Name of the Bank:

cSad dk uke %

Branch Name:
'kk[kk dk uke %

BIHAR STUDENT CREDIT CARD SCHEME

fcgkj LVwMsUV sfMV dkMZ ;kstuk

APPLICATION CUM APPRAISAL FORM FOR EDUCATION LOAN

'kS{kf.kd _.k gsrq vkosnu&lg&ewY;kadu izi=

(PLEASE COMPLETE ALL PARTICULARS
IN BLOCK LETTERS AND TICK BOXES
WHEREEVER APPLICABLE)

d`Ik;k cM+s v{kjksa esa iw.kZ fooj.kh nsa rFkk ckWDl eas lgh
fpUg yxk;sa tgk ekU; gks

Signed photograph
of Student

Signed photograph
of Co-Applicant

fo|kFkhZ dk gLrk{kfjr
QksVks

lg&vkosnd dk gLrk{kfjr
QksVks

CIF No. (FOR OFFICE USE)

CIF No.dk;kZy; O;ogkj gsrq
ACCOUNT No. (FOR OFFICE USE)

[kkrk la[;kdk;kZy; O;ogkj gsrq

(1) PERSONAL INFORMATION OF THE APPLICANTS

vkosnd@lg&vkosnd dh iw.kZ tkudkjh

Name in full of the Student

fo|kFkhZ dk iwjk uke

Name in full-Parent/Guardian

ekrk&firk@vfHkHkkod dk iwjk uke

First Name

Middel Name (Father/Husband)

izFke Hkkx
The name in which the correspondence should
be addressed (Mention 1st or 2nd applicant)

e/; Hkkx
Applicant

vkosnd

Surname

miuke
CO-APPLICANT

lg&vkosnd

i=kpkj gsrq uke izFke vFkok f}rh; vkosnd dk mYys[k

djsa
PARTICULARS

fooj.k

STUDENT(Applicant)

fo|kFkhZvkosnd

CO-APPLICANT

lg&vkosnd

1. Name

uke
2. Father's Name

firk dk uke
3. Mother's Name

ekrk dk uke

4. Detailed Residential Address (House No.

Road Name, Locality, City, Pin, District,State)

vkoklh; irk dk iw.kZ fooj.k vkokl la-]lM+d

la-]eqgYyk]'kgj]fiu]ftyk]jkT; bR;kfn
5. Office Address (House No. Road Name,
Locality, City, Pin, District,State)(if applicable)

dk;kZy; irk dk iw.kZ fooj.k vkokl la-]lM+d

la-]eqgYyk]'kgj]fiu]ftyk]jkT; bR;kfn;fn ykxw gks

6. Permanent Residential Address (House No.

Road Name, Locality, City, Pin, District,State)

LFkk;h vkoklh; irk dk iw.kZ fooj.k vkokl la-]lM+d

la-]eqgYyk]'kgj]fiu]ftyk]jkT; bR;kfn

1 OF 8

PARTICULARS

STUDENT(Applicant)

CO-APPLICANT

fooj.k
7. Address for correspondence (Tick appropriate
box)

i=kpkj dk irkmi;qDr ckWDl esa lgh fpUg yxk;sa

Residential Address

Office Address

vkoklh; irk

Permanent Address

dk;kZy; irk

LFkk;h irk

8. E mail address

bZesy vkbZ Mh

9. Date of birth (DD/MM/YYYY)

tUe frfFk (DD/MM/YYYY) QkWesV esa

10. Age (On Date of Application)

Years

mez vkosnu dh frfFk dks

Months

11. Telephone Number (Personal & Residence) Mobile eks-

nwjHkk"k la[;k O;fxr ,oa vkokl

12. Telephone Number & Fax (Office)

nwjHkk"k la[;k ,oa QSDl dk;kZy;

Years

Months

Mobile eks-

Residence vkokl
office dk;kZy;

Residence vkokl
office dk;kZy;

Fax QSDl

Fax QSDl

13. Whether personal telephone is owned, if

not the type of relationship with the owner :

D;k O;fDrxr nwjHkk"k miyC/k gS] vxj ugha rks nwjHkk"k

ekfyd ds lkFk laca/k
14. Sex

15. Marital Status (Please also tick Single if

no living spouse)

Single

Resident

fyax

oSokfgd fLFkfrd`Ik;k ,dy ij lgh fpUg yxk;s vxj

thoulkFkh thfor u gks
16. Residential Status (indicate date of
permanent return, if any)

vkoklh; fLFkfrd`Ik;k LFkk;h fuoklh gksus dh frfFk

n'kkZ;sa
17. Type of identification Proof (Please indicate (a)
name of the document at (f), if any other

igpku izek.ki= d`Ik;k dkxtkr dk uke n'kkZ;sa

one document is required for identity
and one document is required for
address proof.
igpku gsrq 1 vfHkys[k ,oa irk ds igpku gsrq 1
vfHkys[k vko';d gksxkA

(b)

Married

Single

Married

NRI/PIO

Resident

NRI/PIO

Aadhar Card
(Mandatory)

(a)

vk/kkj dkMZ
vko';d

Passport No.
(if available)

PAN Card No.

(mandatory)

(b)

Voter ID
(if available)

(c)

(d)

Residence
Certificate
(if available)

(e)

Others

(f)

vU;

Voter ID
(if available)

oksVj vkbZ-Mh
vxj miyC/k gks

vkokl
izek.ki=vxj
miyC/k gks
(f)

PAN Card No.

(if available)

iSu dkMZ lavxj miyC/k gks

oksVj vkbZ-Mh
vxj miyC/k gks
(e)

Passport No.
(if available)

ikliksVZ la[;k
vxj miyC/k gks

iSu dkMZ lavko';d

(d)

Aadhar Card
(if available)

vk/kkj dkMZ
vxj miyC/k gks

ikliksVZ la[;k
vxj miyC/k gks
(c)

Residence
Certificate
(if available)

vkokl izek.ki=
vxj miyC/k gks
Others

vU;

vkosnd ,oa lg&vkosnd nksuksa dk Email id okaNuh; gSA lg&vkosnd dk Email id miyC/k ugha gksus dh fLFkfr esa vkosnd dk Email id Hkh lg&vkosnd dsEmail id es
avafdr fd;k tk ldrk gSA

2 OF 8

18. Do You belong to

SC

vuq-tkfr

lacaf/kr oxZ

ST

vuq-tutkfr

BC-II

SC

BC..

BC-I

ST

BC-I

fiNM+h tkfr

vR;ar fiNM+h
tkfr

vuq-tutkfr

General
Children

vkfJrksa dh la[;k

larku

vR;ar fiNM+h
tkfr

General

lkekU;
19. Number of dependents

fiNM+h tkfr

vuq-tkfr

lkekU;
Others

Children

vU;

larku

Others
vU;

20. Educational/Professional qualification

(Highest to be given)

'kS{kf.kd@O;olkf;d ;ksX;rk mPpre ;ksX;rk vafdr

fd;k tk;s

If Yes, Please enclose Proof thereof.

vxj gk rks izek.ki= layXu djsa A

(2) FINANCIAL /INCOME INFORMATION OF THE CO-APPLICANT

lg&vkosnd dh vkfFkZd fLFkfr ds laca/k esa tkudkjh

1. Monthly Gross Salary / Income

ekfld ldy vk;

2. Monthly Net Salary / Income

'kq) ekfld vk;

3. Particulars of deductions from gross salary / Income

ldy vk; ls dVkSrh fooj.kh

4. Other Income as per. I.T. return

vk;dj fjVuZ ds vk/kkj ij vU; vk; lzksr

5. Annual Income as per I.T. return

vk;dj fjVuZ ds vk/kkj ij okf"kZd vk;

(3) EMPLOYMENT DETAILS OF THE CO-APPLICANT

lg&vkosnd ds fu;kstu ls lacaf/kr tkudkjh

1. Name of the employer

fu;kstudkkZ dk uke
2. Name of the department

foHkkx dk uke
3. Designation & Employee No. (if available)

inuke ,oa deZpkjh la[;kvxj miyC/k gks

4. No of years of present employment.

okZeku fu;kstu dh vof/k

5. Date of retirement

lsokfuo`fk frfFk
(4) DETAILS OF SECURITY OFFERED (Security not necessary for loan upto Rs. 4 lakhs)

izLrqr izfrHkwfr dh fooj.kh4 yk[k rd ds _.k gsrq izfrHkwfr vko';d ugha

(A) IMMOVABLE PROPERTY

vpy lEifk
Plot/Flat/House No.

IykWV@ySV@vkokl la[;k

Title deed

In the name of

LokfeRo foys[k

LoRokf/kdkjh dk uke

Lease/Freehold

yht@iw.kZ LokfeRo

Address

irk

Estimated Market Value

vuqekfur cktkj ewY;

Date

frfFk

3 OF 8

(B) VEHICLE/Car-Please give details

including registration number, etc

okgu@dkj&d`Ik;k fuca/ku la[;k dk mYys[k djsa

(C) Others securities

vU; izfrHkwfr

Name of the Security

izfrHkwfr dk uke

Serial No.

Name of the holder

e la[;k

/kkjd dk uke

Maturity value

ifjiDork jkf'k

Estimated Market Value

vuqekfur cktkj ewY;

(5) DETAILS OF THE COURSE/STUDY

dkslZ@ikB~;e dh tkudkjh
1. Name of the Proposed Course of Study

izLrkfor ikB~;e dk uke

2. Name of the College/ Institution

egkfo|ky;@laLFkku dk uke

3. Name of University/Autonomous Institute to which affiliated

fo'ofo|ky; dk uke ftlls lac) gS

4. Duration of course

ikB~;e vof/k

5. Date of Commencement of course

ikB~;e izkjEHk gksus dh frfFk

6.

Expected monthly income of student after completion of

the course

ikB~;e lekfIr gksus ds mijkar vuqekfur ekfld vk;

7. Employment potential after completion of course

ikB~;e lekfIr ds mijkar fu;kstu {kerk

(6) LOAN REQUEST SECTION

_.k vkxzg izHkkx

COST OF THE COURSE

ikB~;e 'kqYd
1. Tuition fees

f'k{kk 'kqYd

SOURCES

lalk/ku
1. Details of non repayable
studentship fellowship, etc,
available to the Student

Nk= dks miyC/k vHkqxrs; Nk=o`fk

bR;kfn dh fooj.kh

2. Essential Books,

Stationery, equipments, if
any
vko';d ikB~;iqLrd]ys[ku lkexzh
midj.k bR;kfn

2. Details of repayable studentship

fellowship, etc, available to the
Student

Nk= dks miyC/k Hkqxrs; Nk=o`fk

bR;kfn dh fooj.kh

3. Examination fees
ijh{kk 'kqYd

3. Details of funds available

4. Maintenance expenditure
vuqj{k.k O;;

4. Amount of loan applied for

_.k dh vkosfnr jkf'k

from family sources for the

course
ikB~;e gsrq ikfjokfjd lzksrksa ls
miyC/k fuf/k dh fooj.kh

5. Insurance premium for the

duration of loan and start

up period
ikB~;e vof/k rFkk LVkVZ vi vof/k
dk chek izhfe;e

4 OF 8

6. TOTAL (Should tally

with the Sources)

TOTAL (Should tally with

the cost)

dqy 'kqYdlalk/ku ls jkf'k dk

feyku vko';d

dqy lalk/ku dqy 'kqYd ls jkf'k dk

feyku vko';d
(7) DETAILS OF FINANCIAL WORTH OF THE CO-APPLICANT

lg&vkosnd ds vkfFkZd fLFkfr dh fooj.kh

PARTICULARS

iw.kZ C;kSjk

Details (Bank, Branch etc)

Amount (Rupees)

cSad] 'kk[kk dh fooj.kh

Bank's assessment

jkf'k:Ik;s esa

cSad dk ewY;kadu

1. Savings in Bank (Savings

Bank + Fixed Deposits)

cSad cpr [kkrkcpr [kkrk$fu;r

tek
1.a. How long the Account has
been maintained?

[kkrk fdrus o"kksZa ls lapkfyr gS \

2. Immovable property

vpy laifk dh fooj.kh

3. Current PF balance (Your

share)

okZeku Hkfo"; fuf/k fooj.khvkosnd

dk va'k

4. Investment in NSCs/Share/
Debentures/bonds, etc.

jk"Vh; cpr izek.ki=@

'ks;j@_.ki=@ckW.M~l esa fuos'k

5. Jewellery/Gold Ornaments

vkHkw"k.k

6. LIC/Postal life, etc.

thou chek@Mkd thou chek

bR;kfn
7. Capital in various firms (Your
share), HUF share and Share
in Associate Concern

fofHkUu O;kikfjd QeZ esa iwth

vkosnd dk va'k] fgUnw vfoHkkftr
ifjokj ,oa lac) laLFkkuksa esa va'k

(8) ADDITIONAL DETAILS OF BANK ACCOUNT OF THE CO-APPLICANT

lg&vkosnd ds cSad [kkrksa ls lacaf/kr vfrfjDr tkudkjh

Name of the a/c holder

[kkrk/kkjd dk uke

Type a/c

[kkrk dk izdkj

Name of Bank and branch

cSad ,oa cSad 'kk[kk dk uke

A/C Number

[kkrk la[;k

(9) DETAILS OF EXISTING LOANS (FROM ANY BANKS)

okZeku _.k fooj.kh fdlh Hkh cSad ls

Purpose

ms';

Bank Name/other details and

a/c No.

cSad dk uke@vU; fooj.kh ,oa [kkrk la[;k

Date of loan

_.k dh
frfFk

Loan Amt.

_.k jkf'k

Present
outstanding

okZeku cdk;k
jkf'k

Mode of
payment

Hkqxrku dh
rjhdk

Housing Loan

x`g _.k
Car loan

dkj _.k

5 OF 8

PF Loan

Hkfo"; fuf/k _.k

Borrowings from friends and
relatives

fe=ksa ,oa lacaf/k;ksa ls m/kkj

Credit Society

sfMV lkslkbZVh
Others (Please specify)

vU;d`Ik;k mYys[k djas

Other details

Details of security charged

EMI

vU; fooj.kh

ekfld fdLr

izLrqr izfrHkwfr dh fooj.kh

Housing Loan

x`g _.k
Car loan

dkj _.k
PF Loan

Hkfo"; fuf/k _.k

Borrowings from friends
and relatives

fe=ksa ,oa lacaf/k;ksa ls m/kkj

Credit Society
sfMV lkslkbZVh
Others (Please specify)
vU;d`Ik;k mYys[k djsa
(10) PROPOSED/PREFERRED REPAYMENT AND PAYMENT OF INTEREST

izLrkfor@vf/kekU; _.k vnk;xh ,oa C;kt dk Hkqxrku

Mode of Repayment (How Many Months or how many EMIs ?)

_.k vnk;xh dk rjhdkeghuk@fdLr dh la[;k

By Student

Nk= ds }kjk

By Guardian

vfHkHkkod ds }kjk

Payment of full interest as and

when applied during the
moratorium

_.k LFkxu dky esa C;kt Hkqxrku

No Interest will be paid during

moratorium

_.k LFkxu dky esa C;kt Hkqxrku ugh

(11) GENERAL

lkekU; tkudkjh
1. Do you have an existing relationship with the Bank,If so,
details thereof

D;k cSad ls iwoZ laca/k gS] vxj gk rks fooj.k nsa

2. Do you wish to open a Savings Bank with the Bank ?

D;k vki cSad esa u;k cpr [kkrk [kksyus ds bPNqd gSa \
3. Is any guarantee given to the Bank/other Bank

Yes

gk

D;k cSad@vU; cSad dks xkjaVh nh xbZ gS \

No

ugha

If yes, details thereof

vxj gk rks fooj.k nsa

(12) DOCUMENTS REQUIRED

Mark sheet & Certificate of Class X, XII & last qualifying examination of the student

eSfVd]$2 ,oa vafre lQy ijh{kk dk vadi= ,oa izek.ki=

Copies of letter conferring scholarship, free ship, etc.(if applicable)

izkIr Nk=o`fk] fu%'kqYd f'k{kk dk i= bR;kfnvxj ykxw gks

Documents evidencing duration of course of commencement thereof, viz Prospectus or Certificate from
the competent authority of the Institution(if the University is from Bihar, then its not needed)

ikB~;e vof/k ds lR;kiu gsrq laLFkku ds l{ke izkf/kdkj ls izkIr ikB~;e foojf.kdk vFkok izek.ki=A ;fn fcgkj ds vanj vofLFkr
egkfo|ky; gks] rks bldh vko';drk ugha gSaA
6 OF 8

Proof of a admission to the course

ikB~;e esa izos'k dk izek.ki=

Schedule of expenses for the course

ikB~;e 'kqYd dh fooj.kh vuqlwph

Copy of the PAN Card of Student & Guardian (both) before disbursement of Education Loan.

f'k{kk _.k foeqfDr ds iwoZ vfHkHkkod ,oa Nk= ds iSu dkMZ dh izfrfyfi
Two copies of Passport size photograph of the student/ parent /guardian/guarantor

Nk=@ekrk&firk@vfHkHkkod@xkjaVj dk ikliksVZ lkbZt QksVksxzkQ nks dkWih esa

Salary certificate & form 16 of previous year (In case of employed)

fiNys o"kZ dk osru izek.ki= ,oa QkWeZ 16 fu;ksftr gksus dh fLFkfr esa
I.T. Returns for the last 2 years (if I.T. Assessed) duly accepted by the ITO

fiNys nks o"kksZ dk vk;dj fjVuZ vk;dj nsus dh fLFkfr esa

Statement of bank account for the last six months of the guardian/parent.

ekrk&firk@vfHkHkkod ds fiNys N% ekg ds cSad [kkrksa dh fooj.kh

Proof of residence (Identity card/Passport/voter Identification card/Driving license)

fuokl izek.ki=igpku i=@ikliksVZ@oksVj igpku i=@MkbZfoax ykbZlsUl

Tax paid receipts etc. (Advance IT/Property Tax/Municipal Tax. etc.)

dj Hkqxrku jlhn bR;kfnvfxze dj@laifk dj@uxj fuxe dj bR;kfn

DECLARATION

?kks"k.kk

I/We hereby apply for a loan from---------------------(Name of the Bank) to the extent indicated in the Loan Request Section of this
application form. I/We declare that the foregoing particulars and information furnished in this application form are true, accurate
and complete and that they shall form the basis of any loan-------------(Name of Bank) may decide to sanction to me/us. I/We
confirm that I/We/Have/had no insolvency proceeding against me/us. Nor have, I/We been adjudicated insolvent. I/We further
confirm that I/We have read the terms and conditions and understood the contents therein. I/We am/are/aware that if I/We opt for
loan at floating rate of interest ,the equated Monthly installment will comprise Principal and interest based on----------------(Name of
Bank) Advance Rate which is subject to change from time to time.

eSa@ge _.k gsrq _.k vkxzg izHkkx esa mfYyf[kr jkf'k dh vf/klhek rd -------------------------cSad dk uke esa viuk vkosnu lefiZr djrk gw@ gSa A eSa@ge ?kks"k.kk
djrs gSa fd vkosnu i= es mfYyf[kr fooj.kh esjh@gekjh tkudkjh ds vuqlkj lgh] lVhd ,oa iw.kZ gS ,oa ------------------------------------cSad dk uke }kjk esjs@gekjs izek.k
i= esa dksbZ _.k Lohd`r fd;s tkus dk fu.kZ; dk vk/kkj xfBr djsaxs A eSa@ge laiq"B djrk@djrs gw@gSa fd esjs@gekjs fo:) fnokfy;kiu dk ekeyk yafcr
ugha gS ,oa u gh eq>s@ges l{ke izkf/kdkj }kjk fnokfy;k ?kksf"kr fd;k x;k gS A eSa@ge ?kks"k.kk djrs gSa fd eSaus@geus blesa Hkfjr rF;ksa ,oa 'kkksZ dk iw.kZ v/;;u
fd;k gS rFkk mUgsa lgh rjhds ls le>k gS A eSa@ge bl ckr ls voxr gw@gSa fd ;fn eSa@ge ifjorZu'khy C;kt nj ij _.k dk fodYi pqurs gSa] rks ekfld
fdLr ds nks ?kVd ewy/ku ,oa C;kt gksaxs] tks-----------------------cSad dk uke dk vfxze nj esa ifjorZu ds vuqlkj ifjorZu'khy gksaxs A
I/We agree that---------------------(Name of Bank) may at its discretion conduct discreet inquires in respect of this application. I/We
undertake to inform as to any change in my/our occupation/employment, residential address and to provide any further information
that the Bank may require----------------------(Name of Bank) will be a liberty to take such action as it may deem necessary if my/our
above statements are found to be untrue. I/We agree that-------------------(Name of Bank) shall have the sole discretion to
reject/reduce loan amount/our loan application without assigning any reason thereof. I/We further agree that my/our loan
transactions shall be governed by the rules of----------------(Name of Bank) which may be in force time to time. I also hereby give
my consent to send the application to loan processing cell for sanction if in order and disbursement on sanction for processing
Cell or any Branch as per process prescribed by-----------------------(Name of Bank). I may carry out future transactions at the,
above mentioned Branch as Home Branch.

eSa@ge lger gw@gSa fd--------------------cSad dk uke vius foosdkf/kdkj ds vk/kkj ij vkosnu esa of.kZr rF;ksa dh foosdiw.kZ tkp djkus esa l{ke gS A eSa@ge opu nsrs
gSa fd esjs@gekjs jkstxkj@fu;kstu] vkoklh; irk esa ifjorZu dh fLFkfr esa eSa@ge cSad dks lwfpr djsaxs rFkk cSad }kjk ;kfpr dksbZ vU; lwpuk Hkh miyC/k
djk;saxs A cSad izLrqr dFkuksa dh vlR;rk dh fLFkfr esa fcuk dkj.k crk;s _.k jkf'k dks j vFkok de djus gsrq Lora= gksxk A eSa@ge bl ckr ls lger gSa fd
_.k jkf'k dk ysu&nsu ---------------cSad dk uke ds le;≤ ij ykxw fu;eksa ds vk/kkj ij gksxk A eSa@ge bl ckr dh lgefr nsrk gw fd esjk vkosnu i= _.k
Lohd`fr gsrq cSad ds +_.k ize.k iz'kk[kk esa Hkstk tk, rFkk _.k dk Hkqxrku cSad }kjk fpfUg~r cSad 'kk[kk ----------------------------cSad dk uke ls fd;k tk, A eSa Hkfo";
eas mi;qDr _.k laca/kh ysu&nsu fufnZ"V cSad 'kk[kk ls gh d:xk A

Signature of the student

Place ..
Date ..

Signature of the CO-Applicant

Place....
Date...

fo|kFkhZ dk gLrk{kj
LFkku%
frfFk%

LFkku%
frfFk%

lg&vkosnd dk gLrk{kj

7 OF 8

At Branch/OSFAT-------------------Branch
(Date related to CIF Creation)
Greetings required
CIS Organization
code

Signature/s of the applicant obtained in our presence

and verified and sent to
-----------------------Branch on------------------------VIP Code (0 for
Customer Type
No, 1 for Yes)
Personal
Occupancy (Home
owner, tenant etc.)
Segment Code

Name &Signature
(Branch/OSF)
Relative Code
(father/spouse)
Customer evaluation
required
CIBIL Reference
Mode

SIGNATURE OF THE APPRAISING OFFICER

Date

vkosnd dh ?kks"k.kk

1
eSa viuk vk/kkj la[;k lefiZr djrk@djrh gw ,oa LosPNkiwoZd lgefr nsrk@nsrh gw fd ;w0vkbZ0Mh0,0vkbZ0 Hkkjr ljdkj }kjk fuxZr vk/kkj@;w0vkbZ0Mh0 la[;k dks esjs
uke ls la/kkfjr vkosnu esa of.kZr cSad [kkrk la[;k ds lkFk tksM+k tk;A
2
bls ,u0ih0lh0vkbZ0 (National Payment Corporation of India)esa ntZ fd;k tk;] rkfd ljdkj }kjk izR;{k ykHk varj.k Mh0ch0Vh0 ;kstuk ds rgr ykHk esjs mDr cSad [kkrk
esa izkIRk gks ldsA eSa le>rk@le>rh gw fd ;fn ,d ls vf/kd izdkj ds ykHk cdk;k gks rks eSa ml ykHk dks blh cSad [kkrs esa izkIRk djuk pkgwxk@pkgwxhA
3
;w0vkbZ0Mh0,0vkbZ0 }kjk iznk vk/kkj la[;k dks esjh igpku dks izekf.kr ,oa LFkkfir djus es mi;ksx fd;k tk;A
4
fcgkj LVwMsaV dzsfMV dkMZ ;kstuk gsrq vkosnu lefiZr djus ds fnu esjh vk;q 25 okZ ls vf/kd ugha gSA
5
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