Vidya Lakshmi Common Education Loan Application Form

Student ID 847820

Application ID 387016

Bank Name State Bank of India

Bank Scheme Name SBI Scholar Loan Scheme

Preferred Bank IFSC Code SBIN0007932

Preferred Bank Branch Name UDAYACHAL (BHOPAL)

Date of Application 03-Dec-2018

1. Personal Information

Field Name Student Parent / Husband Co-obligant / Guarantor

Title Mr. Mrs.

First Name Udit Jyoti

Middle Name Singh

Last Name Panthi Panthi

Father’s /Husband’s First Name Ram Ram

Father’s /Husband’s Middle Name Singh Singh

Father’s /Husband’s Last Name Panthi Panthi

Date of Birth 01/07/1997 12/09/1973

Category SC SC

Sex Male Female

Marital Status Single Widow

Educational Qualification Higher education

Marks obtained in Highest

71.0 0.0 0.0
qualification %

Occupation Student Employee

Income from all sources (Rs) 250000.00

PAN No.#

State Madhya Pradesh Madhya Pradesh

15/3 behind Lily talkies aheerpura 15/3 behind Lily talkies aheerpura
Address Line 1
barkhedi barkhedi

Address Line 2

Village / Area/ Locality Bhopal Bhopal

Block/Taluka /Sub-district/Town Bhopal Bhopal

PIN 462008 462008

Contact No. 7999512007 8517854700

e-mail Id Uditpanthi1234@gmail.com Wahanesaikant.77@gmail.com

Present Banker Details

Branch IFSC SBIN0030230 SBIN0030230

Banker STATE BANK OF INDIA STATE BANK OF INDIA

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Bank Branch BARKHEDI BHOPAL BARKHEDI BHOPAL

Account Type Savings Account Savings Account

SB / OD A/c No. 32746807666 33359072246

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 IAE

Name of the Course Ame

Duration of the Course 02 (Years) 00 (Months)

Date of Commencement 19/08/2018 Date of Completion 19/08/2020

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 250000 250000 500000.00

Exam fees 9000 9000 18000.00

Books Stationery 5000 5000 10000.00

Equipment/Computer 5000 0 5000.00

Hostel Expenses 0 0

Sundries/Travel 118000 0 118000.00

TOTAL 387000 264000 651000.00

Own Source / Scholarship 0 0

Loan Required 387000 264000 651000.00

5.Details of securities offered Guarantor

6.Prospects of earning after completion of the course

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

Repayment proposed
60 11000.00

7.Uploaded Documents:

Marksheet

Proof Of Admission to the course

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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