A Application Form for Education Loan under NBCFDC - Wbbcdfc.org

6 Present Address Vill/RoadPO.PS.GramPanchayat/Ward No.Block/ MunicipalityDistrictPIN:Telephone No. STD No.7 Caste/Sub CasteBACADEMIC STATUS OF APPLICANT1Nmae of ExaminationsPassedBoard/UniversityYearTotalMarksMarksObtainedDivision/Class/RankIiiiiiivJoint AdmissionExamination (Pl. mention)CCOURSE OF STUDY INVOLVING PROPOSED LOAN1 Name of the Course Duration years2 Name of the Institute3 University Yes No4 Whether proof of admission or selection for the course attached

DIiiESTIMATES OF LOANAdmission FeeTution Fee1st year 2nd year 3rd year TotaliiiivvviOther Fees payableCost of articles reqd for thecourse, if anyHostel Charge, if anyOther requirement (Pls.mention)TOTAL:EPARTICULARS OF PARENTS/GUARDIAN1 Father's/Guardian's Name Age2 Mother's Name Age3 Permanent Address Vill/RoadPO.PS.GramPanchayat/Ward No.Block/ MunicipalityDistrictPIN:Telephone No. STD No.4 Annual Income of family:

5Other Children pursuing Education at presentSon/Daughter Course From ToWhetheravailed anyloanWhetherawarded anyScholarshipIiiiiiFPARTICULARS OF GUARANTOR1 Name in Block letter Age2 Organisation/Department3 Post held From4567Whether Permanent, Temporary or ContractualAnnual Income from SalaryIncome from Other SourceDate of superannuation8 Permanent Address Vill/RoadPO.PS.GramPanchayat/Ward No.Block/ MunicipalityDistrictPIN:Telephone No. STD No.

DECLARATIONS(I)BY APPLICANTI hereby solemnly affirm and declare that all information furnished above are true to the best ofmy knowledge and that I shall remain morally and legally bound to utilise the entire amount ofloan, if disbursed for the purposes for which the same will be sanctioned. I shall abide by allterms and conditions of W.B.Backward Classes Development & Finance Corporation and remainliable for repayment of loan with interest as per loan repayment schedule of the Corporation.PlaceDateSignature of Applicant(II)BY PARENT/GURDIANCertified that my ward whose particulars are given hereinabove will complete the course forwhich the loan has been applied and in case he/she does not continue the course or fails torepay the loan after completion of the course I/we shall remain liable for repayment of the loanalong with interest as applicable.PlaceDateSignature of Parent/Guardian(III) BY GUARANTORCertified that I personally know the applicant for last ___________ years and that particularsprovided above in respect of my employment and address are true. I shall act as the Guarantorfor the loan as may be sanctioned for his/her education and execute necessarydeclaration/agreement as and when the same is required by the Corporation.PlaceDateSignature of GuarantorDOCUMENTS ATTACHEDLatest Pay Certificate of the GuarantorAny other document(Pls. Mention)Item No. YES NOA3A5A6A7BCDE4