BIHAR STATE EDUCATION FINANCE CORPORATION LTD.

BIHAR STUDENT CREDIT CARD SCHEME

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APPLICATION CUM APPRAISAL FORM FOR EDUCATION LOAN
~~ :;j[Uf -gg ~--m--~ ~
(PLEASECOMPLETEALL PARTICULARS
IN BLOCKLETTERSAND TICK (..J) BOXES
(WHEREVERAPPLICABLE)
~ ~ 31em B ~ fclcRulT ~ "Cll2.lT <Wm B Signed photograph
Signed photograph
"fltt (vrgT(..J) ~ 11Rf 51) of Student
Cj)T ~ of Co-Applicant
CIF No. (FOROFFICEUSE)
ClFNo.(~~~

ACCOUNTNo. (FOROFFICEUSE)
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(I) PERSONALINFORMATION OF THE APPLICANTS

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First Name Middle Name Last Name
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Full Name of the Student
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Full Name of Father

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Full Name of Mother

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Full Name of Husband (If Applicable)

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Full Name of Co-applicant
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Relationship of co-applicant with

Applicant
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Address
Applicant Co-applicant
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1. Address of Correspondence
(House No. Road Name, Locality,
City, Pin, District, State etc.)
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2. Permanent Address (House No.
Road Name, Locality, City, Pin,
District, State etc.)
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3. E-mail address
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4, Date of birth (DD/MM/YYYV)
\JPl~ (DD/MM/YYYV)

Page 1 of 5
S. Age (as on Date of Application) D Years D Months DYears
~ (~ ctT fc*r CI?T) \..
6. Telephone Number Mobile (1110) Mobile (1110)
(~~) Residence (m) Residence (m)
7. Telephone Number & Fax (Office) Institute (~) Office(~)
~ ~ IfCi ¢rffl (~ Fax (¢rffl)
ffl<!IT'1 ~ ~ ~ m
8. Sex T
OM OF OT OM
fWT
9. Marital Status
~~
o Single o Married o Single

10. Type of identification Proof and (a) Aadhar Card (a)

Residential proof (3ITCTl'X ~)
~qJT~"([?f1:[ti~~
I
"([?f (b) Residence (b) Residence
.:. At least one document is Certificate Certiflcate
required for identity and one (~~ "([?f) (~ ~"([?f)
document for address proof. (c) Voter ID (c) Vot;ID
(~~~~~1:[ti (cftcx ~o-;gro) (cftcx o-;gr0)
"([ClT ct ~ ~ ~ ~
~m-rnl) (d) First page of
(d)
bank passbook f1"t~Of
Bank pa sbook
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(e) Other
(e) Other
(3Rl)
(~

11. Category
~ D 31:l;. vnfu
SC
D BC-II
~vnfu D SC vnfu
31:l;. D
D 31:l;.
ST \JA\ifTfc'r
D BC-1
~~ D ST
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vnfu
General General
D ~ ~
Yes/ No
12. Do you belong to minority
Cfm 31TL[ ;>JC'4{i&:lCll ~ ~ ~ t?
Yes/ No
N /-.nft D N/-.nft D I

13. Required Minimum Education

qualification for applied course
io" o- iz" D From Bihar
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In case of outside Bihar
fiffiTx ~ ~ ctT ~ ~
weft <IT 12cff

;~:D D
State~
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14. Highest educational qualification
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15. Do you belong to disable
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2. Name of the College/Institution

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3. Name of the University to which it is affiliated
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4. Duration of course (Years)

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Page2 5
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~
.5, Date of Commencement of course
~~meft~
6. Address of the College/Institution
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7. Roll no. of applicant in institution

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(III) LOAN REQUESTSECTION

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1. Cost of the course and other fees (including hostel charges)

~ ~ "C[Ct 3Ri ~ (~ ~ cf; "fW.T)
2. Books and stationary (As per Annexure - 2 of the guideline)
"Cf"<').1-~ -w:rfr (1'I1'fc;~f<t>1eft ~ - 2 cf; ~)
3. Living expenses (As per Annexure 2 of the guideline) if hostel is not
available.
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4. Others
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A. Total

B. Funds available from other sources (scholarship etc.)

3Ri mill ~ ~ ~ (~~)
C. Total amount of loan applied for (A-B)
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(IV) BANK ACCOUNTDETAILSOF APPLICANTAND CO-APPLICANT
~ ~ W-~
Applicant (~)
*~~ ctr fctcRufr
Co-applicant ~~)
Name of the Bank (~ <PI ;rr<=r)
Name of the Branch (~ W"<9T <PI ;rr<=r)
Bank Account No. (~ <mffi ~)

(V) PROPOSED/PREFERRED
REPAYMENTAND PAYMENT OF INTEREST
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Mode of Repayment (No. of installment/EMls)
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Repayment by
~
By Student/Applicant By Co-applicant By Both
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(VI) DOCUMENTSREQUIRED
Mark sheet & Certificate of ClassX, XII & last qualifying examination of the student.
D ~, +2 "C[Ct ~ ~ -cRTaTI <PI ~ "C[Ct "W'fTUT q?[ 1

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

D "QT1{1 ~, f.1:~ ~aTI <PI q?[ ~ 1 (~ ~ 61)
Documents evidencing duration of course of commencement thereof, viz Prospectus or Certificate from

D the competent authority of the Institution. (if the University situated inside Bihar then not required)
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.,gIFclSlIC;!<I1'j ~
~ ~ cf; "fTa1l'I ~
3lIq~<I<t>C'l1~
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Proof of admission to the course.

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Page 3 of 5
 .. ,

D Schedule of expenses for the course.

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D Two copies of Passport size photograph of the student and co-applicant.

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,
D Aadhar card of applicant.
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D Aadhar card of co-applicant.

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Proof of residence {Residential certificate or first page of bank passbook in which address is clea Iy
mentioned or electricity Bill or telephone Bill or passport or Driving license or voter J.D.card ,
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Certificate for disability issued from competent authority. (if applicable)
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DECLARATION
tTr-t:rorr
I/We hereby apply for a loan from Bihar State Education FinanceCorporation Ltd. to the extent indicated in th Loan
RequestSection of this application form. I/We declare that the information furnished in this application form are true, a curate
and complete and that they shall form the basis of any loan, Bihar State Education Finance Corporation Ltd. may de ide to
sanction to me/us. I/We confirm that I/We have/had neither insolvency proceeding against me/us nor have been adju icated
insolvent. I/We further confirm that I/We have read the terms and conditions and understood the contents therein. I/We dm/are
aware that as I/we have opted for loan at simple interest, the equated monthly installment fixed shall comprise of principal and
interest.
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I/We agreethat BiharState EducationFinanceCorporation Ltd. may at its discretion conduct discreet inquires in r~pect
of this application. I/we undertake to inform asto any changein my/our occupation/employment, residential/official addre and
to provide anyfurther information that District Registrationand CounselingCenter and Bihar State EducationFinanceCorpo ation
Ltd. may require. BiharState Education FinanceCorporation Ltd. will be at liberty to take such action as it may deem neces~aryif
my/our above statements are found to be untrue. I/We agreethat Bihar State Education FinanceCorporation Ltd. shall ha, the
sole discretion to reject our loan application or reduce loan amount without any reason. I/We further agree that my/ou ' loan
transactionsshall be governed by the rules of Bihar State EducationFinanceCorporation Ltd. which may be in force from ti' e to
time. I

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Signature of the student/applicant Signature of the Co-applicant

Place . Place ..

Date . Date ..

~~:".""."."" ..." ~:"""."".""" ..

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Page 4 of f
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