Signature Name. Bio-data of the Promoters. a. Name. b. Father s/ Husband s Name. c. Date of Birth. d. Gender (Male/Female/Third Gender)

Transcription

1 Bio-data of the Promoters Pl affix recent passport size colour photograph and sign across it) a. b. Father s/ Husband s c. Date of Birth d. Gender (Male/Female/Third Gender) e. Relationship with chief promoter f. Whether belongs to Scheduled Castes / Scheduled Tribes Yes / No g. Do you hold majority shareholding in the company Yes / No h. Residential Address- Temporary i. Residential Address- Permanent j. PAN No k. Mobile No

2 l. Telephone No Office m. Telephone No Residence n. Academic qualifications o. Professional qualifications p. Experience q. Functional responsibilities in the unit r. Reasons for joining / establishing the unit (please mention about motivating factors) s. Family details - Spouse & children (age, educational background & present occupation) t. Details of Past Experience of Entrepreneurship u. Major Skills / Area of Expertise v. Financial/ capital contribution in all the existing enterprises/ businesses in which involved as promoter/ director/ partner/ proprietor etc (face value only) of concern/ associate concerns Capital contribution (Rs. lakh) At beginning At present

3 w. Functional responsibility in the applicant enterprise x. Functional responsibility in the proposed venture y. Any other relevant information I declare that the above particulars are true & correct to the best of my knowledge and belief. () of the Promoter Aadhaar Card Number

4 Verification of and Identity by Banker Photograph of the Promoters / Guarantors Banker s Verification of the Bank: : : Designation: Date: The Person whose photograph and signature are affixed have been verified by the officer mentioned above and his UID Number is , PAN No. is as per the records of our Bank. Designation and Seal

5 Net worth of Promoters 1. of the promoter/ Guarantor : Fathers name : Age and Gender : Address & Contact Details Correspondence : Residential : Permanent : PAN No. / Aadhaar No/ Passport no. : DETAILS OF ASSETS (Rs. lakh) i) MOVABLE ASSETS (other than shares held in the applicant enterprise) a) Cash and Bank (Savings/ FD) :

6 b) Liquid Shares/ Bonds/ Mutual Funds : c) Insurance policies (Surrender value): d) Details of other securities like stake in unlisted concerns, etc.: e) Vehicles/ Jewellery : f) Others (kindly specify) : Total : ii) Kindly provide details of the pledge or hypothecation of the above assets: iii) IMMOVABLE PROPERTIES Date of Location / Whether Land/ Extent of Value Details of Acquisition Address with House/ Flat/ of joint (Rs. lakh) mortgages, PIN Commercial/ holding owner, if encumbrance Agricultural property (%) any Purchase price Market Value TOTAL

7 7. DETAILS OF LIABILITIES S. No. Borrowings from Purpose Secured by Amount still to be repaid (Rs. lakh) 1 2 DETAILS OF GUARANTEES GIVEN Guarantee given to (name On behalf of/ Guarantee valid Amount involved of bank/ person) purpose up to (` ल ख/Rs. lakh) 1 2 Debit Balance shown in Balance Sheet of any company/ firm in which you have financial interest/ stake Any other liabilities Total Liabilities 8. SUMMARY Value of Movable assets : Value of immovable properties :

8 Total Assets (Rs. Lakh) : Less: Total liabilities (Rs. Lakh): Net Assets (Rs. Lakh) : Profit in Business (Rs. Lakh) : DECLARATION I declare that the above particulars are true and correct to the best of my knowledge and belief and I undertake to furnish such other information as may be required. Place : : Date : :

9 Chartered Accountant s Certificate Based on the verifications of all the relevant documents/ vouchers/ books of accounts / bank accounts etc. of Shri/ Smt., we certify that the above information is true & correct to the best of our knowledge. Place : : Date : /stamp of the Firm / Partner: Membership No Note: 1. Net worth details should contain full details of the following : a. immovable properties and whether they are mortgaged with others with details thereof; b. movable c. liabilities including names, amounts, terms etc.

10 SHAREHOLDING PATTERN AS ON (Rs. lakh) Equity shares +Preference shares Authorised capital ` ---- lakh consisting of --- no of equity shares of ` -- each --- no of --- % preference shares of ` each Paid-up capital ` ` ---- lakh consisting of --- no of equity shares of ` -- each --- no of preference shares of ` each of Face value Premium % holding of Face value Premium % shareholder of shares (Rs. equity shares of shares (Rs. holding (Rs. lakh) lakh) (Rs. lakh) lakh) Promoters s Relatives s Friends s Others

11 Total Proposed shareholding pattern (including existing and additional shareholding proposed now) Equity shares Preference shares of Face value Premium % Face value Premium % shareholder of shares (lakh) holding of shares (lakh) holding (lakh) of equity (lakh) shares Promoters s Relatives s Friends s Others Total

12 Please provide last three years balance sheets of the associate concerns along with income tax / sales tax returns. A. Status Regarding Statutory Obligations Sr Particulars Approving Status Whether Expected No Institution / complied with timeline for Authority approval i. Registration under Shops & Establishment Act Yes / No / NA ii. Registration under MSME (Provisional / Final) Yes / No / NA iii. Drug License Yes / No / NA iv. Latest GST Return Filed Yes / No / NA v. Latest Income Tax Returns Filed Yes / No / NA vi. Provident fund Yes / No / NA vii. Employee State Insurance Coroporation Yes / No / NA

13 viii. Consent of Pollution Control Board Yes / No / NA ix. Any other Statutory dues remaining outstanding Yes / No / NA x. Land use / NA permission Yes / No / NA xi. Building plan approval Yes / No / NA (Whether complied with (Select Yes/ No). If not applicable then select NA) Note: Specify any special condition attached to the licenses / consents and the undertaking given by the company in connection herewith. B. Contingent Liabilities details (if any)

14 Details of Management setup / Technical Staff & Employees A. Structure of Board of Directors: of Director / Age Representing Type Responsibilities in the enterprise Existing Shareholding(%) The investor / shareholders / bank being represented by the repsective Director may be highlighted. B. Professional management set up of applicant unit (Brief particulars of key non promoter professionals handling important responsibility areas like finance, marketing, production, technology etc) of Designation & Responsibilites Past experience Shareholding, if any professional in the enterprises ( of previous in applicant unit (%) / Age organisation/ Years

15 C. Details of other executives and Staff: Sr No Particulars Present Proposed i. Executives ii. Supervisors iii. Administrative / Office Staff iv. Skilled Labour v. Unskilled Labour vi. Others (specify) A. Project Cost (Rs. Lakh) Sr No Particulars Already Incurred To be incurred Total Cost Firm Non-firm i. Land including Development ii. Building & other Civil Works iii. Plant & Machinery* Indigenous Imported iv. Essential Tools, Spares &

16 Accessories v. Testing Equipment vi. Miscellaneous Fixed Assets* vii. Erection / Installation viii. Preliminary Expenses ix. Pre-operative Expenses x. Provisions for Contingencies Building Plant & Machinery Other fixed assets xi. Margin for working Capital Required xii. Marketing Expenditure xiii. Any other (please specify) Total * indicate second hand, if any

17 B. Means of Finance (Rs. Lakh) Sr No Particulars Amount already raised Amount proposed to be raised Total i. Capital (specify sources contributing capital) ii. Reserves iii. Term Loans (give full particulars) iv. Unsecured Loans and Deposits (indicate sources, rate of interest, repayment period, etc.) v. Deferred Payment Arrangements including Supplier's Credit vi. Seed Capital vii. Internal Cash Accruals viii. Other sources (specify)

18 Total In case internal accruals are taken as source of finance explain the basis for estimation of internal accruals by means of a statement. Indicate sources from which expenditure already incurred has been financed.

19 Particulars of Proposed Project/ Venture Outlay (applicable heads may be filled in with full details) (A) Strike off whichever is not applicable) A.1 Owned Land: Address/ Type of Land (viz., Purchased / Area of Purchase of seller/ Date of Mortgages/ Location (as per agricultural, industrial, To be Land Price vendor and conveyance Encumbrances document) commercial, etc.) purchased (sq. ft.) (Rs. lakh) relationship with deed, created if promoters if any any

20 A.2 Leasehold Land: Address/ Type of Land (viz., Area of Lease Lease Rent of lessor Key Lease terms Mortgages/ Location agricultural, industrial Land Deposit payable and relationship (tenure, date of lease Encumbrances (as per commercial, (sq. ft.) (All p.a. with promoters agreement, lock in,, created if document) residential etc.) inclusive) (Rs. lakh) if any escalation etc.) any Note: 1. Sale deed / Lease Deed/ Rent deed of the land to be enclosed. 2. Right to access from the lessor should be allowed for leasehold properties. 3. Recent valuation report, if any, to be enclosed

21 (B) Civil Works (Strike off whichever is not applicable) B.1 Owned / Bought Out Building: Sr. Description of civil Type of Total Floor Purchase Basis for Special Details & Remarks No. works construction area in sq. Price selection features Relationship of ft. (Rs. lakh) and price of the previous owner with estimation building promoters

22 B.2 Leased Building Sr. Description of building / Type of Total Floor Lease Lease Basis for Special Relationship of No. premises construction area in sq. deposit Rental per selection and features lessor with ft. (All annum rent of the promoters, if any inclusive) (Rs. lakh) estimation building

23 B.3 Building / Premises Proposed to be Constructed Sr. Description Type of Total Rate of Total Cost of Construction Expected Special Basis for No. of civil works construction Floor construction construction Stage date of features of estimation area per sq. ft. (Rs. Lakh) ( To be started, completion the in sq. (`) Under building ft Construction, Completed) ट प पण / Note: 1. In case contract is awarded for construction of building, furnish details thereof such as name of contractor, amount of contract, reputation of the builder / contractor / architect etc. 2. Other approvals from Inspector of Factories, Drug Controller, Building Plan / Layout, architect estimate etc. if any, should be enclosed. Separate document may be obtained, if necessary. 3. Sale Deed / Lease, N.A permission, Right to access for leasehold properties to be enclosed. 4. Recent valuation report, if any to be enclosed.

24 (C) Service Providers (Strike off whichever is not applicable) C.1. Architects / Contractor/ Interior decorators (kindly indicate method of assigning work i.e. tendering, etc.) S. & Address Scope of Cost of the work Terms of Fee Background and past Basis for No. Work assigned payment (amount, experience of the selection assigned duration etc.) service provider Architect Contractor

25 Note: 1. In case contract is awarded for construction of building, furnish details thereof such as name of contractor, amount of contract, reputation of the builder / contractor / architect etc. 2. Other approvals from Inspector of Factories, Drug Controller, Building Plan / Layout, architect estimate etc. if any, should be enclosed. 3. Sale Deed / Lease, N.A permission, Right to access for leasehold properties to be enclosed. Separate document may be obtained, if necessary. 4. Recent valuation report, if any to be enclosed.

26 (D) PLANT & MACHINERY / TECHNICAL KNOWHOW / EQUIPMENTS *: D.1 INDIGENOUS Sl. of of the of New (N), Total Cost s of 3 Basis of Bank & No machinery / OEM/ Supplier / Second hand (lakh) suppliers from selection A/c details of Technology Technology Dealer/ (SH), Fabricated Basic Taxes/ whom competitive of supplier supplier where (Model / Provider Agent (F), Self cost Duties quotations are payment is to specification/ fabricated (SF) etc. obtained and be made manufacturer) attached 1

27 D.2 IMPORTED Sl. of of the of New (N), Total Cost Payment s of 3 Basis of Bank No machinery / OEM/ Supplier / Second hand (Forex & Terms suppliers from selection & A/c Technology Technology Dealer/ (SH), Rs. lakh) (LC / whom of details of (Model / Provider Agent Fabricated DA/DP) competitive supplier supplier specification/ (F), Self Basic Taxes/ quotations are where manufacturer) fabricated cost Duties obtained and payment is (SF) etc attached to be made 1

28 (E). MISCELLANEOUS FIXED ASSETS* : Sl. of of the of New (N), Second Cost s of 3 suppliers Basis of Bank & No machinery / OEM/ Supplier / hand (SH), (lakh) from whom selection of A/c details of Technology Technology Dealer/ Fabricated (F), competitive supplier supplier where (Model / Provider Agent Self fabricated quotations are payment is to be specification/ (SF) obtained and made manufacturer) attached 1

29 * Note: 1) Kindly attach latest competitive quotations on the letter head / id of the supplier bearing the contact details. 2) The total cost should tally with the cost of the Plant & Machinery mentioned in the Application/ Business Plan. 3) If used machinery is being considered, valuation report regarding age, performance and value from a competent valuer to be submitted and reason to be indicated for going for the same. Prior permission would be required if second hand / used machinery is being contemplated. 4) In case of imported machinery, kindly indicate mode of payment, price of the machinery in foreign currency, whether procured directly or through local agent and the local service capability of the supplier. 5) In case of single source machinery supplier (no competitive quotations) please give adequate justification. 5). Details of machinery to be taken on lease/hire-purchase to be mentioned specifically with terms of the same.

30 (F). INTANGIBLE Sl. Particulars Period Expense Basis of Whom to be Purpose No Amt. estimation paid (Rs. lakh) 1 Lease / Rental Deposits 2 Fees payable to experts / technical know how 3 Marketing & Selling Expenses 4 Others (Pl. Note : Detailed Notes and justification to be mentioned.

31 (G). PRELIMINARY & PRE-OPERATIVE EXPENSES: Sl. Particulars Period Expense Basis of To be paid Purpose No Amt. estimation to (Rs. lakh) 1 Preliminary expenses ( Pl. specify) 2 Pre-operative expenses A) Establishment Expenses B) Interest on loans to be capitalised C) Upfront fee, Insurance, etc. D) Others (Pl. specify)

32 (H) Working Capital/ Working capital margin: Calculations of working capital and margins may be provided ****

33 Technically Feasibility i. of the products (including by products) & (their ) use: ii. Manufacturing process, (in brief) (Indicate technical process, whether it is a continuous process, whether this has been tried in the country, stage-wise capacity data, yield / conversion data, material, flow, etc.). Any R & D / innovation involved. iii. Whether product / service has IPR value iv. Capacity (No. of Units / Quantify in Kg. / Volume in Litres) Capacity for each product Licensed Installed Operating v. No. of working days in a month, No. of shifts in a day and No. of hours per shift

34 vi. In case of any collaboration/ JV, please furnish a brief write-up on the period of collaboration / JV agreement, the name of the collaborator company / JV partner, indicating the activities, size, turnover, particulars of the existing plants, and other projects in India and abroad set up with same collaboration / JV. Please enclose (a) Copy of the published brochure highlighting the activities of the collaborator /JV partner and balance sheet for the latest year (b) Copy of the collaboration / JV agreement (c) fees / royalties payable and the manner in which payable. (d) copy of the government approval, if required, for the services of foreign technicians, if any. vii. If there is no collaboration / JV agreement, please furnish full details of arrangement proposed to be made for obtaining technical advice and services needed for the implementation of the project.

35 viii. Particulars of the Consultants : (a) and address of the consultants (b) Fees payable and the manner in which payable (c) Scope of work assigned to them (d) Brief particulars of consultants including organisational set-up, bio data of senior personnel, names of directors/ partners, particulars of work done in the past and work on hand. Please enclose a copy of the agreement with the consultant and in case of foreign consultant (s), approval of the Government. ix. Whether any of partners / promoters / directors have any interest in consultant / collaboration firm. If so, details to be furnished.

36 x. Locational advantages of existing and proposed premises with reference to (a) absence of civic restrictions (b) proximity to the source of raw materials (c) market for the product (d) availability of - power - water - labour - transport (e) whether backward area and benefits available

37 Raw Material & Components 1 Major raw materials / components 2 Quantity required per annum 3 Imported / indigenous 4 Availability / sources of supply 5 Unit cost / price trends 6 Lead / procurement time 7 s of major suppliers

38 UTILITIES, EFFLUENT & QUALITY CONTROL A. POWER Sr No Particulars Remarks i. Sources of Power and Supply Voltage Taken from Electricity Board Own Generation Stand by arrangements ii. Maximum demand iii. Contracted Load iv. Connected Load v. Energy consumption per year vi. Power Tariff vii. Cost of Power per annum at maximum capacity utilization

39 Note: Please enclose: Certified Xerox copy of sanction for power Certified Xerox copy of agreement with electricity board Certified Xerox copy of electrical lay out of the plant B. WATER, AIR & FUEL Sr No Particulars Remarks i. Requirements and suitability of water ii. Describe water treatment arrangements iii. Sources for supply of water, arrangement proposed and water charges payable iv. Steam Requirement of steam Capacity of boiler Arrangements proposed for steam v. Compressed Air Requirement of compressed air

40 Arrangements proposed for compressed air vi. Fuel: Requirement of fuel Arrangements proposed for supply vii. Arrangement proposed for carrying raw material C. EFFLUENT Please furnish full details of the nature of atmosphere, soil, and water pollution likely to be created by the project and the measures proposed for control of pollution. Indicate whether necessary permission for the disposal of effluent has been obtained from the concerned authority; if yes, a copy of the certificate should be furnished.

41 D. QUALITY CONTROL i. Details of arrangement made for quality control. If BIS/FPO/ISO specifications are followed, no. of BIS/FPO/ISO standards and the particulars thereof should be provided. ii. Particulars of quality assurance system / ERP system / R & D activity proposed ECONOMIC FEASIBILITY / MARKETING ASPECTS i. Marketing* - Industry Scenario (Demand supply, Growth rates, Regulatory issues etc) ii. Consumer profile of the industry

42 iii. Profile of the Major Customers Current FY (no. of months -.) Total no of customers s of top 5 customers existing I II III IV V of product/ service supplied Goods/ services supplied (Rs. lakh) Last FY Total no of customers s of top 5 customers existing I II III IV V of product/ service supplied Goods/ services supplied (Rs. lakh) Previous FY Total no of customers s of top 5 customers existing I II III IV V of product/ service supplied Goods/ services supplied (Rs. lakh) Terms of supply (against LC, advance received, receivable days, etc.)

43 iv. Region / Area where the product is / will be sold v. Extent of competition & major players engaged in similar line in the area vi. How does the unit / meet propose to meet the competition (comment on the competitive advantages enjoyed by the unit) vii. In price and quality, how does the unit's product compare with those of its competitors? viii. Existing marketing, selling, distribution arrangements: If a selling/distribution agency has been appointed, its name, period of contract, commission payable, period by which the bills will be paid by it etc. (enclose copies of agreement, wherever applicable)

44 ix. Details of existing / new customers (with major names) proposed to be serviced through the new venture may also be provided, along with terms of supply. x. Scalability potential of business operations in next 3-5 years. xi. Whether the business model allows for creation of value by way of intellectual property, patents, copy right, brands, etc. xii. Nature and volume of orders / enquiries on hand (xerox copies to be furnished) xiii. If the unit is export oriented, please furnish exporter code no., if allotted and relevant details as per the following details for the preceding three years. Code No. of the product exported of the Country where exported F.O.B. value in US * please enclose a Market Survey Report, if any ===================================================

45 Project Schedule & Anticipated Drawal schedule A. SCHEDULE OF IMPLEMENTATION Sr No Project Activity Likely date of commencement Expected Completion i. Acquisition of Land ii. Development of Land iii. Civil Works for Factory Building Machinery Foundation Administrative Building iv. Plant & Machinery Imported Indigenous v. Arrangement for Power vi. Arrangement for Water vii. Erection of equipment viii. Commissioning ix. Initial Procurement of

46 Raw Material x. Trial Runs xi. Commercial Production SCHEDULE OF ANTICIPATED DRAWALS OF ASSISTANCE (Rs. lakh) For the quarter (future) Q1 Q 2 Q 3 Q 4 Q 5 Q 6 Q 7 Anticipated amount of drawal of assistance for the quarter Pl specify usage of assistance in which project head/ expenditure (name)

47 Details of existing borrowings 1. and address of bank/institution 2. Facilities Availed a) Fund- Based credit facilities (Kindly indicate the nature of facilities e.g. working capital / demand loan / term loan / short term) / Foreign currency loan, corporate loan / line of credit / Channel financing, Bill of discounting etc. amount and purposes) b) Non- fund based facilities other than derivatives (Kindly indicate the nature of facilities e.g. L/C, BG, DPG (I & F) etc. amount and the purposes) 3. Date of sanction 4. Present outstanding 5. Overdues position, 6. Repayment terms

48 7. Security offered/created 8. Requests for facilities under consideration by the bank and yet to be sanctioned, if any

49 Profitability projections for the Unit/ Company as a whole* S. No. Item Actuals for previous Y Y Y Y Y year Total Income 2 Raw materials Power and fuel Wages and salaries Selling and admin. expenses Other expenses Total Cost 3 Profit before depreciation, Interest and taxes (PBDIT) (2-1) 4 Interest on Term Loan 5 Interest on Working Capital 6 Interest on unsecured loans 7 Depreciation 8 Profit before Tax ( )

50 9 Tax 10 Profit after Tax (8-9) 11 Dividends/ Withdrawals 12 Cash Accruals ( ) 13 Repayments of all term liabilities (Principal) 14 Debt Service Coverage Ratio ((10+7+4)/(13+4)) 15 Average DSCR (Total of for projected period/(total of 13+4 for projected period) * Please give projections for the entire tenure of loan.

51 I. Production cycle (no. of days) Sl. No. Product No. of days 1 Lead time for procuring raw material 2 Production time 3 Assembly/ Packaging (dispatch of finished goods) 4 Receipt of payment for bills/ invoices raised II. Monthly turnover / level of inventory, debtors & creditors for the last 6 months Months (Rs. lakh) Net sales Stock holding Sundry Debtors Sundry Creditors

52 1. Unsecured loans : Break-up of of lender Amount outstanding as Interest Repayment unsecured loans on... (Rs. Lakh) (%) p.a. terms (a) Interest bearing (b) Interest free 2. Sundry Debtors and Creditors (Rs. lakh) FY 16 FY 17 Break-up of Sundry creditors Trade Creditors Creditors for Expenses Creditors for Capital goods Others (specify) Break-up of Sundry debtors outstanding for : More than one year Six months to one year Three to Six months

53 Less than three months 3. Operational details for the immediately preceding 12 months from the date of application (latest month figures in 1st column) (Rs. lakh) Gross Sales Holding of Raw material Holding of Finished goods Sundry Debtors Sundry Creditors O/s in CC limit

54 4. Statement of future installments payable in case of the applicant enterprise (Rs. lakh) Bank/ F.I. Outstanding amount Repayment of annual installments FY 19 FY 20 FY 21 FY 22 FY 23 FY 24 Bank Bank Unsecured loans (from promoters, relatives, etc.) (a) Interest free (b)interest bearing

55 on CA s letterhead Annexure 19 Certificate from the Chartered Accountant This is to certify that we have verified the Books of Accounts and other records of M/s., a company within the meaning of the Companies Act, 2013 and having its office/ registered office at and we hereby certify the following on the basis of the Books of Accounts and other relevant particulars furnished by the company/ firm/ concern. 1. The present shareholding pattern of the enterprise as on date is as given below : Equity shares Preference shares Authorised capital ` ---- lakh consisting of --- no of equity shares of ` -- each --- no of --- % preference shares of ` each Paid-up capital ` ---- lakh consisting of --- no of equity shares of ` -- each --- no of preference shares of ` each of Face value Premium % Face Premium %

56 shareholder of shares (lakh) holding value of (lakh) holding (lakh) of equity shares shares (Rs. lakh) Promoters s Relatives s Friends s VC/ PE Investor s Others (specify) Total Details of shares issued other than cash

57 2. The following are the age-wise debtors, creditors and finished goods as on (Rs. lakh) S. No. Particulars Debtors Creditors 1. Up to 90 days 2. > 90 days to 180 days 3. > 180 days to 365 days 4. more than 365 days TOTAL 3. Details of the bad debts provided for and written off during the immediately preceding three years are as under: Amount provided for (Rs. lakh) Amount written off (Rs. lakh) FY 2015 FY 2016 FY 2017

58 4. Details of existing unsecured loans in the enterprise are as under : Break-up of Lender details Amount o/s as on Interest Repayment unsecured loans (`Rs. lakh) (%) p.a. terms (a) Interest free (b)interest bearing 5. No of instances of overdrawals in the Working Capital/ CC Account (more than 10%) during the immediately preceding 12 months. 6. Details of returns of cheques in the WC/ CC account/s due to INSUFFICIENCY OF FUNDS during the immediately preceding 12 months ending on are as under : Date Cheque No Cheque Amount (Rs. Lakh`) Drawn On

59 7. Break-up of the remuneration to the promoters, directors and key management/ technical people for the past 3 years. 8. Details of the Related party transaction. 9. Status of IT assessment of promoters & enterprise for past 3 years. 10. s of other companies/ firms etc. in which promoters/ directors/ partners of the applicant enterprise are promoters/ directors/ partners or have substantial financial stake. I/We hereby note that this certificate would be an input for decision making by the Lender of / Investor in (the Borrower/ investee). Therefore, I/ We hereby agree and confirm that the Lender / Investor may seek any clarifications as may be required to investigate the matter and fix responsibility in the event our certification as aforesaid turns out to be untrue and factually incorrect causing loss to the Lender(s). I / We hereby further agree and give consent for the disclosure of my / our name to the Indian Bank s Association (IBA) for inclusion in the Caution List (maintained by IBA for circulation amongst members Banks/ Financial Institutions) by the lender of/ Investor in the said Borrower/ investee, if it is found that there was gross negligence on my/our part, or I /We have colluded with the said Borrower/ Investee in causing pecuniary damage/ loss to the lender/ Investor. For: of the Chartered Accountant s Firm

60 Date: ( & Seal) ( of Partner/ Proprietor) (Membership No.) Note : Kindly enclose details of debtors and creditors above 180 days. The certificate should be signed on each page by the concerned CA, and his membership number with ICAI should be indicated.

61 Particulars of Existing Assets of the enterprise Kindly provide the following details in respect of all the existing facilities (including registered office/ administration office/ factories/ operation places, godowns etc.) of the enterprise: (Rs. Lakh) Particulars Location Owned property Leased/ Rented property (area in sq. ft.) Purchase Present Lessor Annual Lease period Lease / date/ Market details rent/ valid till rental Price Value lease (please renewal (lakh) (lakh) (`) mention terms month and year) Land Building factory Building - admin Kindly enclose copy of sales/ lease/ rent deed of the land and recent valuation report if any.