Vidya Lakshmi Common Education Loan Application Form

Student ID 948462

Application ID 449086

Bank Name IDBI Bank

Education Loan to Physically Challenged Persons under NHFDC

Bank Scheme Name
scheme

Preferred Bank IFSC Code IBKL0000337

Preferred Bank Branch Name NELLORE

Date of Application 01-Apr-2019

1. Personal Information

Field Name Student Parent / Husband Co-obligant / Guarantor

Title Mr. Mr.

First Name LEELA KONDAPPA

Middle Name MADHU NAIDU

Last Name PASAM PASAM

Father’s /Husband’s First Name KONDAPPA MALAKONDAIAH

Father’s /Husband’s Middle Name NAIDU NAIDU

Father’s /Husband’s Last Name PASAM PASAM

Date of Birth 25/06/1997 25/12/1969

Category Others Others

Sex Male Male

Marital Status Single Married

Educational Qualification PURSUING MBA COURSE

Marks obtained in Highest

70.4 0.0 0.0
qualification %

Occupation Student Farmer/Agriculturist

Income from all sources (Rs) 100000.00 100000.00

PAN No.# EPHPP4236K

State Andhra Pradesh Andhra Pradesh

S/O P.KONDAPPA NAIDU P.KONDAPPANAIDU

Address Line 1 NEDURUPALLI (V) (POST), NEDURUPALLI (V) (POST)
PODALAKUR (M) PODALKUR (M)

Address Line 2

Village / Area/ Locality NEDURUPALLI NEDURUPALLI

Block/Taluka /Sub-district/Town Nellore Nellore

PIN 524309 524309

Contact No. 9440832332 9052366356

e-mail Id pleelamadhu@gmail.com srikanth419189@gmail.com

Present Banker Details

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Branch IFSC SBIN0006052

Banker STATE BANK OF INDIA

Bank Branch ADB PODALAKUR

Account Type Savings Account

SB / OD A/c No. 33434125332

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 Merit

Name of the Institution PONDICHERRY UNIVERSITY

Name of the Course MBA GENERAL MANAGEMENT

Duration of the Course 02 (Years) 00 (Months)

Date of Commencement 12/07/2018 Date of Completion 08/05/2020

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 4000 2500 6500.00

Exam fees 1000 1000 2000.00

Books Stationery 5000 2000 7000.00

Equipment/Computer 5000 45000 50000.00

Hostel Expenses 6000 4000 10000.00

Sundries/Travel 2000 2000 4000.00

TOTAL 23000 56500 79500.00

Own Source / Scholarship 0 0

Loan Required 23000 56500 79500.00

5.Details of securities offered

6.Prospects of earning after completion of the course

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

Repayment proposed
0.00

7.Uploaded Documents:

Marksheet

Proof Of Admission to the course

Proof of Income

Applicant Photo

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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.

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Manager/Senior Manager / Accepted all the terms and
Chief Manager /Asst Gen Manager conditions of sanction Borrower/s

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