F 157
Bank of Maharashtra
Branch: Sahebganj (Branch Code - 2232)
Personal Information of the Borrower / Guarantor for advances
PHOTO
I submit the personal information of myself, assets & liabilities as on
Name in Full
Father’s Name
Spouse’s Name
Residential Address
Permanent Address Present Address
Telephone No. office/ Shop
Mobile No.
Date of Birth Edu. Quali. Category Aadhar No.
Occupation / Business 1.Agriculturist
2.Businessman
3.Service man
4.Daily Worker
5.Other
If in Service:
Name of Employer
Address
Designation Present Posting at
Dt of Joining Dt of Retirement
Present Gross Salary Rs. Present Net Salary Rs.
1
If in Business / Profession:
Line of Activity:
Name of the Firm / Company / Shop :-
Address
Since when established
In which capacity representing Proprietor
Annual Income / Salary of Last Three Years
Rs. Rs. Rs.
Particulars of Legal Heirs
Sr. No. Name Relationship Age Present Address
1
2
3
4
5
6
7
Detail of the Assets
Detail of immovable properties ( Held in Own Name, Joint Name )
(Amt. in Rs)
Properties Location/address Agri/Res/Comm Area Present Value
(a) Total
Whether sole owner/jointly with ……………Sole owner…….
If held jointly, Share %: ……………………………………………………………….
Cost at the time of Purchase Rs.
Present Estimated Market Value Rs.
Whether encumbered/ un encumbered
If encumbered, Name of Charge holder
Detail of the movable properties
2
LIC policies
No. Dt of Sum Branch Annual Premium Surrender
issuance Assured Premium paid upto Value
what period
(b) Total
Shares/ Debentures / Mutual Funds
Name of the Total No. of Certficate Total Amt Whether Current Market
Company Shares Held No. Face Value Fully Piad Value
(c) Total
Savings / Term Deposits a/cs
Bank/ Branch Account No. Date Balance Rs.
(d) Total
Investment in Govt Securities/ NSC/ BONDS. GPF/ PPF:
Dt of issue Amount Name of Post Due Date Maturity Value
Office
NSC’S
Bonds
GPF/ SIF
PPF
Others
(e) Total (Present Value)
Detail of Vehicles:
2-W/ 4-W Maker/Brand Purchase- Year Reg. Purchase Price Present Value
No.
(f) Total
Capital invested in Business:
as on Balance Sheet Dt Rs. Net of Above Rs.
Full detail of Other Investments Rs.
Jewellery (with wife)
Furniture
3
Cash
(g) Total
(A) Total of All Assets a+b+c+d+e+f+g
Details of Loan facilities availed (CURRENT)
Type of Loan /C.C. Balance (in Lakh Rs)
Name of the Bank/ Branch
Purpose
Amount
Dt of availment
Repayment Schedule
ROI
Present O/s
Liabilities of others , if any
Others Contingent Liabilities
(B) TOTAL LIABILITY---
NET WORTH (T.A. - T.L.) =
(A) - (B)
In support of above declaration, photocopies of following documents enclosed:
PAN VOTER ID Telephone/ Electricity Bill Ration Card
Salary/ Copies LIC Bond NSC’S Shares/ TDR’S
Employment
Certificate
Title of Property/ Vehicle RC Book Bank A/c Pass Book Shop / SSI
House / Land Registration
Balance Sheet ITR Returns -3 Form 16 - 3 Years Bank Statement of
3 Years Years A/c - Loan
With assessment
4
orders
Loan Sanction
Letter / Banks
Certificate
(Delete whichever not applicable)
I declare that –
1. I am / I am not ( Tick as applicable ) a director in
………………………………………….
2. There is no litigation against me or the firm /Co. in which I am the proprietor/partner/
director.
3. The name of the firm /Co. or the name of the Partners/Proprietor/Director of the
Company is not on the caution list of RBI/ CIBIL
4. The Partners/Proprietor/Director of the Company are not the Director in any Bank/Co-
operative Bank
I further declare that the above information is complete, true & correct.
Date:
Place: Signatures
(Name and Address)
