Emp. Code No. : | ||||
A/C No. : | ||||
Name of Applicant : | ||||
Father's / Husband's Name : | ||||
Mobile No. : | ||||
Section and office where working : | ||||
Office Telephone No. : | ||||
Designation : | ||||
Basic Pay : | ||||
Date of Superannuation : | ||||
Date of Birth : | ||||
Permanent Address : | ||||
Amount of loan applied for : | ||||
Nature of loan i.e., Ordinary or Emergent : | ||||
Number of instalments by which it is proposed to repay the loan (Not more than 30) : | ||||
Purpose for loan is required : | ||||
Indebtedness to any other co-operative Society : | ||||
Any other outside liabilities : | ||||
Name of Sureties : | Name | Office Address | Designation | A/C No. |
1 : | ||||
2 : | ||||
3 : | ||||
Outstanding liability of the application to the society : | As principal borrower | Person of Persons | ||
As surety to | Amount Due | |||