APPLICATION FORM NKFL

1 / Name of the PLF and Address
2 / Registration Details: (Enclose copy of Registration / Renewal)
-Registration with
-Date of Registration
-Valid upto
3 / Name of the Promoter
4 / No. of SHGs affiliated
5 / Composition of Governing Body / Management Committee
-Number
-Tenure
-Functions
-Meetings (Periodicity, Regularity, Date ofMeeting for last one year)
- Expertise
6 / Other Sub-committee
Details, if any
7 / Trainings undergone by MC Members
8 / Date of Annual General Body Meeting for last 3 years
9 / Nature of Book maintained (Pl. specify)
Who maintains the banks? / -
10 / Books of Accounts
-Updated upto (month)
-Maintained upto(month)
-Maintained by (Name of Book Keeper & Qualification)
11 / Audit of Books of Accounts
-Name of the Auditors
-Completed uptowhich year / NKFL
12 / Activities of the PLF
  1. Financial:
  2. Non- Financial
(Promotion / Nurturing / Capacity Building / Financial Access / Recovery / Liasoning / On-lending / Book keeping / Rating Skill Training/ Facilitation / Micro Insurance / Social Programme / etc.
13 / Rating of PLF
-Rating Agency
-Frequency of Rating
-Rating for last 3 years
14 / Resources of PLF (as on …….. )
-Membership fee
-Savings by SHG’s
-Grants by Govt.
-Loans by Bank/Govt.
-Income Generation from Activities
-Any other
15 / Balance Sheet, Income and Expenditure highlights for 3 years.
(Please enclose copies of B/s)
16 / Nature of support received from State Govt. by PLF ( financial and non-financial)
17 / Infrastructure facilities
-Physical
-Manpower
18 / Details of on-lending to SHGs (3 years)
  1. Disbursements (Amount in Rs.)
  2. Recovery Percentage
  3. Rate of Interest charged %
  4. Overdue loans (Rs)
  5. Age –Wise classification of overdues:
Upto 90 days
90 days upto 180 days
180 days upto 1 year
1 year / 2011-12 2012-13 2013-14
18A / DCB position for last one year (as per format) / NKFL
19 / Details of the SHGs affiliated (as on ----)
a.Totalinternal savings of the SHG (Rs)
b. Age Profileof SHF
c. Rating of the SHGS
d.Linkage Status of SHG to banks
e. Cumulative loans availed by SHGs directly from banks ( Rs) (as per annexure)
  1. f.Outstanding Loans to banks (as on …..)
  2. g.Defaults by SHGs to banks
No
Amount / Age /
Years / 1 / 1-2 / 3-5 / Above 5 yr
No
Rating / A / B / C / D
No
Linkage / 1st / 2nd / 3rd / 4
No
20 / Purpose of the loan
21 / Financial details of the Project ( total cost, margin, subsidy/ govt support, bank loan required)
22 / Borrowing Powers ( Authority, Amount of Borrowing power, unavailed borrowing power, resolutions of competent authority)
23 / Proposed Project (Please prepare a project report)
-Activity
-Objective of the project
-Justification for the project
-Area of implementation
-Number of beneficiaries
-Criteria for selection of beneficiary
-Experience in the line of the activity
-Management of the project
-Project Cost/ Borrower Contribution/ NGO
Contribution (if any)/ loan component
-Schedule of implementation (Time period)
-Backward and Forward linkage available
-Economic of the project ( costs / benefits /IRR /BCW /DSCR/)
-Rate of Interest
-Terms of Repayment
-Securities, etc
-Any other (support from govt/ govt agencies) / NKFL
23 / Monitoring Arrangements
(Monitoring of end use of Credit/Post Disbursement supervision /Recovery /Default management /Arrangement for MIS report – Monthly)

We hereby declare that the information furnished by us is correct. In the event of any of the information furnished by us is found to be false, we may be liable for any action under the law of the land.

Place :Signature:

Date:Designation:

Encl:

  1. Registration Certificate / Renewal
  2. Copy of Bye-laws of the society
  3. Address Proof : Utility bills such as electricity, water and landline telephone bills in the name of the concern
  4. Copies of Balance Sheet / Income & Expenditure / Receipts & Payments for last 3 years
  5. Copy of the resolution of the Executive Committee for availing loan from NABKISAN
  6. Project Report
  7. Loans availed by SHGs directly from Banks

Sr.
No. / Name of the SHG / Total loan availed from banks / Present O/s / Overdue
1st / 2nd / 3rd / 4th / Total
  1. DCB statement for ASF and Incentive loans for last one year

Sr.
No. / Month /Year / O/s loan
(month
begin
-ning) / Loan given / Total Loan o/s / Demand including
overdues / Collection / Balance / Over
dueamt / % Recovery
Prin. / Int / Total / Prin. / Int / Total / Prin. / Int / Total