# # #

MSME Application

Application to the Committee for a Corrective Action Plan under Revival & Rehabilitation of MSME

(For Existing Loan Exposure up to Rs.10 Lakh) ( To be submitted along with documents as per the check list )

Fields marked with * are mandatory


A. Brief Profile of the Enterprise:

B. Details of Proprietor/ Partners/ Directors - (Amount in Rs.)

C. Details of Associate Concern / Sister Concern: - (Amount in Rs.)

FB NFB Net Sales Net Profit Net Worth

D. Social Category


Female Male Transgender

Physically challenged

Yes No

Social Category

General SC ST OBC Women Minority

If Minority Community

Buddhists Muslims Christians Sikhs Jains Zoroastrians

E. Details of Existing Liabilities with the Bank: - (Amount in Rs.)

Fund based working capital (CC / OD/EPC etc.)
Others (please specify)
Fund based sub-total
LC/BG for working capital
Others (please specify)
Non Fund based Subtotal
Total Working Capital
Term Loans
Others (please specify)
Total Exposure

Banking arrangement and sharing pattern:

Financial Arrangement:

Sole Banking Consortium Multiple Banking
  FB NFB Total % Share
  WC TL          
  Limit O/s Limit O/s Limit O/s Limit O/s  

F. Details of Other Liabilities: - (Amount in Rs.)

G. Past Performance & Future Estimates: - (Amount in Rs.)

Net Sales
Net Profit
Capital (Net Worth of the Enterprise)
Tangible Net Worth
Adjusted TNW
Current Ratio
TOL/ Adjusted TNW
Cash Accruals

H. In case of additional Working Capital: - (Amount in Rs.)

Actual Sales Projected
Sales Working Cycle(in days) Inventory(in days) Debtors(in days) Creditors(in days) Promoter’s Contribution

I. For additional term loan facilities projections to be provided till the proposed year of repayment of loan.

J. (a) Details of Existing Security: - (Amount in Rs.)

J. (b)Details of Proposed Additional Security to be offered: - (Amount in Rs.)

K. (a) Details of Existing Guarantors: - (Amount in Rs.)

Name and addresses of the Guarantors Age Occupation Annual Income Other dues as Borrower / Guarantor

K. (b)Details of Proposed Guarantors: - (Amount in Rs.)

Name and addresses of the Guarantors Age Occupation Annual Income Other dues as Borrower / Guarantor

L. Details of stress faced by the Enterprise

M. Suggested Remedial Measures with the estimated time frame to justify the action plan

Declaration: I/We hereby certify that all information furnished by me/us is true, correct and completeto the best of my/our knowledge and belief. I/We shall furnish all other information that may be required by Bank in connection with my/our application.The information may also be exchanged by you with any agency you may deem fit.You, your representatives or any other agency as authorised by you, may at any time, inspect/ verify my/our assets, books of accounts etc. in my/our factory/business premises.You may take appropriate safeguards/action for recovery of bank's dues.

CHECK LIST: (The check list is only indicative and not exhaustive and depending upon the requirements of banks addition/deletion could be made as per necessity)

  • Last two years balance sheets (wherever applicable as per Statutory requirements / Bank's instructions) of the units along with income tax/sales tax return etc.
  • Projected balance sheets for two years in case of working capital limits and for the period of the loan in case of term loan.
  • Sales achieved during the current financial year up to the date of submission of application/Provisional Balance sheet as at Previous Quarter End.
  • Asset & Liability statement of Proprietor/ Partners/ Directors.
  • If funds proposed to be infused by borrower, please specify Sources.
  • Detailed Particulars of securities primary/collateral proposed, if any.
  • Details of all liabilities of the enterprise, including the liabilities owed to the State or Central Government and unsecured creditors, if any.
  • Supporting details for the suggested remedial measures with the estimated time frame by the Enterprise to justify the action plan /solution.