WEST BENGAL MINORITIES DEVELOPMENT & FINANCE CORPORATION

(A Statutory Corporation of Govt. Of West Bengal) , An ISO : 9001-2008 Certified Organisation

APPLICATION FOR TERM LOAN

(USE BLOCK LETTER ONLY)

1. NAME : ...................................................................................................................................................................................
2. FATHERS/HUSBANDs NAME : .............................................................................................................................................
3. PRESENT ADDRESS HOUSE NO. VILLAGE / STREET : ..................................................................................................
Block / Municipality / Panchayat / Ward No : .........................................................................................................................
Police Station : ....................................................................................... Post Office : ............................................................
Sub Division : ............................................................ District : ................................................ Pin : ...... .............................
4. Phone No. Mobile No. ................................... 5. Employment Exchange Registration. ( if any) : ..........................................
6. Marital Status : Single / Married / Divorcee / Widow. 7. Religion............................... OBC : Yes

No

(attach Certificate if OBC)

8. AGE : .................................................. 9 : SEX : Male / Female 10. Eduational Qualification : ...........................................

A. General .......................................................................................... B. : .............................................................................
11. Total Annual Income of the family : ........................................................................................................................................
12. Present Occupation of the Applicant : ..................................................................................................................................
13. Name of the Business for which loan is required ..................................................................................................................
14. Business Address : ..................................................................................................................................................................
15. Place of business OWN / RENTED, if rented, Rent per month Rs. : ....................................................................................
16. Amount of Loan required : .......................................................................................................................................................
17. Expected time to generate profit from the activity : .................................................................................................................
18. Whether the applicant has availed loan / Assistance from any other Govt. Scheme/ Bank ? Yes

No

I hereby declare that the aforesaid particulars are true to my knowledge and belief. I am liable to abide by
the rules, terms and conditions of sanction of loan by the WBMDFC.

Date : ...........................................
Signature of the applicant

Place : ..........................................

Amber : DD-27/E, Sector-1, Salt Lake. Kolkata - 700 064, Phone: 033-40047469, Website : www.wbmdfc.org
Photocopy of this form is allowed

Guarantor Criteria

Guarantor is to be provided as fellow :

i) For Loan upto
50,000
by a Tax Payee or Professionally qualified person ( e.g.. Doctor, Engineer etc.)
ii) For Loan above

50,000

by a Govt. / Semi Govt. Employee / Teacher / A Good Beneficiary of WBMDFC.

Guarantor Certificate

I do hereby undertake to stand as surety / Guarantor for repayment of loan if sanctioned to Sri/Smt
......................................................... Son/Dauther/Wife of ......................................................................
Guarantor Details :

NAME

: ................................................................................................................................................................

Occupation : ....................................................Designation .......................................................Age..............................

Name of the office :

...................................................................................................................................

Office Address : ..........................................................................................................................................

Residential Address : . ...............................................................................................................................
Phone : Mobile : ................................ Office ........................... Resi ............................
If Beneficiary of WBMDFC, Beneficiary Code No.

...................................................................................

Signature of the Guarantor

To the best my knowledge the information furnished above is true

Signature of a Public Representative / Group A Officer with his official seal

For Official Use

Forwarded to DOMA / OC Minority Cell /A. O., WBMDFC (in case of Kolkata)

Signature of BDO (for Rural Areas) or SDO / Dy. Magistrate (for Municipal Areas)
A.O. of WBMDFC , ( for Kolkata) with office seal
1. Remarks : FS to enquire and report

Signature of DOMA / OC Minority Cell /A. O., WBMDFC (in case of Kolkata)

Comment :

Signature of DOMA / OC Minority Cell /A. O., WBMDFC (in case of Kolkata)

Amber : DD-27/E, Sector-1, Salt Lake. Kolkata - 700 064, Phone: 033-40047469, Website : www.wbmdfc.org