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Application Format for Micro
Finance
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APPLICATION FOR
FINANCIAL ASSISTANCE
UNDER NEDFi'S MICRO FINANCE SCHEME
1. Organizational
1.01 Date of
application.
1.02 Name &. address of the Non Governmental Organization.
(Enclose copy of
Memorandum of Association and Rules &. Regulations)
1.03 Date of registration.
1.04 Registration no.
(Enclose copy of
certificate).
1 .05 Contact person and Address.
1.06 Brief write-up on the chief functionaries.
(Give bio-data of chief
functionaries including information on name,
address, age, education!
q~alifications, past industrial/business experience.)
1.07 Provide list of members of the Executive Committee with
qualification
and
occupation.
1.08 Give a brief history of the organization with organizational
structure
(enclose Chart).
1 .09 Provide a note on the activities of the organization. (Enclose
annual
report, audited
statement of accounts and balance sheet for the last
three years).
1.10 Provide details about any training received by chief
functionaries/members
of the organization.
1.11 Give bank details (A/C No. Balance etc.)
1.12 Give details about projects already executed and their impact.
1.13 Details of previous financial assistance availed (if any) as
per format below.
| Name of
the organization from whom loan raised |
Purpose
of the loan |
Original
amount |
Amount
outstanding |
Rate of
Interest |
Defaults,
if any, in the payment of interest and/or principal |
Security
for the loan |
| 1 |
2 |
3 |
4 |
5 |
6 |
7 |
1.14 Details of capital Assets (Land.
building etc.)
2. Project Details
2.1 Title and objective of the
project.
2.2 Detailed description of the project.
2.3 Brief of the project area where it is to be implemented. 2.4
Details
of
Project cost and means of finance.
2.5 Assistance sought and use of funds.
2.6 Details regarding arrangements for procurement of raw material.
2.7 Marketing arrangements of products of the proposed project.
2.8 Project economics (Prepare profitability statement for five
years). .
2.9 Plan for utilizing the surplus income generated by the proposed
project.
Beneficiaries profile (Name. address
& economic status and Expected benefit to target group. Income
of target group after assistance. enterprises promoted. direct and
indirect employment generated marketing linkages established.
improvement in product/service quality etc.)
2.10 Land documents for project site (if any).
2.11 Implementation Schedule.
2.12 Proposed disbursement schedule.
2.13 Proposed repayment schedule.
2.14 Proposed security for the loan along with value (where
personal
guarantees
are proposed, net worth of guarantor)
DECLARATION
"We certify that all information
furnished by us is true; that there is no overdue/statutory dues
against the organization except as indicated in the application;
that no legal action has been/ is being taken against the
organization; that we shall furnish all other information; that this
may also be exchanged by you with any agency authorized by you, may,
at any time inspect/ verify my/our assets, books of accounts, etc.
in our office/business premises as given above."
For
------------------------------------------------
(Authorised Signatory)
Place:
Date:
Note: To be provided in official
letter head and the seal of the authorized signatory
should be affixed.
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