APPLICATION FORM NKFL

(Micro Finance Institutions)

1 / Name of the Company
2 / Date of Incorporation
3 / Address
(Registered/Corporate/ No of Branches)
4 / Area of operation / Geographic Reach
(State /Districts /Villages)
5 / Legal Status
6 / Borrowing Powers
(Authority/ Borrowing powers/ un-availed borrowing power etc.,)
Copy of resolution
7 / Management
(Board members profile such as name, age, qualification, area of expertise, experience in the present/ previous organization, composition of Independent Directors, etc.)
8 / Name of the CEO and other Key Staff
(members’ profile such as name, age, qualification, area of expertise, experience in the present / previous organization etc,.)
9 / Shareholding Details
-Name of the shareholder
-No. of shares
-Value of share
-% of holding
10 / Loan Products Offered
11 / Tenor of loan product
12 / Credit appraisal mechanism
13 / Details of loan disbursed / outstanding for last 3 years
Particulars / 2013-14 / 2012-13 / 2011-12
Loan disbursed (Rs.)
No. of beneficiaries
- Men
- Women / NKFL
Average disbursement per beneficiary (Rs.)
Loan outstanding (Rs.)
No. of borrower o/s
-Men
-Women
Average outstanding per borrower (Rs.)
No. of branches
Average loan account per branch
No. of field officers
Average loan account per field officer
Total no. of group / members
-Men
-Women
% of borrowing members - Men
- Women
14 / Important financial parameters for last 3 years
Particulars / 2013-14 / 2012-13 / 2011-12
Net profit
Recovery percentage
Capital Adequacy Ratio (%)
Interest / Financial Margin (%)
Cost of management %
Net profit margin %
Net profit
Portfolio at risk –Agewise
<90 days
>91-180 days
>181-1 Year
>above 1 year
(please enclose Audited Balance Sheet)
15 / Compliance with RBI Instructions by MFI
-Interest Rate Charged
-Penal interest
-Method of Interest Calculation
-Qualifying Assets
-Processing Fee
-Other charges
-Transparency
-Borrower profile / Income
-Repayment period / periodicity
-Collaterals
16 / Management information system & Recovery mechanism
17 / Details of loan availed and Outstanding
-Bank
-Amount
-Rate of Interest
-Period
-Security
-Overdues, if any.
(please provide copies of sanction letters along with terms and conditions in respect of loan availed during the past one year) / NKFL
18 / Business plan for next 2/3 years
19 / Purpose /justification of loan
20 / Amount of loan required / details of proposed utilization of the funds

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. Certificate of Registration issued by Registrar of Companies and Reserve Bank of India
  2. Memorandum and Articles of Association
  3. Address proof : Utility bills such as electricity, water and landline telephone bills in the name of the company
  4. Copies of audited Balance Sheet and Profit and Loss Account for last three years
  5. Copies of Board resolution for borrowing powers / authority
  6. Copies of sanction letters along with terms and conditions in respect of loan availed during the past one year
  7. Certificate from Chartered Accountant for compliance with RBI instructions