APPLICATION FOR LOAN

FINANCIAL ASSISTANCE UNDER MICRO CREDIT SCHEME  FOR NGOs APPLY DIRECTLY TO NHFDC

(Amount in Rs. ‘000)

i)             Name of Applicant Organisation                                                                                              Regn. No.:

                                                                                                                                                                 Date         :                          

ii)                  Communication Address & Phone No.

iii)                Area of operation

iv)                Main activities/objectives

v)                  Composition of its Management Committee

(Name, Address, Occupation of each member)

1.       LENDING PROGRAMME FOR FUNDS BEING SOUGHT FROM NHFDC

(In Rupees)

i)        DIRECTLY TO BORROWERS

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

            1.         Name of the SHG                                             :

2.         Date of formation of SHG                                 :

3.         Particulars of members                          :

4.         Name of bank and account no. of SHG :

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

a)            Rate of interest charged and provision for penal interest

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

c)            Repayment period; and

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

3         BORROWING RAISED FROM BANKS AND OTHER ORGANISATIONS :

a)            Name of the organisation 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

(Please indicate average salary payable to the above staff)

6.            (I)           PLEASE ATTACH THE FOLLOWING :

a)            Copy of registration certificate along with renewal copy of registration. A copy of Bye laws (with enabling clause to borrow/take loan) and Bye laws of SHGs (if any) with approved copy of MOA authenticated by the Registrar of the Societies.

b)            Printed Balance Sheet, Income & Expenditure A/c. and Annual Report for the last 3 years of NGO and sample Balance Sheets of 5 SHGs, if any.

c)            Name of the main banker with Account Number.

d)            Resolution of management Committee, for borrowing from NHFDC and whether SHGs have passed similar resolutions with the signature of all the members of the Committee.

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

Please indicate, whether terms and conditions 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

Name of the Chief Executive

Date :________________