other terms and conditions:

The Bank may revoke in part or in full or withdraw/stop financial assistance at any stage by giving reasonable notice to the borrower. Credit
facilities sanctioned are to be availed within 6 months from the date of this letter, failing which; the limits will automatically stand cancelled.

Manager/Senior Manager / Accepted all the terms and

Chief Manager /Asst Gen Manager conditions of sanction Borrower/s

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