APPLICATION FORM SEEKING CREDIT FACILITIES FOR INVOICE DISCOUNTING FOR OFFICE USE ONLY (TO BE FILLED BY THE RESPECTIVE RM)

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1 APPLICATION FORM SEEKING CREDIT FACILITIES FOR INVOICE DISCOUNTING FOR OFFICE USE ONLY (TO BE FILLED BY THE RESPECTIVE RM) APPLICATION # APPLICATION DATE SYSTEM GENERATED APPLICATION SYSTEM TO GENERATE THE DATE AUTOMATICALLY AFTER RM APPROVES THE APPLICATION Customer Type New Existing # Application No. and Application date to be generated when customer submits application form IMPORTANT INSTRUCTIONS: 1. Please read the application form carefully before filling it up. Fill the application form and tick where applicable. Mention N.A where not applicable. 2. Please forward to us filled in application form duly signed on all pages along with relevant enclosures 3. Please enclose Address Proof and ID Proof for all directors and the entity.(directors to be self attested and entity to be attested by the authorized signatory with seal) MANDATORY REQUIREMENTS: Application form to be duly filled signed and stamped. Kindly ensure that you have enclosed all the documents as mentioned in the checklist to enable us to process your request expeditely. Processing of your loan request may be delayed due to incomplete documentation. Processing fee of Rs to be paid. Please note this is non-refundable fee must be paid along with the duly completed application form. Payment can be made through Cheque / RTGS/NEFT /Credit card/debit Card. Cheque to be issued favoring Bank details for sending RTGS: Bank name and branch: A/c no: IFSC Code: PLEASE SEND FILLED IN APPLICATION FORM TO; CALIBRE FINANCIAL SERVICES LIMITED NO.67, I FLOOR, BAZULLAH ROAD, T.NAGAR, CHENNAI PH.NO: , FAX: , Page 1 of 6

2 DETAILS OF APPLICANT I/We request you to sanction Credit facility of Rs (Rupees Only). 1. Name of the Applicant.. 2. Constitution: Company Partnership Firm Sole Proprietorship 3. Registered Office Address: a. Address:. b.telephone:. c. id: 4. Address for Correspondence: SAME AS ABOVE a. Address:.. b.telephone:. c. id: 5. Contact Details: (Minimum 2 persons contact details are required) Name of the Contact Person 1:. Contact No: Id: Name of the Contact Person 2:. Contact No: Id: 6. Website address of the applicant: www 7. Date of Incorporation : D D / M M / Y Y 8. Date of business commencement : D D / M M / Y Y Page 2 of 6

3 9. Nature of Activity: Existing* Proposed * *If different from the existing activity 10. Name of Proprietor/Partners/Promoter Directors/Executive Directors of the Company and their Addresses: (Id proof and Address proof of Proprietor/Partners/Directors to be enclosed.) *(Fix Max Column width and wrap text) NAME PAN NO I II III IV DIN NO(Applicable if Director) DATE OF BIRTH ADDRESS I hereby agree and give consent for disclosure by Calibre Financial Services Limited of all or any such ; a. Information and data relating to me/us; b. information or data relating to any credit facility availed of/ to be availed, by me/us and; c. Default, if any, committed by me/ us, in discharge of my/ our such obligation, as Calibre Financial Services Limited may deem appropriate and necessary to disclose and furnish to Credit Information Bureau (India) Limited and any other agency authorized in this behalf by RBI. 11. Details Of Facility Enjoyed by the applicant: *(Fix Max Column width and wrap text) BANK/FINANCIAL INSTITUTION NAME NATURE OF FACILITY LIMIT SANCTIONED (Rs.) OUTSTANDING AS ON DATE (RS.) PURPOSE SECURITY OFFEREDIF ANY Page 3 of 6

4 DETAILS OF CURRENT REQUIREMENT Sl. No 1. List of Top 5 Suppliers and Customers Top 5 Customers Supplies per Month (Rs. In Lakhs) Credit Days from Customers Top 5 Suppliers Purchases per Month (Rs. In Lakhs) 2. Invoice Discounting limit required towards Purchases Sales 3. In Case of Purchase Invoice Discounting Please furnish the following: Name & address of the supplier who are going to draw Invoices Nature of Products Supplied Sales per Month-In Volume Sales per Month-In Rs. Credit Days 0-30 Days Days Days 4. In Case of Sales Invoice Discounting Please furnish the following: Name & address of the Party to whom supplies are being made and who would give an undertaking that payment would be made on the due date Nature of Product Purchased Sales per Month-In Volume Sales per Month-In Rs. Page 4 of 6

5 Credit Days 0-30 Days Days Days 1. Please indicate if any Supplier/Buyer belongs to the same group/or subsidiary of the Applicant Company. If yes please specify... Declaration: Y N A. I / We certify that all information furnished by me / us is true; that I / We have no borrowing arrangements for the unit except as indicated in the application; that there is no overdues / statutory dues against me / us / promoters except as indicated in the application; that no legal action has been / is being taken against me / us / promoters; that I / We shall furnish all other information that may be required by you in connection with my / our application; that this may also be exchanged by you with any agency you may deem fit and you, your representatives, representatives of the Reserve Bank of India or any other agency as authorized by you, may, at any time, inspect / verify my / our assets, books of account, etc in our factory / business premises as given above. Accordingly, I / We, hereby agree and give consent for the disclosure by Calibre Financial Services Limited of all or any such; (a) Information and data relating to me / us; (b) The information or data relating to any credit facility availed of/to be availed, by me / us, and (c) Default, if any, committed by me / us, in discharge of my / our such obligation as the Bank may deem appropriate and necessary, to disclose and furnish to Credit Information Bureau (India) Ltd. (CIBIL) and/or any other agency authorized in this behalf by RBI. B. I / We, declare that the information and data furnished by me / us to the you or your representatives are true and correct. Date: Place: (Authorized Signatory/ Partner/ Proprietor/Directors - sign & stamp) Authorized signatory/ies Page 5 of 6

6 CHECKLIST OF DOCUMENTS FOR INVOICE DISCOUNTING 01. ID Proof of Director/Partners Voter s ID card / Passport / Driving license 02. IT Pan Card of the Company/Firm/Entity 03. IT Pan Card of the Directors/Partners/ Proprietor 04. Signature Verification Card from present bankers for Director, Partner, Proprietor 05. Proof of residence of Proprietor/ Partners / Directors Recent telephone bills, electricity bill, property tax receipt /passport / voter s ID card 06. Proof of business address - Recent Telephone Bill, Electricity Bill. Property Tax Receipt 07. MOA & AOA along with Certificate of Incorporation for company /Partnership deed along with registration certificate for firm 08. SSI / MSME registration, if applicable. 09. Profile of the Company/Firm/Entity (Including List of Directors/Partners, Shareholding pattern, Nature of activity undertaken etc.) 10. Last three years audited Financials of the Company/Firm/Entity along with IT Returns 11. Current Year Estimated Financials of the Company/Firm/Entity 12. Projected Financials for the next two years of the Company/Firm/Entity 13. Last three years Audited balance sheet of Associate/Group Company if any 14. Sanction Letter copies for limits enjoyed if any of the Company/Firm/Entity (The check list is only indicative and not exhaustive and depending upon the Requirements additional documents to be called for) Please return the completed form by and you can courier the form to us at: CALIBRE FINANCIAL SERVICES LIMITED NO.67, I FLOOR, BAZULLAH ROAD, T.NAGAR, CHENNAI PH.NO: , FAX: , Page 6 of 6

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