Tourism, Hospitality, Transport, Electricity, Power generation, Rural Housing, Hospitals, Health care & Education)

APPLICATION FORM

for availing financial assistance by

Service Cooperative

(Tourism, Hospitality, Transport, Electricity, Power generation, Rural Housing, Hospitals, Health care & Education)

NATIONAL COOPERATIVE DEVELOPMENT CORPORATION

 (Credit, Industrial and Service Cooperatives Division)

4, Siri Institutional Area,  Hauz Khas,  New Delhi – 110016

Phone: (011) 26965346  Fax: (011)  26516032, 26962370 Web site : www.ncdc.in

APPLICATION FOR AVAILING FINANCIAL ASSISTANCE

 BY SERVICE  COOPERATIVES

A	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:
	(` in crore) 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	Activities undertaken a)      Main business activities b)      Service sector activities c)      Social sector activities			:
6	Financial Position			:	(` in crore)
	i. Analysis of Profit & Loss Account for the preceding three years
	Particulars 2008-09 2009-10 2010-11 1 Income 2 Gross Profit before Income Tax, & Depreciation 3 Interest Cash Profit 4 Depreciation 5 Profit before Tax 6 Income Tax 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.
7	Audit & Management					:
i	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.					:
ii	Details of Board of Directors & tenure of the existing Board.					:
iii	Whether the Board is elected or nominated					:
iv	Date of preceding election/super-session					:
v	Whether General Body Meeting is being held regularly? If so, date of last meeting.					:
vi	Whether Chief Executive is on deputation or own and    since when the present incumbent is in position.					:
8	Performance of existing unit for preceding 3 years:                                                                                     (` in crore) S.N. Activity As on 31.3. As on 31.3… As on 31.3…. Total
B	DETAILS OF THE PROJECT:
i	Purpose of loan					:
ii	Details of similar units in the area of operation					:
iii	Project Cost:                                     (` in crore)
	1 Land & Land  Development 2 Building & Civil Works 3 Plant & Machinery 4 Misc. Fixed Asset 5 Contingencies 6 Pre Operative Expenses 7 Margin Money for raising Working Capital Total
iv	Means of Finance:
	Percentage of block cost Amount (` in crore) 1 Share Capital from State Govt. 2 Members Share capital 3 Subsidy/Grant 4 Term Loan from NCDC Total
v	Financial Benchmark for the proposed project:
	Internal Rate of Return Debt Service Coverage Ratio Breakeven Point	: : :
vi	Marketing Strategy/Plan	:
vii	Implementation Schedule	:
	Activity Date of Commencement Date of Completion 1 2
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.					: : : : :
C	CHECKLIST  (Please tick against the documents enclosed) Detailed Project Report (DPR) should necessarily contain the following:
1	Brief description of the project
2	Industry Scenario
3	Policy of State Govt. with regard to the proposed activity
4	Fiscal and other incentives, if any, by State Govt.
5	Licensing requirement for the proposed activity (enclose copy of license or specify status)
6	Other Statutory requirements/Clearances, if any, and their status
7	Annual Report of the Society for preceding three years.
8	Audited/tentative balance sheet, profit/loss account of the Society alongwith all schedules for the preceding 3 years.
9	Copy of Bye Laws
10	Existing Capacity (Private/Public Sector and Cooperatives and its utilisation & Performance)
11	Scope for creating additional capacity
12	Production and availability of raw material
13	Details of cooperative linkage
14	Demand and marketability of the product (s)
15	Marketing Plan/ Strategy
16	Implementation Schedule
17	A note on power requirement and power scenario in the state
18	Pollution Control Clearance if required (enclose copy or specify status)
19	Effluent treatment(enclose copy or specify status)
20	Manpower Requirement (current and additional reqm.)
21	Water supply arrangements, specify status
22	Copy of Resolution of Board of Directors for the proposal.
23	Overdue Certificate as at Annexure-I.
24	Viability Analysis (IRR, BEP, DSCR etc.)
25	Sensitivity Analysis
26	Site Details, location, requirement of land (measurement of land) and acquisition of land with documents
27	Plan & Cost estimates for civil works duly certified by qualified Architect/ Engineer) and Plant & Machinery (component-wise with invoice), Fixed Assets (duly supported with quotations)
28	Technology, Process Flow diagram, Material Balance
29	Estimate for Margin Money and requirement of working capital
30	Plan/Source of raising members equity/promoter’s contribution
31	Security for the loan

                                                                          

      

        

Managing Director / General Manager

                                                                                           (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

PART -B

Working Capital/Share Captial /Margin Money assistance for Service  Cooperatives

(Please submit Part A&Part B)

                                                                                    (Rs. In lakhs)

                                              Amount                            No. of   instalments &

                                      Out standing                           Amount paid during

                                                                 the year

                                                ------------------------   -----------------------------------------

 1. Term Loan raised for

      Investments in   

      Infrastructure/Fixed

      Assets  

          a) State Govt.

          b) Coop. Banks

          c) Commercial Banks

          d) Others, if any                        

                                               ------------------                           -------------------------------

                                               

                                                    ------------------                 --------------------------------

2. Investment in Fixed Assets, Securities & Shares etc

Particulars	Investment made from out of borrowings as in (1) above	Investment made out of own funds	Total investment
I	II	III	1V
a) fixed assets of land buildings. Furniture/fixtures. Plant &machinery, transport vehicles etc. b ) Debentures, Bonds Govt. Securities etc. c)Share of other institutions d) Any other Investment of long term nature(please specify)
e) Total

3. Accumulated Losses/deficit, if any.

4. Net disposable resources(NDR)

5.Loans and advances taken for Working Capital during the Year

                                                                                          (Rs.in lakhs)

Type of Business	Type of credit sanctioned(Pledge hypothecation clean etc)	Whether the loans were guaranteed by S/govt	Margin of security prescribed	Source of credit(scheduled Bank)	Credit limit sanctioned	Credit limit utilized	Rate of interest
a.       Name of the bank/FI
b.       Cash credit limit sanctioned as on-
c.        Cash credit limit awarded as on-
d.       Margin provided by the society

6.      Programme for the ensuing year

(Please append a brief note &give the following information)

Programme         I	Value       II	No.of business/ Production Turnovers Expected       III	Working Capital required for production/sale      IV	Margin money needed for production Sale                V
a)       Worth of services rendered/generated b)       Service generation inputs (pl. specify in quantitative terms) c)       Others (pl specify)
d)    Total

1.                Gap in margin money

(V(d) of Item 6-NDR

 President/Secretary’s Signature with Seal