National Minorities Development & Finance Corporation
 C. MICRO FINANCING SCHEMES
 
APPLICATION FORM FOR AVAILING MICRO CREDIT SCHEME. ANNEXURE - I
NATIONAL MINORITIES DEVELOPMENT AND FINANCE CORPORATION

APPLICATION FORMAT FOR AVAILING MICRO-CREDIT SCHEME

1. Organisation Directory

a. Name of the Organisation : _____________________________________
b. Address : _____________________________________
c. State : _____________________________________
d. District : _____________________________________
e. Block : _____________________________________
f. Phone No. (With STD Code) : _____________________________________
g. Fax No.(if any) : _____________________________________
h. Nearest Railway Station : _____________________________________
i. Registration No.of the Organisation
 : _____________________________________
j. Date of Registration : _____________________________________
k. Date of Renewal, if any : _____________________________________
l. Area of Operation
I) As per MOA
ii) For implementation of this programme
 : _____________________________________
m. Name of the Bank of Organisation
 : _____________________________________
n Account No. : _____________________________________
o. Name and Designation of Chief Functionary
 : _____________________________________

2. Details of socio-economic development programmes implemented by the organisation during the last three years (yearwise)
Year Name of the Programme Funded by Amount received Achievements
1. 2. 3. 4. 5.
         
         
         
Note: Please enclose a copy of your annual reports of last three years.

3. Experience of the organisation in Credit activity (yearwise)

a) Through SHGs
(Amount in Rs.)
Year Name of Activities for which loans given No.of SHGs No.of Borrowers Amount of loan disbursed Amount which was due for recovery i.e. Demand Amount actually recovered %age of Recovery to Demand 7/6 Source of funds
1. 2. 3. 4. 5. 6. 7. 8. 9.
                 
                 
                 

b) Directly to borrowers
(Amount in Rs.)
Year Name of Activities for which loans given No.of borrowers Amount of loan disbursed Amount which was due for recovery i.e. Demand Amount actually recovered %age of Recovery to Demand 6/5 Amount
outstanding at the end of the year		 Source of funds
1. 2. 3. 4. 5. 6. 7. 8. 9.
                 
                 
                 

4. Proposed lending programme in the current year

a) Through SHGs
(Amount in Rs.)
Name of Activities No. of SHGs No. of Borrowers Average Amount of Loan per beneficiary Total amount required
1. 2. 3. 4. 5 = (3x4)
         
         
         

b) Directly to borrowers
(Amount in Rs.)
Name of Activities No. of borrowers Average amount of loan per beneficiary Total amount required
1. 2. 3. 4 (2x3)
       
       
       

5. Resources available with the Organisation
(Amount in Rs.)
Sl. No. Source Balance at the beginning of year Amount expected during the current year Total amount
1. Own sources 3. 4. 5 = (3x4)
2. Saving of SHGs/ Members      
3. Recovery sources such as grants/donations etc.      
4. Borrowings (other than this application to NMDFC)      
5. Total      

6. Financial assistance required from NMDFC (i.e. para 5-6)
(Amount in Rs.)
Amount Name of Activities No. of SHGs No. of borrowers Average amount of loan per beneficiary Amount required from NMDFC
i) As per para-5          
ii) minus (-) as per para-6          
iii)Balance required from NMDFC          

7. Please indicate for NGO & SHGs terms and conditions for each type of lending in terms of:

a) Maximum amount per beneficiary.
b) Rate of interest charged and provision for penal interest
c) Security, margin money, if any, taken from the member.
d) Repayment period ; and
e) Type of documents taken under each category from the borrower.

8. Financial position of the organisation as per Balance Sheet (As on .......................)
i) Fixed Assets Rs..........................................
ii) Current Assets Rs..........................................
iii) Borrowings (Details of borrowing if any, may be given in the proforma mentioned below) Rs..........................................
iv) Other Liabilities Rs..........................................

(Amount in Rs.)
Name of the Lending Institution Date Amount borrowed Amount repaid Balance of borrowings outstanding
1. 2. 3. 4. 5.
         
         

9. Organisational Set-up and Training

i) Details of staff
(Amount in Rs.)
No. of staff withthe organisation Trained Untrained Total
1. 2. 3. 4.
       
       

ii) Details of arrangements available with the organization for training of its staff/SHGs.

10. Check List : (Please enclose the following)
Sl. No. Details of enclosures Yes/No Page No.
1. 2. 3. 4.
1. Attested Copy of the original Registration Certificate/Renewals 3. 4.
2. Attested copy of Memorandum of Association/Bye-laws    
3. Indicate the provision to borrow from outside agency (please give para/page No. Bye laws)    
4. Main objectives/purpose/background of forming the organisation - a brief note.    
5. Bio-data of the chief functionary.    
6. Composition of the current Managing Committee with name, designation and address of the members (with relevant copy of resolution of general body.)    
7. Copy of the audited accounts and Balance Sheet of the organisation for the last three years along-with Auditors Report    
8. Copy of the resolution passed by Management Committee seeking loan (amount Rs................) from NMDFC.    
9. Copies of Annual Report of last three years.    
10. Copies of testimonials received from funding agencies/Govt. Departments etc., if any.    

DECLARATION

I _______________________________________ (full name with designation) certify that the facts and figures furnished in the application form and the annexures are correct and tally with the records of our organisation.
Place:
Date : 		(Signature with official stamp)
Name & Designation of Chief Executive
   
Encls: __________ sheets  
 
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Micro Credit Scheme
Application form for availing Micro Credit Scheme. Annexure-I
Scheme of Interest Free Loan to NGOs
Application form for availing Interest Free Loan Scheme. Annexure-II