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 PleaseTick (/) One of No.l and any one of Numb6r 2

I Male F€male 2 Gen sc ST oBc Minority Ex-Serviceman PH HBA

Bank
H.O./C.O.

ffO BE FILLED IN BLOCK LDTTERSOR TYPED)

From :- Full PostalAddressofthe Branch
The Branch Manager,
..... Branch Vill./Town :
.......Tehsil Road :
District pin
P.O......,.....................
State District:
State:
Ref. No. Date:

To
The Secretary
RajasthanKhadi & VI. BoarC
JLN Marg
JAIPUR

(THROUGH THE FINANCING BANK's NODAL BRANCH)

Sub :- Paymentof "Govt. Subsidv" rgsirsl the Bark Financesarctiofled under

Sir,

Seoetary / Chairman / President/ Managing Trustee / Proprietor of

herebyinform thata VillageIndustryprojecthasbeensanctionedin my / our favourunderthe

Stato
ef..................
DetailsofProject Cost Amornt (Rs.) MeansofFinancc Amount(Rs.)
A) Capital Expenditure r Owr Cortdbution
(i) Workshed
(ii) Machinery/Equipment Term Loan for Fixcd Capital
B) Working Capital CashCredit for Working Capital
TOTAL (Rs.) TOTAL(ns.)
Note : l. Cost of land should not be included in the Capital Expenditureunder the Foject cost.
2. Total cost ofthe project should not exceedRs. 25.00 lakkhs for manufacturingand
Rs. 10.00Lakhs for Business/ ServiceSector.

Signatur"of thc b€neliciary Contd...-.21-

 .2:
2. I / We,th€r€fore youto pleaseadvisetheBankto disburse
request an amountof Rs.......................................

my /ourprojectis asunder.
2.1 (a) FullNameofthe beneficiary/ Society/ Institution/ Trust
(b) Father's
Name(ln caseoflndividual)
(c) Dateof Birth of individual
(d) FullAddress(with PinCode)
(e) LcgalStatus/Constitution
(Partnershipfirm not eligibl€)
(0 Registration No. and date,i fany
2.2 Locationofth€Unit
(Village,Taluka,Dist.andStatewith PinCode)

2.3 VillageIndustryActivity(Pleasespecify)

2.4 (a) GeneralCategory

or Y E S iN O
(b) Whetherthebeneficiarybelongsto SC/STMinority
/OBC/Ex-Serviceman/PHC/women/HBA.
(Please
specify)

z.:r PerCapltal'rxedInveslmenl Rs.

(C.E,dividedby fulltimeenrployment
equalto
Rs.1,00,000)

2.6 Employment :-
envisaged a)Fulltime

' 2.7 Particula6ofdepositof a)NatureofDeposit SB/CD

owncontribution b)AccountNo.
c) Dateofd€posit
d)Amountdeposited Rs.

2.8 Bank'sSanction
LetterNo.: (Copyofsanction
ordertobeenclosed)
DateofSanction

2.9 Dateandamountoffirstdisbursement
(Certilied copyofledger ertrscts to beenclosed)

2.l0Wheth€rthesanctionis coveredunderCredit
GuaranteeFundSchemeforMicro,Small IndustriesofCGTMSE
:

3. I / Weherebyagr€eto abideby thetermsandconditionsandinstructionsissuedby theKhadi& V L Commissionin this behalffrom

time to time and thoseto be issuedin futur€with regardto PMEGP I/We also agreeto furnish ouarterlv prosressreport on
production.sales.employment.wagespaid €tc. to the Bank which ir turn will sendthe information on ouarterlv basisto th€
R8j. Khadi& V.L Bosrd forrecord and further information.
4. I / Weh€rebydeclarethattheGovi. Subsidyhasnot beenclaimedeitherby m€or by anyotherp€rsonofmy family forthe sameor any
otherProjectin the pastand "one frmily onc subsidy" nom hasbeenfollowed.Further,the Bank credit hasnot been/willnot be
utilized to adjustor squareolIany previousloar/advancctakenby me/ ush the past.

(activity/indqstry) is a newVillageIndustryuritand notanexistingunit.

6. lt is alsocertifiedthattheunit locatedat theaddress mentionedin theGovt.Subsidyis inmynameonlyand I amthesoleproprietorof
this unit. It is alsodeclaredthat, it is not a Partnership Firm / PrivateCompanyetc.

Signaturcof the beneficiary Conld.....3/-

-'--------

t 5 :

7 . Certift€dthat I / We have alreadyundergonenecessaryEDP Trainingof .-.................... Days / Months during

conducted
theyear..................-.......-................ by ......

the tnining institute).

Certified that I / Weshall display following sign-boardat themain entranccofmy / our projcct site i

(Unitname)
............

Financed
by......-.....-

of MoMSME
UnderPMEGPScheme

I / Wearereadyto bearthe a ouotofcuaranto€feeandAnnualServicefge in respectofcredit GuaranteeFundSchemefor Micro,

ShallIndustriesoperatedby CCTMSE,ifthe Bankin itsdisFetiondecidesto r€coverthesame.

amountofcovt. subsidy calculatedonworting capitalloan/ cashcreditfacility,ifth€

10. I / We,herebyundenaketo refundproportionate
saidWC Loan/ CC facility is not ad€quatelyutilizedasper stipulatrdnormsof KVIC. The averageutilizationof workingcapital
ofthe sanctioned
duing the first yearofoperationofthe unit shouldnot bc lessthan75olo limit andthe limit shouldtouchat leastooe

peaklevel ut il izstion of I 00% with in threeyears'p€riodbeforethe Govt. Subsidy amountis adjustedwith the loanamount.

ti. lt f lereby dcclarcd that rll fscts furoished.bove by nelus in lhe Govt SubsktyclNimsr€ correct rDd ifany irformrtkm is

found to b€ frlse or leadsto misguiding the .uthoriticr with ulterior motive of availlng Govt. Subsidy, I r' W€ should be

s[bjected to rny purishment rs d€Gmedlit in the €yesoflsw.

12. TheAdvanceStampReo€iptofcovt. Subsidyamountis alsoattach€d.

Yoursfaithtully,

Place:

Datc: Signaturcof the Beneficiary

SEAL

COUNTERSIGNED

BRANCHMANAGER

(Scalofthc BankBranch)
 RECEIPT

thc ChiefExecutiveOfficer,Khadi and Village IndushiesCommissionMumbai-56,towardsth€ paymentof "Govt. Subsidy"in

(Revenue
StamP)
(Signatureof theApplicant)
Noter In caseofe Co-operstiveSociety/Instiluion,Seslhasto b€8flixed.

(For the use of the Bank/Branch)

l. ln considention of the project of the above beneficiary/ lnstitution, our Bank / Branch has sanctioneda loan of
Rs.......................................afterproperappraisaloftheprojectatthisend.AsagainstaloanofRs.............
W.C.Rs..........................................) theBankhasreleased
(C.E:Rs..........,,.........-.................... / lull lumpsum
firstinstalltrlent
a m o u n6tf l o a no f R s .........on......,..................................TheBankshallarrangetodepositth
Govt.Subsidyin TermDepositin thenameofthe beneficiaryfor 3 yearsfrom thedateofreleaseoffirst installmentofthe loan.
It is confirmedthat no interestwill be paid on the amountof TDR by the Bank and no interestwill be chargedon the
corresponding amountofthe loanfor aperiodof3 years.The Bankis aware,thatifthe advancegoes"bad"befbre3 years,Covt.
Subsidywill be adjustedto liquidateloan liability of the beneficiarywith interest.Recovery,if any,effectedlater will be
remittedto thecommission.

Certifiedthatlheunitsanction by ourBankBranchin favourofShri/SmtAiVs. ............

is a new unit and not an existingunit. The instantGovt. Subsidyclaim is in conformitywith the guidelinesand instructions
issuedby RBI, KvlC andour Bank.The instantprojecthasnot beensanctioned for utilization,iadjustmentpartl; or wholll', of
anydebtdeemedbador doubtfulofrecoveryorto adjust/ liquidateany past /
loan advance.

3 . Certifiedcopli of the Sanctionorderofthe Bank andcertifiedledeerextractsof theborrower'sTemrloanA./candCashcredit

accountis/areenclosed.

wife of .,..............-.. ..... has beenundergone

EDP traininsand a cop] of the
certificateis enclosed.

5 . Certifrid that the unit sanctionedby our B ankBranchin favour of Shri/Smt/M/s./Kum/.

ang Covt. Subsidyamountreleasedto the unit will be propotionatelyrecoveredand remittedto KVIC if th€ unit doesnot
adequatclyutilizethe WC/CCfacility asper KVIC norm i.e.theaverageutilizationof WC duringthe first yearofoperationof
thc unitshouldnot be lessthan75%ofthe sanctioned limit andthe limit shouldtouchatleastonepeaklevelutilizationof 100%
within 3 years'periodbeforethe 6ovt. subsidy amoult is adjustedw ith the loanamount.

(Signature)
Plece: (Designationofthe Bank Oflicial)
Drc: (SealoftheEank)
Enclosulrs:
Asrbovc. SignaturcCode/P.A. No................
 TO BE STAMPEDAS AN AGREEMET{T
AS PERTIIE STATESTAMPACT IN FORCf,

r rTTf,R, OTUNDI'RTAKINGIrIEE{Iq{E4
EX:TFEBORROWER
UNDERKVIC-PMEGP
FINAITCf,

To,
Thc Bnncb Manager,

l/Wehavebeensanctioned
wirh a lorn for Rs. (Rupees
for which necessary
documentshavebcencxecutedby mey'us.
vwc shar becomeerigiblefor Ma3in
M;ncy Assistmceof Rs. (Rupe€s
underthc abovc
schemconly 8fter KvIc aprov€s ny/cb cligibility for the Mrrgin Mon€y.pending
approval& admissionofthe ctaimby KVIC thc
MnrginMoneysubsidylmout|t mayb€rttainedin aTermDcpoohAccoulrtwith
thcBankin my/ournamefor threeyearswio licn ma*cd
forth€losnsEnctioned.
ln c'"€ ofnon-ldmbsion/ nonrpprovalofclaimbyKv tc th€Bankshall
beentithdto.
{a) Rctundthesubsidyin fu[ to rbeKVIC.
(bj Toconventhcsrnctioni ooneorthedher
ofits schernG.titssolediscrctionwithoutanyfunherrefer€nceto mein rhisrcgard.
(c) -lfurthcr
undenake
to bindmyselfmdrbldcbythedecisions/acdons tskenbytheBankio thisrg3ait asaforcsaid.

Yoursfaithfully,

Datc:

. Signat re of Dororver
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 On StampPaperofValueRs. 15i-

AIfiPAVTT

S/oShri Permanent
R/o Village PO. District
State

I solemnlydeclaredthat the informationsubmittedto KVIC/KVIB/DIC is correctin aUresp€ctup to the bestofmy lnowledge and

belief. FurtherI declarethat :-

1. I amProminentpenon ofthe societyandat presentthereis no liability pendingagainstm€for anyGow. Deparbnent/Co-operative

Soci€tyandindividual firms aswell astherein no anytrial pendingor underconsiderationwith crimeor fraud.

2. IamnotinGovt.Sewice.
3. I amapplyingfor loanunderPMEGpscheme.
4. I wi II setup theunit in therural areacertifi€dby therBvenuedeparEnentin th€Village PO
_
Tehsil Dist State
5. I will setupa newunit aftergettinglosnfrom bankunderPMEGPandwill not manipulatein anyrespectwitli old units.
6. I will abidecompletelyby therulesandregulatioms
laid downunderpMEGp scheme.
?' I will allow andco-operatethe Govt.officials to inspeatmy unit installedunderPMEGPscheme& duringthe in$pectionifthere is
any irreguladty or manipulationfound by KVIC/KVIB/DIC Officials, the concemedagencyhavei.rll authority to recoverthe
Margin Moneywith interest.
8. I will usetheloanamountunderPMEGPfor setingup tbeunit for wiich it is takenandwill notmis-utiliz€ it.
9. I will submittheprogressreportofthe unit seaup und€TPMEGP
slchemeto KVIC/RKVIB/DIC asthecasemy be,regularlyin time
. withoutfail.
10.1will befully responsiblefor anytypeofmisutilisationofthe loanunderpMEGpscheme.
I I Myselfor anyofmy family membershavenot availedanyfinancialassistance
underREGP,pMRy or anyotherschemeofcovt. of
hdia or StateGovemmedtscheme.
12.Ihavenotavail€d/ appliedforanysubsidyfiom anyotherDepartne forthepropos€dunit.

(DEPONENT)
Witness. l.

2. Signature
 T'NDERTAXING

underhke to dcposit own contibution in

(Name,address& Ph.No. of Bankwhichwill financaproject) Ph.No.

Address

r
 I'NDERTN,KING

undedake to deposit own contibution in

(Name, address& Ph. No. of Bank which will finance project)

Ph. No.

Yoursfaithfirlly

Signature
ofapplicant
Name

Address

Place:
Date: