A(a)-1

Agricultural
Loan Application Form for above Rs.1 Million
For Bank Use Only
(Production/Development)

Account No.: 10
Applicant’s
Application No.: Picture

Date:

Individual: Joint:

Corporate:

The Manager

JS Bank Limited
Branch

I request you for the Agriculture finance of Rs. for (Production purpose) and/or

Rs. for (Development purpose).

Working Capital/Development Finance: /

Crops Agri. Equipment/ Tractor Dairy Poultry Fishery Other

Funded: Non-Funded:

(For corporate loans only)

Applicant’s information:
Note: Separate application form must be attached for Co-Applicant or Joint applicant.
(A) Individual Applicant:
Name: S/o D/o W/o:

CNIC No: Date of Birth: Caste/Bradri:

DD / MM / YYYY
/ /
Marital Status: Account No: NTN: (if any)

Qualification: Present Address:

Permanent Address:

Tel. No. Mobile No. (1): Mobile No. (2):

(B) Partnership Customer:

Name of Firm: Registered/Unregistered:

Registration No. (if applicable): Date of registration:

Address:

Name of Partners: 1) 2) 3) 4)

CNIC of Partners: 1) 2) 3) 4)

Name of Authorized Signatory Name of Authorized Signatory

 A(a)-2

(C) Corporate Customers:

Name of Company Reg. / Inc No. Date NTN No Group

Name of CEO/Director-1:

CNIC No. of CEO/Director

Name of Director-2:

CNIC No. of Director-2

Use extra sheet in case of more than 2 directors

Companies Registered Office

Plant / Business Address

Business of company as per

memorandum of association

Board Resolution Dated Date of Minutes

Authorized Signatory-1 Name Authorized Signatory-1

Designation

Authorized Signatory-2 Name Authorized Signatory-2

Designation

In case directors are not major shareholders,

the resolution must contain the signature of major shareholders.

2. Status of Applicant:

Owner Lessee Owner cum Lessee Tenant Other (Please Tick one)

Agri. Land / Agri. Business Address:

Total Area /Land Holding:

Total Cultivated Land:

Name of Actual Owner of Property (In case of lessee)

(C) Estimated Requirement of Financing/Feasibility

Working Capital-Farm/ Amount in Rs/

Input requirement Amount of

Season Crops Orchards Area (Acres) Misc Total Finance Required

Kharif

Rabi
 A(a)-3
Working Capital-Non Farm/ Amount in Rs/

Other Input Amount of

Type Feed Material Labor Misc Total
& Utilities Finance Required

Dairy farm

Livestock

Fish farming

Poultry farming

Others
(please use separate sheet)

Development Loan/ Amount in Rs/

Loan Purpose Price Borrower’s Equity % Bank Finance %

Requirement

Tractor/Implement

Tube well/irrigation system

Land preparation

Dairy / Poultry farm/fish pond

Others
(please use separate sheet)

(D) References: (Not applicable for corporate customers)

Name: Name:

CNIC No.: CNIC No.:

Tel. No.: Tel. No.:

Address: Address:

Signature*: Signature*:

* In presence of Bank official

(E) Details of Existing Credit Facilities, if any (Fund & Non Fund Based):

Name of Bank Finance Amount Purpose Nature of Security

Use extra sheet in case of more facilities

Signature & Thumb impression - Applicant - 1 Signature & Thumb impression - Applicant - 2
 A(a)-4
Security & Estimated Value Annexure - A

(1) Collateral / Security:

Residential Commercial Industrial

Agri. land Property Property Property SSC Gold Stock Other

Please mention above value of the respective security & also specify further details here under:

Details and value of above security:

(a) Passbook No: Date of issue: Place of issue: PIU Value:

(b) Property Description:

(c) SSC/Gold/Stock:

(d) Other:
(Use extra sheet if required)
Undertaking/Declaration
Annexure - B

I/We jointly & severally (as the case may be) hereby solemnly declare and affirm as follows;
That the above information is true and correct to the best of my/our knowledge and belief and nothing has been concealed therein.
That I/We agree that the submission of above information and the Finance application form is not approval of finance and I/We shall
have no right whatsoever to claim for finance before any forum, in case the finance is declined/ rejected by competent authority of
the bank.
I/We declare and affirm that the contents of the Finance application form alongwith all the declaration/affidavit/undertaking have
been read/read out to me/us and i/we agree to comply with the obligations mentioned there-above.

Signature of Customer Signatory with seal Authorized Signatory with seal Authorized

Date: Date:

Bank Officer's Sign & Stamp for verification of Signature & Thumb Impression

Date:

For Bank Use

Application No.: Received Date:

Name Agri Credit Officer: Employee ID:

Signature ACO/MCO/AFO Signature & Stamp Branch Manager

Receiept Agri Finance Application Form

Name of Farmer: S/O:

ACO/MCO/AFO Name: ACO/MCO/AFO Contact No.:

Signature & Stamp of Receiving Bank Officer: Date: