Basic & ICT information Annexure-A

MFIs Name:
License No:
Branch Name:
Address:
Upazilla Name:
District Name:
Values
Sl No.
(in number)
1. Individual Person
1 Number of Member
2. Firms (Micro Enterprise)
1. Individual Person
2 Number of Borrower
2. Firms (Micro Enterprise)
1. Individual Person
3 Number of Credit Account
2. Firms (Micro Enterprise)
4 Total Saving Amount (In Tk.)
5 Average no. of Credit Request per Month
6 Average no. of Loan Disbursed per Month
7 Maximum Size of Loan Santioned/Maximum Ceiling (In Tk.)
8 Total Outstanding Amount (In Tk.)
9 Total Overdue Amount (In Tk.)
10 Total Default (Overdue) Borrower (In Number.)
11 Law Suite (In Number.)
ICT Information
Hardware In Number
12 No of Desktop Computer
13 No of Laptop Computer
14 No of Normal UPS / Modem -GP
Software Remarks
15 Accounting system YES NO
16 Financial management system YES NO

17 Microfinance Software YES NO

Human Resource (for Branch Office)
19 Computer Operator YES NO
20 MIS Officer YES NO
21 Accoutant /MIS/Operator YES NO
Human Resource (for HO)
22 System Analyst YES NO
23 Database Administrator YES NO
24 Programmer YES NO
25 Maintenance Engineer YES NO
26 Others YES NO
 Subject Data/Personal information
MFIs Name:
License No:
Branch Name:
Address:
Upazilla Name:
District Name:

SL Available Not Available

Not Available
No. Data Fields Available Available Electronic Electronic Partial Mandatory Optional
form Form

1 Branch Code
2 Member ID
3 Name
4 Occupation
5 Father's Name
6 Mother's Name
7 Marital Status
8 Spouse Name
9 Gender
10 Date of Birth
11 National ID Number
12 Smart Card ID No.
13 Other ID Type
14 Other ID No
15 Expiry Date

16 Place of Issuing Country

T.I.N. Taxpayer
17 Identification Number
18 Contact No
Permanent Address: street
+ nr.+Village+ Postal
19 Code
Permanent Address:
20 Thana/Upazilla
Permanent Address:
21 District
Permanent Address:
22 Country

Present Address: street +

23 nr.+Village + Postal Code
Present Address:
24 Thana/Upazilla

25 Present Address: District

26 Present Address: Country

27 Academic qualification
Comments:

** Where Applicable please put value "YES "

 Contract Data/Loan information
MFIs Name:
License No:
Branch Name:
Address:
Upazilla Name:
District Name:

Available Not
SL Not Available Available
Data Fields Available Available Electronic Electronic Partial Mandatory Optional
No.
form Form

1 MFI Code
2 Member ID
3 Loan Code
Loan Type:
4
Single/Multiple/Seasonal
(Please mention in Comments)

5 Loan disbursement date

Planned end date of the contract
6

7 Periodicity of Payment
Number of remaining
8 Installments

Number of Overdue Installments

9

Loan status:
Regular/Watchful/Sub-
Standard/Doubtful/Bad
10 Loan/Write off (Please mention in
Comments)

11 No. of time(s) rescheduling

12 Date of Last Rescheduling
Contract Phase:
Requested/Renounced/Refused/L
iving/
Terminated/Full Paid/Terminated
13 in advance/Full Paid in Advance
(Please mention in Comments)

14 Loan Duration
Actual End Date of the contract
15

16 Economic Purpose Code

17 Flag Subsidized Credit
18 Mode of Payment
 19 Advance Payment Amount
20 Law suit
21 Micro Enterprise (ME)
Member Welfare Fund Coverage
22

23 Date of Last Payment

Loan Amount Disbursed
24 (Principle)

25 Service Charge Rate

26 Number of Installments
Minimum Amount
27 Due/Instalment

28 Loan Outstanding (Taka)

29 Amount Overdue (Taka)
30 Write Off Amount (Taka)
Date of Write-Off (if written-off)
31

Amount Compulsory Savings

32 (Taka)

Amount Voluntary Savings (Taka)

33

34 Amount Term Savings (Taka)

35 Insurance Coverage
Comments:

** Where Applicable please put value "YES "

 Company/Firm/Micro Enterprise information
MFIs Name:
License No:
Branch Name:
Address:
Upazilla Name:
District Name:

Available Not
SL Not Available Available
No. Data Fields Available Available Electronic Electronic Partial Mandatory Optional
form Form

1 M.F.I. Code
2 Branch Code
3 Member ID
4 Title
5 Trade name
6 Legal Form
7 Registration Number
8 Registration Date
9 T.I.N.

10 Business Address: street + nr.

Business Address: Thana/
11 Upazilla
12 Business Address: District
Business Address:
13 Country(Code)
14 Factory Address street + nr.

15 Factory address:Thana/ Upazilla

16 Factory Address: District

17 Factory address: Country(Code)

18 Sector Type
19 Sector code
20 Phone Nr.
Comments:

** Where Applicable please put value "YES "