Date/ZvwiLt To/eivei

Head of Branch/e¨e¯’vcK ……………….Branch/kvLv Bank Alfalah/e¨vsK Avjdvjvn&

Dear Sir, I / We, the SME Entrepreneur (s), am / are applying for loan / Investment of BDT ………………… in the form of working capital / business expansion & purchase of Machineries / other purpose at your Branch……………… of your organization in favor of my / our enterprise for a period of ………………… months. Details of my / our personal, business related and proposed SME loan / Investment related information are provided below:

wcÖq g‡nv`q, Avwg/Avgiv GmGgB D‡`¨v³v wn‡m‡e Avcbvi cÖwZôv‡bi.........................................kvLv n‡Z Avgvi/Avgv‡`i cÖwZôv‡bi AbyK~‡j PjwZ g~jab/e¨emv m¤úªmviY I hš¿cvwZ µq/Ab¨vb¨ eve`................... gvm †gqv`x .....................UvKvi FY/wewb‡qvM Gi Rb¨ Av‡e`b KiwQ| wb‡†æ Avgvi/Avgv‡`i e¨w³MZ, e¨emv msµvš— Ges cÖ¯ZvweZ GmGgB FY/wewb‡qvM welqK Z_¨ †ck Kiv njt

Loan/Investment Application Form for SME Entrepreneur(s) GmGgB D‡`¨v³v wn‡m‡e FY/wewb‡qvM Gi Av‡e`b

1 Details of the Applicant Enterprise for loan/investment: FY/wewb‡qvM Gi Rb¨ Av‡e`bKvix cÖwZôv‡bi e„Ëvš— t 1.1 1.1

Name of Enterprise cÖwZôv‡bi bvg

: :

1.2 1.2

Address (Owned / Rented) wVKvbv (wbR¯̂/fvov)

: :

1.3 1.3

Nature of Business e¨emv‡qi cÖK…wZ

: :

□ Manufacturing □ wkí

□ Commercial □ e¨emv

□ Service □ †mev

1.4 1.4

Ownership Structure gvwjKvbvi aiY

: :

□ Sole-Proprietorship □ GKK gvwjKvbvaxb

□ Partnership □ Askx`vwi

□ Joint-Venture □ †hŠ_ g~jabx

1.5 1.5

Paid-up Capital e¨emvq wewb‡qvMK…Z g~jab

: :

1.6 1.6

Trade License No. & Expiry ‡UªW jvB‡mÝ b¤̂i I ‡gqv`

: :

1.7 1.7

Date of Incorporation e¨emv ïi“i ZvwiL

: :

1.8 1.8

TIN (Tax Identification Number) wUb (U¨v· AvB‡Ww›Uwd‡Kkb b¤̂i)

: :

1.9 1.9

Bank Account Type & Number e¨vsK wnmv‡ei bvg I b¤̂i

: :

1.10 1.10

Annual Sales of the Enterprise (where applicable) cÖwZôv‡bi evwl©K weµq (cÖ‡hvR¨ ‡¶‡Î)

: :

1.11 1.11

Annual Revenue of the Enterprise cÖwZôv‡bi †gvU evwl©K Avq

: :

1.12 1.12

Annual Expense of the Enterprise cÖwZôv‡bi †gvU evwl©K e¨q

:

1.13 1.13

Fixed Assets of the Enterprise (excluding Land & Building) cÖwZôv‡bi ’̄vqx m¤ú̀ (f~wg I BgviZ e¨ZxZ)

: :

1.14 1.14

No. of Employees at the Enterprise cÖwZôv‡b wb‡qvwRZ Rbe‡ji msL¨v

: :

1.15 1.15

Value of Inventory gRy` c‡Y¨i g~j¨

: :

2

Liabilities of the Applicant Enterprise: Av‡e`bKvix cÖwZôv‡bi `vq t 2.1 2.1

Bank / NBFI e¨vsK/A-e¨vsK Avw_©K cÖwZôvb

: :

2.2 2.2

Others Ab¨vb¨

: :

3 Details of the Applicant (In case of Partnership / Joint-Venture Enterprise, separate sheets to be added with similar information for other Sponsors) Av‡e`bKvixi e„Ëvš— (Askx`vwi/†hŠ_g~jabx Kviev‡ii ‡¶‡Î cwiPvjK‡`i Abyiƒc Z_¨ c„_K KvM‡R mshy³ Ki‡Z n‡e) 3.1 3.1

Name (in Bengali) bvg (evsjv)

: :

3.1 3.1

Name (in English) bvg (Bs‡iRx)

: :

3.2 3.2

Birth Date & Place Rb¥ ZvwiL I ’̄vb

: :

3.3 3.3

Academic Qualification wk¶vMZ †hvM¨Zv

: :

3.4 3.4

Training cÖwk¶Y

: :

3.5 3.5

Father's Name wcZvi bvg

: :

3.6 3.6

Mother's Name gvZvi bvg

: :

3.7 3.7

Marital Status ˆeevwnK Ae ’̄v

: :

3.8 3.8

Spouse's Name ¯̂vgx/ ¿̄xÕi bvg

: :

3.9 3.9

Present Address (including Phone No. & E-mail Address) eZ©gvb wVKvbv (†dvb b¤̂i I B-‡gBj AvBwWmn)

: :

3.10 3.10

Permanent Address ¯’vqx wVKvbv

: :

3.11 3.11

Income from Other Sources Ab¨vb¨ Drm n‡Z gvwmK Avq

: :

3.12 3.12

Ownership in Other Entities gvwjKvbvaxb Ab¨vb¨ cÖwZôv‡bi bvg

: :

3.13 3.13

TIN (Tax Identification Number) wUb (U¨v· AvB‡Ww›Uwd‡Kkb b¤̂i)

: :

3.14 3.14

NID (National Identification) Number RvZxq cwiPqcÎ b¤̂i

: :

4

Liabilities of the Applicant: Av‡e`bKvixi `vq t 4.1 4.1

Bank / NBFI e¨vsK/A-e¨vsK Avw_©K cÖwZôvb

: :

4.2 4.2

Others Ab¨vb¨

: :

5

Purpose of Loan/Investment: FY/wewb‡qvM MÖn‡Yi D‡Ïk¨ t 5.1 5.1

Working Capital PjwZ g~jab

: :

5.2 5.2

Business Expansion & Purchase of Machineries e¨emv m¤úªmviY I hš¿cvwZ µq

: :

5.3 5.2

Others Ab¨vb¨

: :

6 Details of Security (where applicable) Rvgvb‡Zi weeiY (cÖ‡hvR¨ †¶‡Î)

: :

7 Guarantor's Name Rvwgb`v‡ii bvg

: :

7.1 7.1

Details of Guarantor Rvwgb`vi m¤úwK©Z Z_¨

7.1.1 7.1.1

Name (in Bengali) bvg (evsjv)

: :

7.1.1 7.1.1

Name (in English) bvg (Bs‡iRx)

: :

7.1.2 7.1.2

Birth Date & Place Rb¥ ZvwiL I ’̄vb

: :

7.1.3 7.1.3

Academic Qualification wk¶vMZ †hvM¨Zv

: :

7.1.4 7.1.4

Father's Name wcZvi bvg

: :

7.1.5 7.1.5

Mother's Name gvZvi bvg

: :

7.1.6 7.1.6

Spouse's Name ¯̂vgx/ ¿̄xÕi bvg

: :

7.1.7 7.1.7

Address wVKvbv

7.1.7.1 7.1.7.1

Present (including Phone No.) eZ©gvb wVKvbv (†dvb b¤̂imn)

: :

7.1.7.2 7.1.7.2

Permanent ¯’vqx

: :

7.1.8 7.1.8

Occupation †ckv

: :

7.1.9 7.1.9

Monthly Income gvwmK Avq

: :

7.1.10 7.1.10

Guarantor’s Net Worth Rvwgb`v‡ii m¤ú‡`i cwigvY

: :

7.1.11 7.1.11

TIN (Tax Identification Number) wUb (U¨v· AvB‡Ww›Uwd‡Kkb b¤̂i)

: :

7.1.12 7.1.12

NID (National Identification) Number RvZxq cwiPqcÎ b¤̂i

: :

7.1.13

7.1.13

Bank Account Type & Number (if available) e¨vsK wnmv‡ei bvg I b¤̂i (hw` _v‡K)

: :

7.1.14 7.1.14

Loan/Investment Availed from Bank / NBFI e¨vsK/A-e¨vsK Avw_©K cÖwZôvb n‡Z FY/wewb‡qvM MÖn‡Yi cwigvY

: :

7.1.15 7.1.15

Others Ab¨vb¨

: :

7.1.16 7.1.16

Relationship with the Applicant Av‡e`bKvixi mv‡_ m¤cK©

: :

(If required, separate sheets to be added with this application form.) (cÖ‡qvR‡b c„_K KvMR mshy³ Ki‡Z n‡e)

_______________________ Guarantor Signature & Date

Rvwgb`v‡ii ¯̂v¶i I ZvwiL

[The applicant must provide any other information, proof, and documentary evidences to the Bank / NBFI necessary for sanctioning of loan / Investment.] [*FY/wewb‡qvM gÄywii Rb¨ Avek¨Kxq Ab¨ †h †Kvb Z_¨, cÖgvYcÎ Ges `wjjvw` e¨vsK/A-e¨vsK Avw_©K cÖwZôv‡bi Pvwn`v Abyhvqx MÖvnK cÖ`vb Ki‡Z eva¨ _vK‡e ]

(This Form is Free of Charge)/ (webvg~‡j¨ cÖ‡`q) ______________________ Applicant Signature & Date Av‡e`bKvixi ¯̂v¶i I ZvwiL