Kisan Credit Card-Animal Husbandry (KCC-AH)
To,
The Branch Manager,
Name of Bank *************i**************************************
Name of Branch *****************************""**********************
Address of Branch
LOANAPPLICATION FORM FOR
KISAN CREDIT CARD-ANIMAL HUSBANDRY (KCC-AH)
Madam/ Sir,
/We hereby apply for a Kisan Credit Card Animal Husbandry (KCC-AH) loan aggregating
RS. .Only) and furnish
below the necessary information.
A. For office Use:
Application SI. No.
Category of Applicant (Please mark v) Small Farmer Marginal Farmer Other
B. Purpose, Type and Quantum of KCc-AH Loan Facility: -
(Applicable Interview-cum-appraisalform to be enclosed to this opplicotion, depending upon the purpose of loan)
Loan Type Cattle/ Buffalo/ Poultry/Duck Goat/ Sheep Pig Other
Bullock Rearing Farming Farming Husbandry
Loan Amount (Rs.)
C. Particulars of the Applicant(s):
SI. Full Name(s) of the Date of Age Gender Aadhar No. Voter's ID/ DL/
PAN No. **
No. Applicant(s) Birth (Optional)
** Any one as per R8I KYC Norms)
D. Address with Contact Number (Correct contact number is mandatory)
Present Address Permanent Address (Mark V if same)
House House
Street/ Hamlet Street/ Hamlet
Village Village
Post Office Post Office
Locality/ Area Locality/ Area
District District
PIN Code PIN Code
Phone/ Mobile No. (1) (2)
E. Social Category- (Please mark v in the right box)
Social General OBC Physically Handicapped Minorities
Category ST
If Minority Muslims Christians Buddhists Sikhs Jains Parshi/ Other
Community
F. Details of family members:
Annual
SI. Name of Family Age Gender Relationship with Occupation
No. Memberss the applicant Income (Rs.)
1
Nameof the Karta (in case of Hindu Undivided Family/HUF:
G. Existing Banking/Credit Facilities
Types of Bank Facilities Name of Branch and Branch Account No. Deposit Balance/ Loan
Outstanding (Rs.)
Savings Bank Account
Fixed Deposit
KCC- Crop Loan / Other
Working Capital Loan
Term Loan
Other
if banking with this bank, customer ID to be given here:
H. Particulars of Assets of the Applicant(s):-
(f required, separate sheet may be ottoched with this opplication form)
Type of Asset Particulars Approx. Value (Rs.)
No
Land related
2 Building related
Vehicle related
Household goods related
5 Cultivation related
6 Animal Husbandry related
7 Other
Total Approx. Value (Rs.)
[Submission of land-building related documents is not mandatory except the applicable cases of collateral
security. KCCAH is not related to availability of land/ land document. There is requirement of owned/
leased/ rented shed or space for keeping the animals/ birds]
Applicant's present annual income along with the sources:
Incomefrom animal husbandry activities Rs.
2
Incomefrom agriculture activities RS.
3 Income from othersources (Specify) RS.
Total Income Rs.
. applied KCC-AH Loan:
Brief descriptions in relation to the
Type of animal husbandry activity: (Please mark Vin the right box)
Dairy Farming Poultry Farming Goat Rearing
()
Cattle i )Buffalo () Broiler i)Layer Sheep Rearing
(ii) Backyard Poultry PigHusbandry
Bullock Rearing Other
Number of Animals/ Poultry Birds/ Ducks available for one working capital cycle:
Brief particulars of one working capital cycle:
Particulars Amount (Rs.)
Recurring Cost:
Feed cost
Insurance cost (If required)
Cost of veterinary aid, medicine, A.l. etc.
Labour cost
5 Cost ofelectricity,fuel, wateretc.
6 Miscellaneous expenditure
Total Recurring Cost (A)|
Income:
Income from sale of milk/egg
Income from sale of animal/ birds
Incomefrom manure
4 Income from gunney bags
5 Income from other
Total Income (B)
Profit/ Benefit from one working capital cyele (A-8)
Amount of working capital loan applied under KCC-AH: Rs.
Description of other supportive facilities available for the activity:
Number of animal/ poultry birds/ ducks
available for the proposed scheme
Description of availability of owned/
leased/ rented shed or space for keeping
the animals or birds
Number of year of experience in the
proposed animal husbandry activity
Description of availability of other facilities
like water, electricity, equipments etc. for
theproposed activity
Availability of facilities of veterinary
services
Facilities of market to sale the produce
lonly h u laa, autuut laluh or M
hessed
K. Particulars of Security offered for the proposed KCC-AH loan:
Primary Security
Collateral Security (Where applicable)
esures
L. Guarantors offered (if any):
Telephone/ Occupation Net Worth
Name of the Age Residential
Mobile No. (Rs.)
Guarantor(s) Address
M. Declaration:
to the best
I/We hereby declare that all information furnished by me/us is true, correct and complete
those mentioned in
of my/ our knowledge and belief. 1/We have no borrowing/ liabilities excepting
details of
the application form. /We hereby authorities the Bank to disclose all or any particulars
or
information relating to my/our loan accounts with the Bank, to any other financial institution,
the Bank. It will be in
8Overnment of any agency(ies) as may be considered necessary or desirable by
facilities from the Bank in case it is
order for the bank to disqualify me/us from receiving any credit
of
proved that the declaration of my/our outside borrowings made above contain misrepresentation
in
facts. 1/We hereby undertake to abide by the terms and conditions that the Bank may stipulate
sanction of this loan and inform Bank in the event of acquiring any other assets during the tenure of
the advance. The Bank may take appropriate safeguards/action for recovery of bank's dues
3 3.
Signature/ Thumb Impression Signature/ Thumb impression
of Borrowers of Guarantors
Date: *******************
Place:se******s*******************
