PKCC

Application No………….
Name of the Bank……

Branch…….
To:
The Branch Manager

…………………….
LOAN APPLICATION FORM FOR PASHUDHAN KISAN CREDIT CARD (PKCC)
(Production Credit/Crop Loans/KCC/Agri-Term Loan)
A. For office Use:

Application Sl. No. Category SF MF Others
B. Purpose and Type of Loan facility (Crop Loans/Agri-Term Loan) – Applicable

Interview – cum- appraisal form to be enclosed to this application, depending upon
the purpose of loan.
C. Particulars of the applicant(s)

Full Name(s) of the Date of Age Gender Aadhaar No. Voter’s
Applicants(s) Birth (optional) ID/DL/PAN
No.
Shri/Smt
S/D/W of
Shri/Smt
S/D/W of
Shri/Smt
S/D/W of
D. Details of family members:

Sl. Name of the family Age Gender Relationship Occupation Annual
No. members income (Rs.)
1.
2.
3.
4.
Name of the Karta (in case of Joint Hindu Family)
E. Address with Contact Nos.
Present Address Permanent Address
House No: ; Street No.: House No: ; Street No.:
Village: Village:
Post Office: Post Office:
Taluk/Mandal: Taluk/Mandal:
District: District:
Pin: Pin:
Telephone/Mobile.
F. Social Category:
Social  SC ST OBC Physically Handicapped Minorities
Category
If Minority  Buddhists Muslims Christians Sikhs Jains Zoroastrians
Community
G. Existing Banking/Credit Facilities:

Types of Facilities Presently Banking with Account No. Balance
outstanding (Rs.)
Savings Account
Fixed Deposit
PMJDY OD Account
CC/Term Loan
Whether covered  PMJJBY/PMSBY/APY
Under
If banking with this bank, customer ID to be given here:
H. Particulars of total land holdings of the applicant (If Lease hold/share cropper,
specify):
Name of Survey/ Title Area Of Encumbrance if
the Village Khasara Owned Leased Share in which any
No. Cropper acres irrigated
I. Of total landed properties mentioned at (H) above, land / crop details pertaining
to the loan applied:
Name of Survey/ Area in Source of Name of Crops to be Grown
the Village Khasara No. acres Irrigation Kharif Rabi Other Crops
Crops Crops
J. Sources of Income
Agricultural Income
Other Income (Specify)
Total Income
K. Particulars of Immovable Assets Owned:

Immovable Assets Particulars/Description Present Market Value (Rs.)
Agricultural Land
Non Agricultural Land
House/Building
Tractor Shed/Farm Shed
Fishing Ponds/Tank
Total Value:
L. KCC to Fisheries and Animal Husbandry Farmers:

Name of Total Total Sheep Total Pigs Total Poultry Others
Village Productive & Goat
Dairy Animals
Inland Fisheries & Aquaculture Marine Fisheries & Mariculture
M. Particulars of existing liabilities as borrower, if any:

Name of the Institution Purpose Balance Of which Security
of loan outstanding overdue offered
(Rs.)
Our Bank
Other Banks
Agricultural Credit Societies
Land Development bank
Other Creditors (Gov. dues)
Total Outstanding:
N. Net Worth of Applicant(s): [(K+L)-M] Rs. …………..
O. Particulars of Liabilities as Guarantor:

Loan sanctioned Name of the Amount of Balance Status of Account
to Shri/Smt. Bank/Institution Loan (Rs.) Outstanding (Regular/Overdue)
(Rs.)
P. Security Proposed to be offered:

Particulars of Primary Security offered Particulars of Collateral Security (where
applicable)
Q. Guarantors offered (if any):
Names of the Age Residential Telephone Occupation Net Worth
Guarantors Address No/Mobile No. (Rs.)
R. Declaration:
I/We hereby declare that all information furnished by me/us is true, correct and complete
to the best of my/our knowledge and belief. I/We have no borrowing/liabilities excepting
those mentioned in the application form. I/We hereby authorities the Bank to disclose all
or any particulars or details or information relating to my/our loan accounts with the Bank,
to any other financial institution, government of any agency(ies) as may be considered
necessary or desirable by the Bank. It will be in order for the bank to disqualify me/us
from receiving any credit facilities from the Bank in case it is proved that the declaration of
my/our outside borrowings made above contain misrepresentation of facts. I/We hereby
undertake to abide by the terms and conditions that the Bank may stipulate in sanction of
this loan and inform Bank in the event of acquiring any other assets during the tenure of
the advance. The Bank may take appropriate safeguards/action for recovery of bank’s
dues.
1. 1.
2. 2.
3. 3.
Signature/thumb impression of Borrowers Signature/thumb impression of

Guarantors
Date:……………………. Place: ………………………

CHECK LIST: (The check list is only indicative and not exhaustive and depending
upon the requirements of the bank addition/deletion could be made as per necessity)
1. Proof of identity: Self attested copy of Voter’s ID Card / Driving License / PAN
Card / Aadhaar Card / Passport / Photo IDs issued by Govt. authority etc.
2. Proof of Residence: Recent telephone bill / electricity bill / property tax receipt
(not older than 2 months) / Voter’s ID Card / Aadhaar Card / Passport /
Certificate issued by Govt. Authority / Local Panchayat / Municipalities etc.
3. Applicant’s recent Photograph (2 copies) not older than 6 months.
4. Particulars of Land Records.
ACKNOWLEDGEMENT
Received the loan application from Shri…………………………………………………………

Residence of …………………………………………………………………………………… on
…………………………………….. for the purpose of …………………………………………….
All the required information / documents have been furnished on ………………………. / yet
to be furnished by the applicant.
Date…………………………. Officer / Manager
………………………………………………… ….Cut Here …………………………………………
Customer Copy:
Received the loan application from Shri/Smt…………………………………………………….
Residenceof ………………………………………………………………………………………. on
……………………………………………..for the purpose of ….………………………………….
All the required information / documents are furnished on yet to be furnished by the
applicant.
Date ………………………………………….. Officer/Manager
Please Note that:

1. This is only an acknowledgement for having received the application and this should
not be construed as an indication of our acceptance of the proposal, a decision on
which will be taken only after due consideration of the proposal on its merit and / or
on fulfillment of conditions if any, that may be stipulated by the Bank.
2. The application will be taken up for consideration only after all the particulars / data /
documents as may be required are received by the Bank.
3. The application will be disposed of within …………………… days from the date of
receipt of all the details / papers / documents / clarifications sought by the Bank.
4. In case the proposal is rejected/not considered the reasons for the same will be
intimated to the applicant.

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Application No………….

Name of the Bank……

The Branch Manager

A. For office Use:

B. Purpose and Type of Loan facility (Crop Loans/Agri-Term Loan) – Applicable

C. Particulars of the applicant(s)

D. Details of family members:

G. Existing Banking/Credit Facilities:

K. Particulars of Immovable Assets Owned:

L. KCC to Fisheries and Animal Husbandry Farmers:

Inland Fisheries & Aquaculture Marine Fisheries & Mariculture

M. Particulars of existing liabilities as borrower, if any:

N. Net Worth of Applicant(s): [(K+L)-M] Rs. …………..

O. Particulars of Liabilities as Guarantor:

P. Security Proposed to be offered:

Signature/thumb impression of Borrowers Signature/thumb impression of

Date:……………………. Place: ………………………

Received the loan application from Shri…………………………………………………………

Date…………………………. Officer / Manager

………………………………………………… ….Cut Here …………………………………………

Date ………………………………………….. Officer/Manager

Please Note that:

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