Annexure-III

APPLICATION FORM

FINANCIAL ASSISTANCE UNDER MICRO CREDIT SCHEME IN CASE OF NGO’S APPLIED DIRECTLY TO NHFDC

i) Name of Applicant of Organization                                                                                                 (Amount in Rs.      ‘000)
                                                                                 Regn. No:                                                        

                                                                                                                                                         Date:               

ii) Are of Operation                                                                                         

iii) Main activities/Objectives

iv) Composition of its Management Committee

     (Name, Address, Occupation of each member)    

1. LENDING PROGRAMME FOR FUNDS BEING SOUGHT FROM NHFDC

(i) DIRECTLY TO BORROWERS

(ii) PROPOSED TO BE LENT THROUGH SELF HELD GROUPS (SHGs)

2.TERMS AND CONDITIONS FOR EACH TYPE OF PROPOPSED LENDINGS IN TERMS OF :

a)      Rate of interest charge and provision for panel interest

b)      Security/margin money, if any, taken from members

c)      Repayment period; and

d)      Type of documents taken under each category from the borrower.

3. BORROWING RAISED FROM BANKS AND OTHER ORGANIZATIONS:

a)      Name of organization from whom borrowed

b)      Amount borrowed

c)      Purpose

d)      Balance Outstanding

e)      Whether repayment is made regularly

f)        Amount defaulted

4. FINANCIAL ASSISTANCE REQUIRED FROM NHFDC

5.DETAILS OF EXTENSION/FIELD STAFF AVAILABLE WITH NGO & SHGs FOR CREDIT BUSINESS

a) Supervisory Staff                                                                        No. of officials

b) Field staff/extension workers                                                       No. of officials

6.PLEASE ATTACH THE FOLLOWING:

a)      A copy of Bye Laws (with enabling clause to borrow/take loan) and Bye Laws of SHG’s (if any).

b)      Printed Balance Sheet, Income & Expenditure A/c and Annual Report for the last three years of NGO and sample Balance Sheet of 5 SHG’s if any.

c)      Name of the main banker.

d)      A copy of resolution of Management Committee for borrowing from NHFDC and whether SHG’s have passed similar resolution.

e)      Copies of testimonial received from foreign donors / Government Department etc.

Please indicate, whether terms and condition of borrowing from NHFDC as given in annexure and agreement are acceptable.

DECLARATION

I ………………………………………………………………………………….. (full name) Certify that the facts and figures furnished in this application form are correct and tally with the records of our organization. 

                                                                                    Signature

Date:                                                                                                                                                                              Name of the Chief Executive