Annexure - I

Bank of Baroda
Revised Application Form For
Baroda Kisan Credit Card

Photographs

The Branch Manager

Bank of Baroda
_____________ Branch
_____________
Dear Sir
Re. :

Availment of Baroda Kisan Credit Card facility from your bank

I / We the undersigned Mr. / Miss / Mrs. __________________________________ son /

daughter / wife of ________________________ belonging to village ______________ Taluka
___________ District ___________________ hereby apply for sanction and issuance of Baroda
Kisan Credit Card facilities for my / our farming activities.
For the purpose, I / We furnish the required information in the format enclosed which is correct
as per my / our knowledge and belief. I am/ we are aware that in case any of the information
furnished by me/us in this respect is proved to be incorrect, false or incomplete, my /our BKCC
facility is liable to be cancelled/withdrawn forthwith by you without any notice to me/us.
I / We have read the latest rules and regulations of Baroda Kisan Credit Card scheme of your
Bank and undertake to abide by / adhere to the same.
I / We hereby authorise you to debit our account for the material purchased / payment made
through cheques / charge slip in case of material purchased by me/us from authorised Member
Establishment dealers.
I / We hereby undertake to operate upon / maintain our accounts within the sanctioned limits.
Yours faithfully,
Signature

Name

1. X________________________________

___________________________________

2. X________________________________

___________________________________

3. X________________________________

___________________________________

4. X________________________________

___________________________________

Annexure to Application for BKCC

Information to be furnished by the Applicants for Baroda Kisan Credit Card
1. Applicant Details
Sr.
No.

Name of the
Applicant

Age

Educational
Qualification

Present
Activity

(1)

(2)

(3)

(4)

(5)

Annual Residential
Address
Income
(Rs.)
(6)
(7)

I / We belong to following categories.

SC _____ ST ______ Minority Community (Please specify) ____________
Small Farmers ___________ Marginal Farmers _____________ Tenant _________
Share Croppers ___________
2. Details of agricultural land cultivated by the applicants
Market
UnType of
Name of Survey Types of Irrigated
A. G.
irrigated Irrigation Value of
Revenue
No.
Ownership
facility
Agri.
A . G.
Village
land per
acre
(1)
(2)
(3)
(4)
(5)
(6)
(7)

Total
value of
Agri.
Land
(8)

Total
Latest Revenue abstracts 8A, 7/12 and No. 6 / Khasara,Khatauni are enclosed.
3. Details of crop cultivated by the applicants (Last year or average)
Season

Name of
crop

Irrigated
A G

Unirrigated
A
G

Crop
cultivation
expenses
incurred
(Rs.)

Annual
Crop
Productio
n in
quintal

Value of
crop per
quintal
(Rs.)

Total value
of crop
received
(Rs.)

Profit /
Income
(Rs.)

(1)

(2)

(3)

(4)

(5)

(6)

(7)

(8)

(9=8-5)

Total
4 At present I am / we are enjoying credit facilities from Banks / Co-operative Societies /
Private Money Lenders as under :
Sr.
No.
1

Name of Creditor

Place

Purpose of
Finance

Balance
Outstanding

Overdue if
any,

2
3
4
5
Total
5

Our application / requirements of credit facilities from your Bank are given below :

Sr. No.

Purpose

Amount
required

Likely date of
availment

Total

Place :
Date :

Signature of applicant/s
-----------------------------------------------------------------------------------------------------

Operational Instruction in respect of Baroda Kisan Credit Card

(To be obtained on a separate sheet)
We are having Composite Agriculture Cash Credit Account No. ______________ in our joint
names.
Therefore,
we
hereby
authorise
one
of
amongst
us
Mr./
Mrs
_________________________
son
/
daughter
/
wife
of
Mr.
_______________________________ residing at _________________ to operate upon our
said composite cash credit account (Production Credit Account) sanctioned to us jointly under
Baroda Kisan Credit Card Scheme.

Sr. No.

Names of Joint Borrowers

Signature

=x=