APPLICATION FOR LOAN

Transcription

1 APPLICATION FOR LOAN FINANCIAL ASSISTANCE UNDER MICRO CREDIT SCHEME FOR NGOs APPLY DIRECTLY TO NHFDC ( in Rs. 000) i) Name Applicant Organisation Regn. No.: Date : ii) Communication & Phone No. iii) iv) Area operation Main activities/objectives v) Composition its Management Committee (Name,, Occupation each member) 1. LENDING PROGRAMME FOR FUNDS BEING SOUGHT FROM NHFDC i) DIRECTLY TO BORROWERS (In Rupees) ii. PROPOSED TO BE LENT THROUGH SELF HELD GROUPS (SHGs) 1. Name SHG : 2. Date formation SHG : 3. Particulars members : 4. Name bank and account no. SHG : 2. TERMS AND CONDITIONS FOR EACH TYPE OF PROPOSED LENDINGS IN TERMS OF : a) Rate interest charged and provision for penal interest b) Security/margin money, if any, taken from members c) Repayment period; and d) Type documents taken under each category from

2 3 BORROWING RAISED FROM BANKS AND OTHER ORGANISATIONS : a) Name organisation from whom borrowed b) borrowed c) Purpose d) Balance outstanding e) Wher repayment is made regularly f) defaulted 4. FINANCIAL ASSISTANCE REQUIRED FROM NHFDC DETAILS OF EXTENSION/FIELD STAFF AVAILABLE WITH NGO & SHGs FOR CREDIT BUSINESS a) Supervisory staff No. ficials b) Field staff/extension workers No. ficials (Please indicate average salary payable to above staff) 6. (I) PLEASE ATTACH THE FOLLOWING : a) Copy registration certificate along with renewal copy registration. A copy Bye laws (with enabling clause to borrow/take loan) and Bye laws SHGs (if any) with approved copy MOA aunticated Registrar Societies. b) Printed Balance Sheet, & Expenditure A/c. and Report for last 3 years NGO and sample Balance Sheets 5 SHGs, if any. c) Name main banker with Account Number. d) Resolution management Committee, for borrowing from NHFDC and wher SHGs have passed similar resolutions with signature all members Committee. e) Copies testimonial received from foreign donors/government Departments etc. Please indicate, wher terms and conditions borrowing from NHFDC as given in annexure and agreement are acceptable. DECLARATION I (full name) Certify that facts and figures furnished in this application form are correct and tally with records our organization. Date : Signature Name Chief Executive

3 APPLICATION FORM FINANCIAL ASSISTANCE UNDER MICRO CREDIT SCHEME IMPLEMENTED BY STATE CHANNELISING AGENCY (For Non Government Organisation) 1. Name NGO : 2. a) Registration no. & date : b) Renewal date registration : 3. a) Registered : b) Present Function : 4. Composition its managing committee (Name,, Occupation each member) : 5. Details activities undertaken during last three years for disabled persons or weaker section society : 6. grant-in-aid / loans received : during last three years (year wise) a) From Union/ State Govt. Organisations: b) From International Organisations : c) Financial Institutions / Bank etc. : 7. Particulars Proposed s The antecedents NGO have been verified and having regards to information furnished on infrastructure, financial statements, record past performance/ activities, I am satisfied that NGO has requisite capabilities and capacity to implement Micro Credit Scheme. I (full name) hereby declare that facts and figures as stated above have been verified from relevant documents and are true and correct to best my knowledge & belief. Date : Place : Signature M.D. SCA with Office Stamp

4 APPLICATION FORM FINANCIAL ASSISTANCE UNDER MICRO CREDIT SCHEME IMPLEMENTED BY STATE CHANNELISING AGENCY (For Self - Help Groups Non Government Organisation) NGO Name : 1. Name SHG : 2. Date formation SHG : 3. Particulars members : 4. Name bank and account no. : SHG 5. Details training (if any) : for capacity building I (full name) hereby declare that facts and figures as stated above have been verified from relevant documents and are true and correct to best my knowledge & belief. Date : Place : Signature M.D. SCA with Office Stamp

5 Details NGO i) Name NGO : ii) Regn. No. and Date : iii) Communication & Phone No. : iv) Area operation : v) Main activities/objectives : vi) Composition its Management Committee : (Name,, Occupation each member)