INFRASTRUCTURAL FACILITIES

APPLICATION FORM

for availing financial assistance by

Agricultural Credit Coops. for development of infrastructure facilities

NATIONAL COOPERATIVE DEVELOPMENT CORPORATION (NCDC)

Regional Office, 5^th Floor, Co-Bank Towers,  Palayam,  Trivandrum – 695033

Phone: (0471) 2318497  Fax: (0471)  2311673,Web site : www.ncdc.in

Email -  RO.TVM@ncdc.in

APPLICATION FOR AVAILING FINANCIAL ASSISTANCE FOR DEVP. OF INRFASTRUCTURAL FACILITIES BY  AGRI. CREDIT COOPERATIVES

			DETAILS OF THE IMPLEMENTING SOCIETY
		1	Name, Telephone No. Postal &  email address of the applicant Society    :			:
		2	Registration No.                                     :   Date of registration                                :        Date of commencement of business        :
		3	Area of operation                                   :
		4	Membership & paid-up share capital in the preceding 3 years:
			(Rs in lakhs) S.N. Category of members As on 31.3. As on 31.3… As on 31.3…. No. Share capital No. Share capital No. Share capital Total
		5       6	Gender  Profile of the members & Board. Membership of the society    S.C   S.T.    OBC  Others   Total Male Female Total Members of the Board    S.C.    S.T.     OBC   Others   Total Male Female              Activities undertaken by the society for preceding 3 years : Sl no Activity as on 31/3/ as on 31/3/ as on 31/3 1. Agri. Credit 2. Non-agri credit 3. Non-credit 4. Others, specify TOTAL
		7	Financial Position				(` (s (Rs in Lakh)
			i. Analysis of Profit & Loss Account for the preceding three years
			Particulars 31.03…. 31.03…. 31.03…. 1 Income 2 Gross Profit before Income Tax, & Depreciation 3 Interest  4 Cash Profit 5 Depreciation 6 Profit before Tax 7 Income Tax   8 Net Profit ii.  Analysis of Balance Sheets for the preceding 3 years Particulars 31/03/ -- 31/03/-- 31/03/-- 1 Fixed Assets a Gross Block b Depreciation Net Block (1-2) c Work in progress d Investments Total Fixed Assets 2 Current Assets a Cash, Bank Balance & Deposits b Inventory c Sundry Debtors d Loans, Advances &Prepaid Exp. e Others Total Current Assets 3 Current Liabilities a Working Capital Loan b Sundry Creditors c Interest Payable d Short Term Loans/Deposits e Other Provisions & Liabilities Total Current Liabilities 4 Net Working Capital (b-c) 5 Long Term Loans & Deposits 6 Paid-up Share Capital 7 Reserves(excluding Depreciation) & Funds 8 Undistributed Profit 9 Net Worth
			Please furnish audited balance sheet, profit/loss account of the Society alongwith all schedules for the preceding three years.
		8	Audit & Management					:
		a	Year upto which statutory audit has been completed, audit report issued and audit classification obtained. If the audit is in arrears, reasons may be indicated.					:
		b	Details of Board of Directors & tenure of the existing Board.					:
		c	Whether the Board is elected or nominated					:
		d	Date of preceding election/super-session					:
		e	Whether General Body Meeting is being held regularly? If so, date of last meeting.					:
		B	DETAILS OF THE PROJECT:
		1	Purpose of loan         :
		2	2.Project Cost:                                     (Rs in lakhs)
			1 Cost of construction of building 2 Renovation/Expansion/Repair  of existing building 3 Bank Counter 4 Strong Room 5 Safe Deposit Vault 6 Furniture & Fixtures 7 Vehicles Total  NB: Enclose detailed of plan and cost estimates for Sl (1) and (2) and three quotations for Sl no. 3,4,5,6 & 7.
		3	Means of Finance:
			Percentage of block cost Amount (Rs in lakhs) 1 Term Loan   50% 2 Investment loan /Share capital   40% 3 Society’s contribution   10% Total
		4	Financial Benchmark for the proposed project:
			Internal Rate of Return Debt Service Coverage Ratio Breakeven Point	: : :
		5	Implementation Schedule	:
			Activity Date of Commencement Date of Completion 1 2 3 4 5
		viii	Security Cover to be provided in case of Direct Funding:
			a.  Nature of security offered b.   Whether the society has clear &      marketable title on the assets proposed      to be mortgaged c.  Whether land to be mortgaged to NCDC is      purchased, lease-hold or acquired land d.  Whether the society is in possession of      original title deeds e.  In cases where pari-passu charge or second charge      is proposed to be created in favour of NCDC, whether      NOC from earlier charge-holder(s) would be available.					: : : :
			CHECKLIST  (Please tick against the documents enclosed) Detailed Project Report (DPR) should necessarily contain the following:
1   1	Brief description of the project
2	Policy of State Govt. with regard to the proposed activity
3	Fiscal and other incentives, if any, by State Govt.
4	Other Statutory requirements/Clearances, if any, and their status
5	Annual Report of the Society for preceding three years.
6	Audited/tentative balance sheet, profit/loss account of the Society alongwith all schedules for the preceding 3 years.
7	Copy of Bye Laws – preferably in English
8	Details of cooperative linkage
9	Implementation Schedule
10	Copy of Resolution of Board of Directors for the proposal.
11	Overdue Certificate as at Annexure-I.
12	Viability Analysis (IRR, BEP, DSCR etc.)
13	Site Details, location, requirement of land (measurement of land) and acquisition of land with documents
14	Plan & Cost estimates for civil works duly certified by qualified Architect/ Engineer) and Fixed Assets (duly supported with quotations)
15	Plan/Source of raising members equity/promoter’s contribution
16	Security for the loan

                                                                           

      

        

Chief Executive/Secretary of the Society

                                                                                           (with Seal)

                                                                                      ANNEXURE - I

NO OVERDUES CERTIFICATE

1.       This is to certify that  ______________________(name of the society),  as on date,  is not in default in repayment of  loans and payment of interest to NCDC  and any Financial Institution/ Bank

OR

          Position of default in repayment of dues by the society to NCDC and other institutions as on date is as follows:

Name of Lending Institution/ Bank	Loan  received		Principal repaid	Outstanding dues
	Date	Amount		Principal		Interest	Total
				Overdue	Not  yet due

 2.      It is also certified that other cooperatives on which Directors of our Board  are   Directors or associated with are  not in default in repayment of loans and payment of interest to NCDC and  any Financial Institution/ Bank as on date. 

OR

          Position of default in repayment of dues by the  Cooperatives on which Directors  of our Board   are Directors or associated with is as follows:

Name of Director	Name of defaulting cooperative society	Nature of Financial Institution/ Bank	Name of Financial Institution / Bank	Amount of default	Reasons and period of  default

                                                                       (Chief Executive of the Society)

Place:

Date:

Note : Strike out which is not applicable