Online Loan Application form for MSME & SME

* Fields must be filled.
Select nearest Branch where loan required 
1. Name of the Factory / Shop / Unit* 2. Registered Office Address* 3. Address of Factory/Shop/Unit* 4.Does the loan applicant belong to SC/ST/OBC/Minority Community*
SC  ST  OBC  Minority  Other
5. Telephone Number* 6. Email* 7. Mobile Number* 8. PAN*
9. Constitution* 10. Date of establishment*
Proprietary  Partnership Firm  Pvt. Ltd
Ltd. Company  Co-op Society 
date picker

11. Name of Proprietor/Partners/Director of Company and their addresses

Name* Date of Birth* PAN* Academic Qualification* Residential Address* Telephone / Mobile Number* Years of experience*
(a) Proprietor date picker
(b) Partner date picker
(c) Director date picker
12. Activity*

13. Names of Associate Concerns and nature of association:

Names of associate concern Address of associate concern Presently banking with Nature of association Extent of interest as a Prop./Partner/Director or just investor in associate concern
14. Relationship of Proprietor/ Partner/ Director with the officials or Board of Directors of the Bank

15(a). Credit Facilities (Existing):

Type of facilities Limit(INR Lakh) Outstanding(INR Lakh) as on
date picker
Presently Banking With Security Lodged Rate of Interest(%)
per annum
Repayment Terms
(in months)
Do you bank with DCB Bank ? Please mention account number
Any other facilities
Cash Credit
Term Loan
15(b). It is certified that our unit has not availed any loan from any other bank/ financial institution in the past and I am not indebted any other bank/ financial institution other than those mentioned in 15(a) above.

16. Credit Facilities (Proposed):

Type of facilities Amount(In Rs.) Purpose for which required Security Offered
PRIMARY SECURITY(Details with approx. value to be mentioned) INR Lakh Is Collateral security offered? (Select Yes/No. If yes, please provide details in row 17 - Details of Collateral Security Offered)
Cash Credit Yes  No
Term Loan Yes  No
LC/BG Yes  No
In case of Term Loan requirements, details of the machinery may be given as under:
Type of Machine Purpose for which required Whether imported Name of supplier Total cost of machine(INR Lakh) Promoters Contribution (INR Lakh) Loan required(INR Lakh)
Yes  No
Yes  No
Yes  No
17.Details of Collateral Security offered, if any, including 3rd party guarantee.

18. Past Performance/ Future Estimates (Actual performance for two previous years, current year and projections for next year to be provided for Working Capital facility. However for the Term Loan Facility projections to be provided till the proposed year of repayment of loan):

(INR Lakh) PAST YEAR-II (Actual)* PAST YEAR-I (Actual)* PRESENT YEAR (Estimate)* NEXT YEAR (Projection)*
Net Sales
Net Profit
Capital (Net Worth in case of companies)

19. Status regarding Statutory Obligations:

Statutory Obligation Whether complied with Remarks or details with regards to the relevent obligation
1. Registration under Shops and Establishment Act Yes  No  NA
2. Registration under SSI (Provisional/Final) Yes  No  NA
3. Drug License Yes  No  NA
4. Latest Sales Tax return filed Yes  No  NA
5. Latest Income Tax return filed* Yes  No  NA
6. Any other statutory dues remaining outstanding Yes  No  NA
20. Date*
I/we hereby unconditionally and irrevocably agree, understand and certify that access to any changes/updates in the terms and conditions applicable to this relationship shall be available on the Bank's website only; all information furnished by me/ us is true, correct and complete to the best of my/ our knowledge and I/ we have not withheld any information; I/ we have no borrowing arrangements for the unit except as indicated in the application; there is no overdue/statutory dues against me/us/promoters except as indicated in the application; no legal action has been/is being taken against me/ us/ promoters, nor I/ we have had any insolvency proceedings initiated against me/ us nor I/ we have ever been adjudicated insolvent; I/ we shall furnish all other information that may be required by you in connection with my/ our application; the information contained herein as also any further information furnished by me/ us may be shared/exchanged by you and/ or Reserve Bank of India, with any agency, as may be deemed fit; your representatives, representatives of Reserve Bank of India or any other agency as authorized by you and/or Reserve Bank of India may, at any time, inspect/verify my/ our assets, books of accounts etc. in my/ our factory/ business premises at the address given above or at any place wherefrom I/ we am/ are running my/ our business; the Bank reserves the right to reject any application without providing any reason and/or reference to me/ us and that the Bank reserves the right to retain the application forms, and the documents provided therewith, including photographs, and shall not return the same to me/ us.
 I have read and agree the Terms & Conditions

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