F. No. 117ABANK OF BARODA

(HEAD OFFICE : MANDI, BARODA)

NAME OF THE BORROWAL A/C.

1 Name in full :-

2 Age :-

3 Father's / Husband's Name :-

4 Residential Address (Permanent) :-

Residential Address (Present) :-

5 Telephone Numbers : office / Shop :- Residence :- Office/Shop:-

6 Occupation / Line of business :-

(A) If in service : Name of Employer & Address Designation

(B) If in business / profession :-

( i ) Name of the firm / Company :- and its address :

( iii ) Since when established : :-

( iii ) In which capacity he / she is representating :-

7 Annual Income Rs: :-

8 Value of Total Assets (As per details overleaf :-Rs.

9 Details of loans taken in individual/Firm's/Company'sNamea) Name/s of the Bank/other institution and its branch :-

b) Purpose and amount of loans availed :-Rs. Rate of interest

c) Present outstanding balance :-Rs.

d) Security & Repayment schedule :-Rs.

e) Other details :-

10 Total liabilities :-Rs.

11 Net means (7 - 9) :-Rs.

12 Details of guarantees given :-

Name of the Institution to Name of the person/concern Amount of guarantee givenwhom guarantee is given on whose behalf guarantee

is given

13 Remarks, if any :-

Date :- JT. MANAGER BRANCH MANAGER

REPORT ON THE MEANS AND STANDING OF THE BORROWERS/GUARANTORS/SURETIES

PARTICULARS OF MOVABLE PROPERTY OF MR. / MRS. / MISS.

1 LIFE INSURANCE POLICIESPolicy No. Date of Sum Amount of Premium Total Amt.

issuance Assured Premium paid upto of premium of policy Rs. paid in a yr what period paid

2 INVESTMENT IN GOVERNMENT SECURITIES LIKE BONDS / NSC PPF & MUTUAL FUNDS

Bond / Certificate No. Date of Name of Amount Due Maturity

Purchase Post office / Rs. Date Value

M.F. Rs.

3 TERM DEPOSIT / SHARES / DEBENTURES ETC.Name of Bank & Branch Date of FDR/Share/ Total Amt. Due Date Latest Mkt.

Purchase/ Debentures of FDR/ & Maturity Issue Certificate No. Debentures Value of FDR

4 OTHER ASSETS

a) Jewellery :-

b) Vechicles :-

c) Capital Invested in Business :-

d) Any other movable assets (please specify) :-

5 DETAILS OF IMMOVABLE PROPERTY

i) Particulars of the property

a) Type of Property :-

b) Location :-

c) Survey / House No. :-

d) Area / Loacality Village, Town, District :-

ii) Property standing in the Name of :-

iii) Share of Applicant in the property :-

iv) Whether encumbered / unencumbered partially :- encumbered (give details viz. with whom, consideration and major terms & conditions)

v) Value of Property

a) Cost (original + Value added) :-

b) Present estimated market value :-

6 TOTAL OF ALL ASSETS :-

Date :- JT. MANAGER BRANCH MANAGER