Vidya Lakshmi Common Education Loan Application Form

Student ID 4691999

Application ID 2628599

Bank Name Bank of Baroda

Bank Scheme Name BARODA GYAN

Preferred Bank IFSC Code BARB0VJSADK

Preferred Bank Branch Name SARAPADY

Date of Application 14-Aug-2024

1. Personal Information

Field Name Student Parent / Husband Co-obligant / Guarantor

Title Mr. Shri

First Name ROHITH RAMA

Middle Name

Last Name POOJARY POOJARY

Father’s /Husband’s First Name RAMA SEETHARAMA

Father’s /Husband’s Middle Name

Father’s /Husband’s Last Name POOJARY POOJARY

Date of Birth 05/08/2003 14/01/1970

Category OBC OBC

Sex Male Male

Marital Status Single Married

Educational Qualification DIPLOMA 6th STD

Marks obtained in Highest

82.0 60.0 0.0
qualification %

Occupation Student Professional others

Income from all sources (Rs) 90000.00

PAN No.# GZQPR2414Q DNQPP5938G

State Karnataka Karnataka

Address Line 1 ERUKDAPU HOUSE ERUKDAPU HOUSE

Address Line 2 SARAPADY SARAPADY

Village / Area/ Locality BANTWAL BANTWAL

Block/Taluka /Sub-district/Town Dakshina Kannada Dakshina Kannada

PIN 574211 574211

Contact No. 6363407370 9448548360

e-mail Id [email protected] [email protected]

Present Banker Details

Branch IFSC BARB0VJSADK BARB0VJSADK

Banker Bank of Baroda Bank of Baroda

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Bank Branch SARAPADY SARAPADY

Account Type Savings Account Savings Account

SB / OD A/c No. 70650100008921 70650100005806

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

SAHYADRI COLLEGE OF ENGINEERING & MANAGEMENT

Name of the Institution
MANGALORE

Name of the Course MECHANICALENGINEERING

Duration of the Course 03 (Years) 00 (Months)

Date of Commencement 17/09/2024 Date of Completion 17/09/2027

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 100000 100000 100000 300000.00

Exam fees 4500 4500 4500 13500.00

Books Stationery 1180 1180 1180 3540.00

Equipment/Computer 60000 0 0 60000.00

Hostel Expenses 750 0 0 750.00

Sundries/Travel 9960 3510 3510 16980.00

TOTAL 176390 109190 109190 394770.00

Own Source / Scholarship 0 0 0

Loan Required 176390 109190 109190 394770.00

5.Details of securities offered

6.Prospects of earning after completion of the course

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

Repayment proposed
0.00

7.Uploaded Documents:

Marksheet

Proof Of Admission to the course

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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.

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Manager/Senior Manager / Accepted all the terms and
Chief Manager /Asst Gen Manager conditions of sanction Borrower/s

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