PF-146

Prime Bank Limited

Request for Credit Limit The Manager Prime Bank Limited Dhanmondi Branch Dhaka.

Photo

Dear Sir, I/We request you to kindly grant/renew/enhance/extend me / us a credit limit in the form of cash Credit / Overdraft / Demand Loan / Hire-Purchase / Lease Finance / Bank Guarantee / Loan/ SOD / Letter of Credit/_________________________________ amounting to Tk.___________________________ (Taka ________________________________________________) on your usual terms and conditions. I/We state the following particulars and bind myself/ourselves to furnish you with any other information and comply with required formalities which you at any time require : 1. Name of the A/C _________________________________________ a) b) c) d) 2. Account No. ______________________________________ Date of A/C. opened _______________________________ Date of first sanction _______________________________ First sanctioned amount ____________________________

Business address : _______________________________________ (whether rented _______________________________________ or owned) Telephone No : _________________________________________

3.

Permanent Address : ____________________________________ ____________________________________ Telephone No : ________________________________________

4.

Factory Address : ______________________________________ ______________________________________ Telephone No : ________________________________________ Contd...P/02

Page-02 5. 6. 7. 8. 9.
Sl. No.

Constitution / Status of the applicant :

Individual/Proprietorship/Partnership Private Limited/ Public Limited

Date of establishment / Incorporation : ______________________ GIR No. / TIN No. : (Copy of last assessment order enclosed) Trade Licence No. .. date . Validity (Copy enclosed) Name and Particulars of the Proprietor/Partners / Driectors (Separate sheet should be enclosed if required)
Name & Fathers name with residential address, Phone No., Fax No. Age Education Experience Share Holding Position/ Status Personal Networth

10. 11. 12.

Nature of Business

Paid-up Capital in case of Limited Co. Investment in business : a) b) c) Working Capital Fixed Investment Total Investment (a+b) : : : Tk._______________ Tk._______________ Tk._______________

Contd...P/03

Page-03 13. Type Amount of Credit facility required : Amount Period for which required Purpose Mode of Adjustment/ Repayment

14. 15.

Item of manufacture or trade Nature of securities offered a) b) Primary Collateral

: : : :

16.

Name & fathers / husbands name & address of the owner of the property proposed to be mortgaged :

17. 18.

Relationship of the applicant with the owner of the property to mortgaged : Property of the firm / company : (Use Separate sheet, if required ) a) b) Movable Immovable : : Tk._________________ Tk._________________ Contd...P/04 Encumbrance, if any

Page-04 19 Name of the guarantor (if any) : a) b) c) Fathers Name : Present Occupation : Present address : Telephone No : d) Permanent address : Telephone No : e) ______________________________________ ______________________________________ ______________________________________ ______________________________________ ______________________________________ ______________________________________

Networth of the guarantor ____________________________________ (Total assets total liability)

20.

Present liabilities of the applicant in different accounts : a) b) With Prime Bank Ltd. With other Banks : : Tk.___________________ Tk.___________________

21.

Name of sister concern(s), if any:

22.

Liabilities of sister concerns (if any) : a) b) With Prime Bank Ltd. With other Banks : : Tk.___________________ Tk.___________________

23. Last years business position a) Total purchase/production/service b) Total Sale c) Net Profit/Loss

Year Tk. Tk. Tk.

199

199

199

Contd...P/05

Page-05

24.

Particulars of work order/supply order (if facility is required to finance against work order/contract) Description of works Validity Work value Bill received Progress

Work order No. date & Name of the Authority

25.

List of major works completed (last three years) : Description of works Work value Date of completion

Name of the Authority

26.

For working capital finance production Capacity

: Installed Utilization last year Qty. Rate Value Contd...P/06

Page-06 Assessment of working capital in brief : I. II. III. IV. V. VI. VII. Imported raw materials . Local raw materials.. Work-in-process .. Finished goods stock .. Stores, spares etc. Accounts receivable . Other expenses . Total 27 28. 29. 30. 31. . Months Months Months Months Months Months Months Tk.________________ Tk.________________ Tk.________________ Tk.________________ Tk.________________ Tk.________________ Tk.________________ Tk.________________

Source of power supply : PDB/DESA/REB/Own generator Balance sheet/Income statement or statement of Accounts of the following years attached. (preferably of last 3 years). Cash flow statement enclosed. Other relevant information (use additional paper, if necessary) Business projection for the next year :

I/We do hereby solemnly declare and affirm as follows : i) That I/We have not taken any loan or enjoyed any credit facility in my/our personal name or in the name of my/our Proprietorship/Partnership firm/company from any other Branch of Prime Bank Ltd. or any other commercial Bank save and except as stated above. That the statements made above are true and nothing has been concealed and if at any time it transpires that I/We have supressed fact regarding availing of credit facility from any Bank. I/We shall be criminally liable. ____________________ ____________________ ____________________ ____________________

ii)

Signature Date : ___________________

PRIME BANK LIMITED

Dhanmondi Branch, Dhaka PERSONAL NETWORTH STATEMENT Name : Address (Res.) : ...................................................... ...................................................... ...................................................... Business Address: ...................................................... ...................................................... ...................................................... For the purpose of procuring and maintaining credit from time to time in any form whatsoever with Prime Bank Limited the undersigned submit(s) the following as being a true and accurate statement of his/her financial condition on the date mentioned herein and also agree that if any change occurs, that on materially reduces the means or ability of the undersigned to pay all claims or demands against him/her, the undersigned will immediately notify the Bank. Unless the Bank is so notified it may continue to rely upon the statement herein given as true and accurate. NETWORTH STATEMENT AS ON ...................... LIABILITIES Payable to Bank (Schedule-A) a)Secured b)Un secured Tk. Tk. ASSETS Cash a) In hand Tk. b) With Prime Bank Ltd. Tk. c) With other Banks Tk. INVESTMENT Other Creditors Unpaid Taxes Tk. Tk. Government Securities Tk. Shares, debentures,Bonds etc. Tk. Debtors Tk. Real Estate(Encumbered) Tk. (Schedule - B) Real Estate(Unencumbered) Tk. (Schedule - C) Cash surrender value for life policy Tk. Other (details attached) Tk. FDR/Saving Certificate Tk Total Assets Tk. S/O .................................................... Age .................... Profession ......................................... Position ............................................. Marital Status .................................... Children-Male........Female.................

Other Liabilities Tk. (Details attached)

. Total Liabilities Tk.

Net Worth (Asset - Liabilities) = Tk. ............................... Contd.....P/02

Page-2 Payable to Bank/Financial Institutions: Schedule-A Name & Address of the Bank/Institution Date of availing of the Loan Limit with validity Present Outstanding Secured or Unsecured with nature of security

REAL ESTATE (ENCUMBERED) Schedule-B Location & tenure of ownership Area of Land Description & schedule of the property and type of Building Mortgage & Mortgaged amount Market Price Building

Land

Total

REAL ESTATE (UNENCUMBERED) Schedule-C Location & ownership Area of Land/ Building Description & schedule of the property and type of building Land Market Price Building Total

The undersigned certifies that the information furnished thereon is true and correct.

Signature : Date :

The Manager Prime Bank Limited Dhanmondi Branch, Dhaka Sub : Dear Sir, I/We do hereby declare that the name(s) and particulars of my/our sister/allied concern(s) is / are as follows : 01. 02. 03. 4. 5. 06. 07. Name of the Business Concerns Name of the Proprietor/Partners/Directors Business Address Fathers/Husbands Name of the Proprietor/Partners/Directors Residential Address of the Proprietor/ Partners/Directors Name of the Banker Liability Limit : : : Declaration of sister/allied concern / liability

: : : : Present Outstanding Security

Nature of facility

I/We confirm that I/We have no other sister/allied concern and liabilities beyond those as declared above.

Date

__________ Signature(s) Name

Use additional sheet / paper, if necessary.