Name of Borrower

Statement Of Select Operational Data For The Month Of:

A. Estimate for the current accounting a. Gross sales

year indicated in the annual plan b. Net sales

B. Sales a. During the month

b. During the current accounting
year up to the end of the month

C. Receivable including these in a. Due in respect of bill have been

respect of which will have been discounted purchased by the bank
negotiated in the month. b. Other outstanding debts
c. Total (A+B)

D. Sundry Creditors for purchase

outstanding as at the end of the month

E. Short term borrowings from the a. Cash Credit

banks including bill purchased and b. Bills Discounted
discounted. c. Total (A+B)

F. Details of opening and closing stock

Particulars Opening Closing Stock as on
Stock last day of the mon
Value of stock charg
Other Bank
a.
b.
c.
Total

Name of Borrower
of Borrower
(Rs. In lacs)

Closing Stock as on the

last day of the month
Value of stock charged to
This Bank
 BANK OF MAHARASHTRA - BRANCH - VIJAYNAGAR INDORE
Statement of stock hypothecated to bank as of
Name of the borrower :
Sr. Description of Place of Qty. Rate of Value Remarks
No. the Goods Storage Valuation (In Lacs)

1
2
3

4
5
6
7

8
Total Rs.
Creditors for Goods
Sales During the Month
Purchases During the Month

I/We solemnly declare that the quality, quantity and rates of the items noted over leaf hypothecated
to the Bank are correct and the said stock is either absolutely my/our own property or that I/We have
such an interest in the same as to hypothecate these to the Bank to the full extent of the Bank's
advance/s to me/us against these goods and that they are not subject to any lien, claim or charge
of any sort and on the strength of this declaration of mine/ours the accommodation has been granted.
In order to verify our above statement the bank is at liberty to get the goods weighed and valued at
any time at our expenses and I/We hereby agree to accept as conclusive proof, the result of such
weighment and valuation as certified by a duly authorised officer of the Bank. I/We further declare
that the place of storage is owned by me/us or is held by me/us as leassee/tenant.

I/We further declare that at present a hypothecation credit facility is being availed of by me/us with
the Bank of Maharashtra. I/We undertake that the stock is affered as security and therefore, the
same will not be hypothecated to any other Bank without prior approval in writing of the Bank
of Maharashtra and I/We also declare that necessary label/board/s has/have been disolayed to
indicate that the stock is hypothecated to the Bank of Maharashtra.

Name of Borrower along with seal

To be signed by the borrower/s (Exactly in the
same manner as cheques on the account
are signed two or more signatures being
appended in appropriate cases)

For Office Use Only

Date of Receipt
Expected Date of Receipt
Delay in No. of days
Received By
Signature of Branch Manager
Officer Incharge
 NAME OF THE BORROWER :
Statement of Bills Receivable/Book debts as on
(Applicable to the accounts having N.C. limits of Rs. 10 lakhs and above)
Sr. Name of the drawee whether Outstanding Bills Payment Return/ Net Of Which outstanding for
No. Sister/ as per last raised received rejection Balance upto between between above
Assoc.. Statement during during during 60 60 to 90 91 to 180 180
concern month month month days days days days
1 2 3 4 5 6 7 8 9 10 11

TOTAL

Total Books Debts Outstanding As On The Date Rs.

I/We solemnly declare that the information furnished over leaf towards the bookdebts hypothecated to the Bank is
true and all the bills have been raised on account of genuine trade transactions done by the company/firms during
the month. I/We have an interest in the same as to hypothecate these bookdebts to the Bank to the full extent of
the Bank's advance's to me/us against these bookdebts and that they are not subject to any lien, claim or charge
of any sort or have not been factored and on the strength of this declaration of mine/ours, the accommodation has
been a\granted. In order to verify our above statement the bank is at liberty to get the books of accounts/invoices
and such other records verified at any time at our expenses and I/We hereby agree to accept as conclusive proof,
the result of such verification done by a duly authorised officer of the Bank/Independent Chartered Accountant's
Firm appointed by the Bank. I/We further declare that all such invoices/books of accounts are in my/ore custody.

I/We further declare that at present a hypothecation credit facility is being availed of by me/us with the Bank of
Maharashtra. I/We undertake that the bookdebts are offered as security and therefore, the same will not be
hypothecated to any other Bank without prior approval in writing of the Bank of Maharashtra.

I/We also undertake to collect the bills and deposit the proceeds in our account with Bank of Maharashtra
branch or such other branches as specifically approved by Bank of Maharashtra in writing.

Name of Borrower along with seal

To be signed by the borrower/s (Exactly in
the same manner as cheques on the account
are signed two or more signatures being
appended in appropriate cases)
E OF THE BORROWER :
Bills Receivable/Book debts as on
ounts having N.C. limits of Rs. 10 lakhs and above)
Remarks
 BANK OF MAHARASHTRA, BRANCH VIJAYNAGAR
NAME OF THE BORROWER :
Statement of Trade Creditors as on
(Applicable to the accounts having W.C. limits of Rs. 10 lakhs and above)
Sr. Name of the Supplier Net Remarks
No. Balance
1 3

Total Rs.

Bills of small amounts upto Rs. 25,000/- may be clubbed.

Total Creditors Outstanding As On The Date Rs.
Bills raised on sister/Associate concerns for genuine trade transactions
Rs.