PM Street Vendor’s AtmaNirbhar Nidhi(PM SVANidhi)

(Common Loan Application Form)

* Mandatory fields
** Only for SV's from Assam and Meghalaya, not having Aadhaar Number
# Data Fetching From Aadhaar

Application No. PMS08238345142 Name of Preferred Bank/Lender UCO BANK

#Name of Street Vendor Saraswati Gorai Father/Spouse Name* NIMAI GORAI

#Date Of Birth 01/12/1975 Marital Status* Married

#Mobile Number* 9091397376 #Gender Female

Social Category* General

Are you vending in the same State you Are you vending in the same district
belong to?* you belong to?*

PwD (Divyangjan)* Minority*

KYC Details

#R-Token Number* Voter ID Card No.*

725461144912 WB/38/257/102453

Family Details
Name* Relationship With Applicant* Age*
SAWAP GORAI Husband 53

Proof Of Vending
Vendor ID Card Certificate of Vending No. Letter Of Recommendation (LoR) No.
(Issued by ULB) (Issued by ULB) (To be issued by ULB electronically through PM SVANidhi Portal)
WB/250032/230809/5180676

Address as per e-KYC

#House No. / Locality NULL #State WEST BENGAL

#Ward/Village Jamgram
#Town/Dist

#Pin Code 713343

Current Address

House No. / Locality* JAMGRAM, KULTI State* WEST BENGAL

Town/Dist* Paschim Bardhaman Ward/Village* 62

Pin Code* 713343

Vending Activity

Name Of Activity* Others (Pls Specify)

Other MURI SELLING

Place Of Vending* Fixed Location

Duration Of Vending* 05/2017

Location/Area of Vending

Stationary Vendor JAMGRAM, KULTI Nearest Landmark BAJRANGBALI MANDIR

Mobile Vendor Nearest Landmark

State* WEST BENGAL Town/Dist* Paschim Bardhaman

ULB Name* Asansol Municipal Corporation

Ward/Village*

Pin Code 713343

Total Monthly Family Income (₹) (Family means husband, wife and unmarried children)

Total Monthly Family Income (₹)* 3000

Bank Account Details

Name Of Bank* Name Of Branch* IFSC Code* Account No*
UCO Bank KULTI UCBA0000408 04080100012115

Digital Payment

Payment Aggregator UPI ID / VPA Durable QR Code

Existing Loan Outstanding

Bank/Lending Institution Outstanding Amount (in Rs.) Monthly EMI (in Rs.)

Loan Amount Required (₹) Loan Tenure Status

1stTerm Loan Amount 10000/- 12 Months

2nd Term Loan Amount 20,000/- 18 Months Active

3rd Term Loan Amount 50,000/- 36 Months

Loan Purpose* Working Capital Business Expansion Purchase Of Assets

Declaration and Authorization:

A. I hereby certify that all information furnished by me is true, correct, and complete.I have not applied to any other lending institution under the PM
SVANidhi scheme. The information submitted herein may be exchanged by you with any agency, you may deem fit. You, your representatives, Lending
Institution (LIs) or MoHUA, or any other agency as authorized by you / MoHUA / LI, may at any time, inspect/ verify my/our assets etc. You may take
appropriate safeguards/action for recovery of lending institutions’ dues.

B. I understand that by submitting this application form, I am providing my consent for application for loans in remaining 2 cycles. After full repayment of
2nd loan; in the 3rd cycle, maximum loan amount will increase to ₹50,000/-. I will become eligible for the 3rd cycle of the loan only after full repayment of
current loan and submission of digital consent for the 3rd loan.

I understand that minimum repayment period of 9 months is required for the 2nd loan to be eligible for 3rd loan. If my loan is fully repaid before 9 months,
I would be eligible for the 3rd loan only after the stipulated period of 9 months from the date of disbursement of the 2nd loan.
C. I have no objection to authenticate my Aadhaar number, share the same with other Ministries / Departments under the Government of India or the State
Government for the purpose of extension of benefits under any of their Schemes, carry out e-KYC and accessing my credit history & credit score
from credit bureau by the lenders and their authorized agents. The consent and purpose of collecting Aadhaar has been explained to me in local language.
MoHUA/Lending Institution has informed me that my Aadhaar submitted herewith shall not be used for any purpose other than mentioned above, or as per
requirements of law. I have been informed that this consent and my Aadhaar will be stored along with my account details with MoHUA or their authorised
agent.

D. I have been vending in the urban local body on or before “Vending Since (05/2017) selected by SV”.
E. I hereby declare that the above information is correct / accurate to the best of my knowledge.

Date : 26/09/2024 Signature of Applicant(s)

Place : Paschim Bardhaman