Vidya Lakshmi Common Education Loan Application Form

Student ID 3835658

Application ID 2141908

Bank Name Bank of Maharashtra

Bank Scheme Name Model Education Loan Scheme-2021

Preferred Bank IFSC Code MAHB0001615

Preferred Bank Branch Name PUNE-MOHAMADWADI

Date of Application 28-Jul-2023

1. Personal Information

Field Name Student Parent / Husband Co-obligant / Guarantor

Title Kum. Mr.

First Name Nikhil Maliba

Middle Name

Last Name Kharat Kharat

Father’s /Husband’s First Name Maliba Maruti

Father’s /Husband’s Middle Name

Father’s /Husband’s Last Name Kharat Kharat

Date of Birth 30/08/2000 01/06/1966

Category SC SC

Sex Male Male

Marital Status Single Married

Educational Qualification Graduate 10th

Marks obtained in Highest

59.0 40.0 0.0
qualification %

Occupation Student Business

Income from all sources (Rs) 400000.00

PAN No.# KMFPK9272K

State Maharashtra Maharashtra

Address Line 1 Ghule Nagar Ghule Nagar

Address Line 2 Mohammadwadi

Village / Area/ Locality Hadapsar Hadapsar

Block/Taluka /Sub-district/Town Pune Pune

PIN 411060 411060

Contact No. 9356864490 9370108890

e-mail Id nikhilkharat40@gmail.com kharatr706@gmail.com

Present Banker Details

Powered & Maintained by Protean eGov Technologies Ltd. (Formerly NSDL eGovernance Infrastructure Ltd.) © 2015 Protean eGov.page 1
Branch IFSC MAHB0001615 MAHB0001615

Banker Bank of Maharashtra Bank of Maharashtra

Bank Branch PUNE-MOHAMADWADI PUNE-MOHAMADWADI

Account Type Savings Account Savings Account

SB / OD A/c No. 60346164038 60116803182

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

Name of the Institution

Name of the Course

Duration of the Course 02 (Years) 00 (Months)

Date of Commencement 01/08/2023 Date of Completion

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 250000 250000 500000.00

Exam fees 0 0

Books Stationery 0 0

Equipment/Computer 0 0

Hostel Expenses 0 0

Sundries/Travel 0 0

TOTAL 250000 250000 500000.00

Own Source / Scholarship 0 0

Loan Required 250000 250000 500000.00

5.Details of securities offered Home

6.Prospects of earning after completion of the course

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

Repayment proposed
60 5000.00

7.Uploaded Documents:

Marksheet

Proof Of Admission to the course

Powered & Maintained by Protean eGov Technologies Ltd. (Formerly NSDL eGovernance Infrastructure Ltd.) © 2015 Protean eGov.page 2
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:

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

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:

Powered & Maintained by Protean eGov Technologies Ltd. (Formerly NSDL eGovernance Infrastructure Ltd.) © 2015 Protean eGov.page 3
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.

Manager/Senior Manager / Accepted all the terms and

Chief Manager /Asst Gen Manager conditions of sanction Borrower/s

Powered & Maintained by Protean eGov Technologies Ltd. (Formerly NSDL eGovernance Infrastructure Ltd.) © 2015 Protean eGov.page 4