Vidya Lakshmi Common Education Loan Application Form

Student ID 349589

Application ID 275791

Bank Name State Bank of India

Bank Scheme Name SBI STUDENT LOAN SCHEME

Preferred Bank IFSC Code SBIN0040004

Preferred Bank Branch Name PALACEROADBRANCH KUPPAM

Date of Application 31-Jul-2018

1. Personal Information

Field Name Student Parent / Husband Co-obligant / Guarantor

Title Mr. Mrs.

First Name manapalli pavan praneeth k

Middle Name

Last Name sharma vasanthi

Father’s /Husband’s First Name manapalli manapalli

Father’s /Husband’s Middle Name

Father’s /Husband’s Last Name sreenivas rao sreenivas rao

Date of Birth 05/04/2018 26/02/2018

Category Others Others

Sex Male Female

Marital Status Single Married

Educational Qualification B.TECH BA

Marks obtained in Highest

64.32 55.0 0.0
qualification %

Occupation Student Employee

Income from all sources (Rs) 209000.00

PAN No.# DCUPP9578M ALZPV5614M

State Andhra Pradesh Andhra Pradesh

Address Line 1 14-398, North palace raod 14-398,north palace road

Address Line 2

Village / Area/ Locality kuppam kuppam

Block/Taluka /Sub-district/Town Chittoor Chittoor

PIN 517425 517425

Contact No. 8754329598 9000086467

pavan.praneethsharma16@gmail.c
e-mail Id kvasanthi1965@gmail.com
om

Present Banker Details

Branch IFSC SBIN0018403 SBIN0040004

Banker STATE BANK OF INDIA STATE BANK OF INDIA

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Bank Branch KAMATHAMUR KUPPAM

Account Type Savings Account Savings Account

SB / OD A/c No. 35627120578 64012699452

Direct/Indirect liability details (Rs)

2. Whether related to Chairman /Directors / employee of our Bank or any other Banks. No

If yes, details of relationship

3. Particulars of course, for which loan is required.

Whether under: Merit / Management Quota Management Quota

Name of the Institution KUPPAM ENGINEERING COLLEGE. CHITTOOR

Name of the Course M.TECH(ELECTRICAL ENGINEERING)

Duration of the Course 02 (Years) 02 (Months)

Date of Commencement 16/08/2017 Date of Completion 30/09/2019

Cost of Finance Details

4. Cost of Course / Source of Finance: (All amounts are in (Rs))

Particulars Year 1 Year 2 Year 3 Year 4 Year 5 Year 6 Total

Tuition fees 65000 65000 0 130000.00

Exam fees 0 0 0

Books Stationery 0 0 0

Equipment/Computer 45000 0 0 45000.00

Hostel Expenses 0 0 0

Sundries/Travel 0 0 0

TOTAL 110000 65000 0 175000.00

Own Source / Scholarship 0 0 0

Loan Required 110000 65000 0 175000.00

5.Details of securities offered

6.Prospects of earning after completion of the course

No. of Installments Amount (Rs) p.m.

Repayment proposed
60 2900.00

7.Uploaded Documents:

Marksheet

Proof Of Admission to the course

Schedule Of Expenses for the course, as given by institution

Proof of Income

Form16 (latest)

Applicant Photo

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Parent Photo

Co-obligant / Guarantor Photo

I / We declare that all the particulars and information given in the application form are true, correct and complete and binding on me / us. Further,
the above particulars shall form the basis of any loan Bank may decide to sanction to me / us. The loan amount will be used for the purpose for
which it is granted.

Signature of the Signature of the Signature of the

Student Parent/Guardian Co-obligant/Guarantor

Place:

Date:

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For office use

Credit Report No. Date : Customer ID/Application ID:

Details of security including

Rate of Repayment Whether eligible under CSIS
Nature of limit Amount (Rs.) Margin(Rs.) Personal Guarantee/Co-
Interest* conditions Scheme / (Yes/No)
obligation.

Other terms and conditions:

The Bank may revoke in part or in full or withdraw/stop financial assistance at any stage by giving reasonable notice to the borrower. Credit
facilities sanctioned are to be availed within 6 months from the date of this letter, failing which; the limits will automatically stand cancelled.

Manager/Senior Manager / Accepted all the terms and

Chief Manager /Asst Gen Manager conditions of sanction Borrower/s

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