Vidya Lakshmi Common Education Loan Application Form

Student ID 1514019

Application ID 753723

Bank Name Bank of Baroda

Bank Scheme Name BARODA SCHOLAR

Preferred Bank IFSC Code BARB0HARNIX

Preferred Bank Branch Name HARNI ROAD

Date of Application 02-Mar-2020

1. Personal Information

Field Name Student Parent / Husband Co-obligant / Guarantor

Title Ms. Mr. Mr.

First Name pranjal Bhaumin bhaumin

Middle Name bhaumin Jagdishbhai jagdishbhai

Last Name patel Patel patel

Father’s /Husband’s First Name Bhaumin Jagdishbhai jagdishbhai

Father’s /Husband’s Middle Name Jagdishbhai shivdasbhai shivdasbhai

Father’s /Husband’s Last Name patel patel patel

Date of Birth 26/01/2001 24/10/1971 24/10/1971

Category Others Others Others

Sex Female Male Male

Marital Status Single Married Married

Educational Qualification 10th Graduate Graduate

Marks obtained in Highest

92.0 0.0 0.0
qualification %

Occupation Student Business Business

Income from all sources (Rs) 750000.00 700000.00

PAN No.# AKEPP1098B AKEPP1098B

State Gujarat Gujarat Gujarat

Address Line 1 H-4/42, satyam appartment H-4/42, satyam appartment H-4/42 Satyam appartment

Address Line 2 water tank road water tank road water tank road

Village / Area/ Locality vadodara vadodara karelibaug

Block/Taluka /Sub-district/Town Vadodara Vadodara Vadodara

PIN 390018 390018 390018

Contact No. 9558557516 9898566502 9898566502

e-mail Id mark210mp@gmail.com bhauminpatelin@gmail.com bhauminpatelin@gmail.com

Present Banker Details

Branch IFSC BARB0HARNIX SBIN0014104 SBIN0014104

Banker BANK OF BARODA STATE BANK OF INDIA STATE BANK OF INDIA

Bank Branch HARNI ROAD BRANCH MUKTANAND KARELIBAUG MUKTANAND KARELIBAUG

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Account Type Savings Account Savings Account Savings Account

SB / OD A/c No. 26520100027861 30373700414 30373700414

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 University of prince edward island

Name of the Course Bachelor of Business administration

Duration of the Course 03 (Years) 04 (Months)

Date of Commencement 08/09/2020 Date of Completion 20/09/2024

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 738481 738481 738481 738481 2953924.00

Exam fees 5000 5000 5000 5000 20000.00

Books Stationery 15000 15000 15000 15000 60000.00

Equipment/Computer 6000 6000 6000 6000 24000.00

Hostel Expenses 512861 512861 512861 512861 2051444.00

Sundries/Travel 90000 90000 90000 90000 360000.00

TOTAL 1367342 1367342 1367342 1367342 5469368.00

Own Source / Scholarship 0 0 0 0

Loan Required 1367342 1367342 1367342 1367342 5469368.00

5.Details of securities offered Housing property

6.Prospects of earning after completion of the course

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

Repayment proposed
98 40000.00

7.Uploaded Documents:

Marksheet

Proof Of Admission to the course

Proof of Income

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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.

Manager/Senior Manager / Accepted all the terms and

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

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 User Application History

Application ID Application Date Status

NA NA NA

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