Vidya Lakshmi Common Education Loan Application Form

Student ID 808690

Application ID 362090

Bank Name State Bank of India

Bank Scheme Name SBI STUDENT LOAN SCHEME

Preferred Bank IFSC Code SBIN0030406

Preferred Bank Branch Name THAKUR ROAD JAGDALPUR

Date of Application 29-Oct-2018

1. Personal Information

Field Name Student Parent / Husband Co-obligant / Guarantor

Title Ms. Mr.

First Name AYUSHI SHAILESH

Middle Name

Last Name DAYAL DAYAL

Father’s /Husband’s First Name SHAILESH LATE RAINESH

Father’s /Husband’s Middle Name

Father’s /Husband’s Last Name DAYAL DAYAL

Date of Birth 09/05/1994 14/03/1969

Category Others Others

Sex Female Male

Marital Status Single Married

Educational Qualification B.SC NURSING 12 TH

Marks obtained in Highest

59.88 50.0 0.0
qualification %

Occupation Student Business

Income from all sources (Rs)

PAN No.#

State Chhattisgarh Chhattisgarh

Address Line 1 NATHAN GALI NATHAN GALI

Address Line 2 SHANTI NAGAR WARD NO 25 SHANTI NAGAR WARD NO 25

Village / Area/ Locality JAGDALPUR JAGDALPUR

Block/Taluka /Sub-district/Town Bastar Bastar

PIN 494001 494001

Contact No. 8839497952 9407751608

e-mail Id ayushi.dayal143@gmail.com ayushi.dayal143@gmail.com

Present Banker Details

Branch IFSC SBIN0030406 SBIN0008119

Banker STATE BANK OF INDIA STATE BANK OF INDIA

Bank Branch THAKUR ROAD JAGDALPUR COLLECTORATE JAGDALPUR

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Account Type Savings Account Savings Account

SB / OD A/c No. 37815156541 10460933641

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

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

Whether under: Merit / Management Quota Management Quota

Name of the Institution

Name of the Course

Duration of the Course 04 (Years) 00 (Months)

Date of Commencement 29/10/2016 Date of Completion 30/12/2020

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 55000 55000 55000 55000 220000.00

Exam fees 0 0 0 0

Books Stationery 0 0 0 0

Equipment/Computer 0 0 0 0

Hostel Expenses 0 0 0 0

Sundries/Travel 14000 14000 14000 14000 56000.00

TOTAL 69000 69000 69000 69000 276000.00

Own Source / Scholarship 0 0 0 0

Loan Required 69000 69000 69000 69000 276000.00

5.Details of securities offered

6.Prospects of earning after completion of the course

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

Repayment proposed
0.00

7.Uploaded Documents:

Marksheet

Proof Of Admission to the course

Applicant 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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