tÉ tka î *skEkaia ,sñgâHNB Finance Limitedvr; vd; gP gpdhd;]; ypkpl;ll;

SME Loan Application Form iq¿ yd uOH mßudK Kh wheÿïm;

ld¾hd,Sh m%fhdackh ioyd $For Office Use Only /fhupahya ghtizf;F kl;Lk;

1' jHdmdrfha ku Name of the business tpahghuj;jpd; ngah;/ /

;ks mqoa., jHdmdr Sole Proprietor jdpg;gl;l tpahghuk;

yjq,a jHdmdr Partnership $l;L tpahghuk;

iSudiys; iud.ïLimited Liability CompaniestiuaWf;fgl;l fk;gdp

jHdmdrfha ixiaÓ;shType of Business tpahghuj;jpd; tif

Loan Application No.

Customer Registered Date

Customer No.

Loan Cycle

Customer Branch Code

D D M M Y Y Y Y

Entered By

SME Executive

Entered By

Amount of the loan Rs.

whs;slref.a $ yjq,alrejkaf.a $ wOHCIjrekaf.a kï Proprietor's / partners'/ directors' name’s $ cupikahsupd; $ gq;Fjhuu;fspd; $ gzpg;ghsu;fspd;

ku

Name

ngah;

jhi

Age

taJ

cd;sl ye÷kqïm;a wxlh

National Identity Card No.

Njrpa milahs ml;il ,y.

Nd¾hdjf.a $iajdñ mqreIhdf.a ku Name of the spouse kidtpapd; $ fztdpd; ngau;

2' jHdmdrh iSudiys; iud.ula fkdjk úg iy Tjqkaf.a úia;r by; we;=<;a fkdjk úg when the business is not a limited company and their particulars are not included above tpahghuk; tiuaWf;fg;gl;l fk;gdpahf ,y;yhjtplj;J mtu;fsJ tpguq;fs; NkNy cs;slf;fg;glhjtplj;J

/lshdjEmploymentnjhopy;

hefmkakka .KkNo. of Dependantsjq;fptho;gtu;fspd; vz;zpf;if

3' jHdmdrfha f;dr;=re$Business Details /tpahghuj;jpd; tptuq;fs;

jHdmdrfha iajNdjhNature of Business tpahghuj;jpd; jd;ik

jHdmdrh msysá ia:dkh Location of the Business tpahghuk; mike;Js;s ,lk;.

jHdmdrh mgka .;a ÈkhDate Business Commencedtpahghuj;ij Muk;gpj;j jpfjp

jHdmdr f.dvke.s,af,a whs;sh / Ownership of the Business Premises / tpahghuf; fl;llj;jpd; cupik

whs;slre / Owner / cupikahsu;nÿ .ekqïlre / lessee / Fj;jiff; nfhs;tdTfhuu;

^nÿ .ekqïlre kï & noao wjika jk oskh If lessee, Expiry date of the lease/Fj;jifvdpy; KbtilAk; jpfjp

oekg isák fiajl ixLHdjNo. of employees at present jw;NghJ gzpahw;Wk; Copau;fspd; vz;zpf;if

udisl l=,sh re' Monthly rental Rs. khjhe;j Fj;jifj; njhif &.

Form 01

rwpa kw;Wk; eLj;ju tpahghu fld; tpz;zg;gq;fs;

cd;sl ye÷kqïm;a wxlhNational Identity Card No.Njrpa milahs ml;il ,y.

4' wfmalaIs; Kh uqo, ms<sn`o úia;r / Details of the Proposed Loan / vjpu;ghf;Fk; fld; njhlh;ghdtpguq;fs;

Kh uqo, wjYH ldrKh $Purpose of the loan $fld; njhif Njitf;fhd fhuzk;

wfmalaIs; Kh uqo, i|yd ;nk wemh iy tys o< jákdlu $Security for the expected loan and its value $vjpu;ghu;f;fpd;w fld; njhiff;fhf itf;fpd;w gpiz kw;Wk; mjd; mbg;gilg; ngWkjp

5' j;alï ms<sn| úia;r ^Kh b,aÆïlreg fyda Nd¾hdjg ysñ& Details of assets (belonging to the applicant or his wife) nrhj;Jf;fs; njhlu;ghd tpguq;fs; (fld; ngWeUf;F my;yJ kidtpf;F cupj;jhd)

foam< msysá ia:dkh

Location of property Mjdk; mike;Js;s ,lk;

Wlia lr we; $ ke;has / has not mortgagedmlF Mk; $,y;iy

úia;r Particularstpguq;fs;

jákdlu ^re'&Value (Rs.)ngWkjp (&)

wfmalaIs; Kh uqo,Expected amount of loanvjpu;ghu;f;fpd;w fld; njhif

wdmiq f.ùug wjYH ld,hPeriod of repaymentkPsr; nrYj;Jtjw;F Njitahd fhyk;

6' r:jdyk $Vehicles $thfdq;fs;

,shdmÈxÑ wxlh Registration No gjptpyf;fk;

Wlia lr we; $ ke;has / has not mortgagedmlF Mk; $,y;iy

udÈ,sh Type tif

fjf<|fmd< jákdlu ^re& Market Value (Rs.)re;ijg; ngWkjp (&)

7' fjk;a j;alï we;akï $Other assets, if available $NtW nrhj;Jf;fs; ,Ug;gpd;

fldgia $ ðú; rCIK

Shares / life insurances gq;F $ MAs; fhg;GWjp

fldgiaj, j¾;udk w.h Current value of shares

gq;Ffspd; jw;Nghija ngWkjp

iud.fï ku Name of the Company

fk;gdpapd; ngau;

rCIK Tmamqfõ jákdlu Value of Insurance policy

fhg;GWjpapd; ngWkjp

8' ,nd f.k we;s Kh myiqlï ^fl%äÜ m;a we;=¿j& $Existing Credit Facilities (including credit cards)$ tq;fp kw;Wk; epjp epWtdq;fsplkpUe;J ngw;Ws;s fld; trjpfs;

nexl=j$ wdh;kh

Bank / Financial Institution tq;fp / epWtdk;

uq,a Kh uqo, ^re&Original amount of loan (Rs.) Muk;g fld; njhif (&)

oekg f.ùug we;s fYaIh ^re& Outstanding balance (Rs.)

jw;nghOJ nrYj;jNtz;bAs;s kPjp (&)

udisl jdrslh ^re&Monthly installment (Rs.) khjhe;j jtiz (&)

;nd we;s wem ms<sn| úia;r Particulars of securityitj;Js;s gpiznjhlu;ghdtguq;fs

9' cx.u .sKqï ms<sn| f;dr;=re ^miq.sh udi ;=fka udisl m%ldYkhka wheÿïm; iu. wuqKkak&' Particulars of Current Accounts (attach monthly statements for the past three months ) eilKiwf; fzf;F njhlu;ghd tpguq;fs; (fle;j %d;W khj fhyj;Jf;fhdJ khjhe;j $w;Wf;fis tpz;zg;gj;Jld; ,izf;fTk;)

nexl=jBanktq;fp

YdLdjBranchfpis

.sKqï wxlh Account No.

fzf;F ,yf;fk;

10' fjk;a uq,H f;dr;=re $Other financial information $gpw epjp tpguq;fs;

a) miq.sh udi 6 we;=<; l< .ekqï úl=Kqï Particulars of sales, Purchases for the past 6 months fle;j 6 khjq;fSf;Fs; Nkw;nfhs;sg;gl;l nfhs;tdTfs; kw;Wk; tpw;gidfs;.

''''''''' udih'''''''''Month'''''''''khjk;

úl=Kqï / Sales tpw;gid

.eKqï /Purchases nfhs;tdT

''''''''' udih'''''''''Month'''''''''khjk;

''''''''' udih'''''''''Month'''''''''khjk;

''''''''' udih'''''''''Month'''''''''khjk;

''''''''' udih'''''''''Month'''''''''khjk;

''''''''' udih'''''''''Month'''''''''khjk;

''''''''' tl;=j'''''''''Month'''''''''khjk;

fiajl mä / Salaries / Ntjdhjpfs;

re / Rs / (&)

.ukd.uk úhoï $Travelling expenses $Nghf;F tuj;J nryTfs;

wÆ;ajeähd yd kv;a;= $Repairs & maintenance $GJg;gpj;jYk; guhkupj;jYk;

wdOdr $Donations $epthuzq;fs;

fg,sf*daka yd úÿ,sh $Telephone and Electricity $njhiyNgrp kw;Wk; kpd;rhuk;

mqoa.,sl úhoï ^.eks,s& $Personal expenses $nrhe;jr; nryT

fnodyeßfï úhoï $Distribution expenses $tpepNahfr; nryTfs;

nÿ $Taxes $tup

Kh fmd<sh $ Loan Interest $ fld; tl;b

fjk;a $Other $NtW

''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''

'''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''

tl;=j $Total $nkhj;jk;

b) jHdmdrfha idudkH udisl úh meyeoï ms<sn| úia;rhla An account of average monthly expenses of the business tpahghuj;jpd; toikahd khjhe;j nrytpdq;fs; gw;wpa tpguq;fs;

úia;rh Description tpguq;fs;uqo, ^re&

Amount (Rs.) nryT nra;j njhif (&)

c) miq.sh j¾Ih we;=<; isÿ≥l< úfYaI wdfhdack" ñ, oS .ekSï fyda úhoï ^bvï" foam<" r: jdyk fyda mjqf,a lghq;= iïnkaOfhka& Investments or purchases made during last year (on lands, property, vehicles or family requirements) fle;j Mz;L Nkw;nfhz;l tpNrl KjyPLfs;> nfhs;tdTfs; kw;Wk; nrytpdq;fs;> fhzp Mjdq;fs;> thfdq;fs; my;yJ FLk;g eltbf;iffs; njhlu;gpy;

d) Tn jHdmdrhg ,eìh hq;= Kh uqo,aj, tl;=j $Total receivables from debtors $ cq;fs; tpahghuj;Jf;Ff; fpilf;f Ntz;ba fld; njhif (debtors) nkhj;jk;

e) iemhqïlrejkag f.úh hq;= uqΩ¿ uqo, $Total amount payable to suppliers $ toq;Feu;fSf;F (suppliers) nrYj;j Ntz;ba nkhj;jj; njhif

f) Tn wdodhï nÿ≥ f.jkafkla kï my; i|yka úia;r imhkak $If yes, please give details below $ePq;fs; tUkhd tup nrYj;Jgtuhapd; gpd;tUk; tpguq;fisj; jUf

31$03$'''''' wjika jQ j¾Ih i|yd For year ended as at 31/03/................... 31$03$'''''' Kbtile;j Mz;Lf;fhf

ks;H wdodhu $Regular Income $epue;ju tUkhdk;

nÿ l< yels wdodhu $Taxable Income $tup mwtplf; $bajhd tUkhdk;

nÿ≥f.úh hq;= wdodhu / Assessable income / Ntz;ba tUkhdk;

f.jq nÿ / Tax paid / nrYj;jpa tup

31$03$'''''' wjika jQ j¾Ih i|yd For year ended as at 31/03/................... 31$03$'''''' Kbtile;j Mz;Lf;fhf

31$03$'''''' wjika jQ j¾Ih i|yd For year ended as at 31/03/................... 31$03$'''''' Kbtile;j Mz;Lf;fhf

Tfí wheÿïm; my; oelafjk kshuhka yd ne£ mj;S' Your application is bound by the following rulescq;fsJ tpz;zg;gk; gpd;tUk; epajpfSld; fl;Lg;gl;Ls;sJ.

1' .dia;=jla ndr .ekSu" wdh;kh úiska Kh b,aÆïm; fjkqfjka l%shd;aul ùu i|yd jk ne£ula fkdjkq we;' Acceptance of a fee will not be an obligation on the part of the Company to initiate work on the loan application fl;lznkhd;iwg; ngw;Wf;nfhs;sy; epWtdj;jpdhy; fld; tpz;zg;gj;ij nraw;gLj;Jtjw;fhd flg;ghlhf mikahJ.

2' iq/l=ï i|yd ,nd .kakd foam< iïnkaOfhka ysñlï yd ;lafiare jd¾;d ,nd .; hq;= w;r ta i|yd jk úhoï whÿïlre úiska oeßh hq;=h' Applicant needs to obtain title and valuation reports for the property to be mortagaged and relevant chargers have to be borne by the applicant gpizf;fhf ngw;Wf; nfhs;Sk; Mjdq;fs; njhlu;gpyhd cupj;J kw;Wk; kjpg;gPl;L mwpf;iffisg; ngw;Wf; nfhs;s Ntz;Lk; vd;gJld;

,jw;fhd nrytpdq;fis ePq;fs; Vw;Wf; nfhs;sy; Ntz;Lk;.

3' Wlia neÿïlrh il%Sh lsßu i|yd jk kS;suh yd uqoaor .dia;= fukau wfkl=;a iïnkaO;d .dia;= o whÿïlre úiska oeßh hq;=h' Legal charges, stamp fees and other connecting charges pertaining to execution of mortgage bond should be borne by the applicant mlF Kwpia eilKiwg;gLj;Jtjw;fhd rl;l kw;Wk; Kj;jpiuf; fl;lzq;fSld; Vida ,jNdhbide;j fl;lzq;fisAk; ePq;fs; Vw;Wf;

nfhs;sy; Ntz;Lk;.

4' by; i|yka .dia;= wdmiq wh lr .ekSug fkdyels nj uu$wms oksñ$uq' I/we know that the above mentioned charges are un-recoverable. NkNy Fwpg;gpl;l fl;lzq;fs; kPs mwtpl;Lf; nfhs;s KbahJ vd ehd; $ ehq;fs; $ mwpNtd; $mwpNthk;.

m%ldYhuu $ wm úiska wheÿï lr we;s Kh iïnkaOfhka l%shd lrkq ms◊i wdh;kh fj; imhd we;s by; i|yka f;dr;=re ish,a, i;H yd ksjerÈ nj uu $ wm úiska iy;sl lrk w;r Kh iïnkaO ;SrK .ekSfï § bjy,a úh yels lsisu f;dr;=rla i.jd fkdue;s nj fuhska m%ldY lr isáñ$uq' bÈßfha § uf.a $ wfma uQ,H ia:djr;ajh ;=< isÿjk ´kEu fjkila Tn wdh;kh fj; ,sÅ;j oekqï Èfï j.lSu uu $ wm úiska Ndr .kakd nj o ;j ÿrg;a m%ldY lr isáñ$uq'

DeclarationI/we certify that all the above mentioned information furnished to the company by me/us are true and correct and hereby declare that no information which could be helpful in taking decisions on the proposed facility has been withheld. I/we further declare that I/we take the responsibility to inform your Company in writing any change that may occur in my/our financial position in future.

$w;W

ehd;$ehq;fs; tpz;zg;gpj;j fld; rk;ge;jkhf nraw;gLk; nghUl;L epWtdj;Jf;F toq;fpAs;s NkNy Fwpg;gpl;l tplaq;fs; ahTk;

cz;ikahdJk; rupahdJk; vdTk; ehd;$ehq;fs; cWjpg;gLj;JtJld; fld; rk;ge;jkhf jPu;khdq;fs; vLf;Fk; NghJ Njitg;gLfpd;w

ve;jnthU

jftiyAk; kiwf;ftpy;iy vdTk; ,j;jhy; njuptpf;fpd;Nwd;$njuptpf;fpd;Nwhk;. vjpu;tUk; fhyj;jpy; vdJ$vq;fsJ epjp epiyikfspy;

Vw;gLfpd;w ve;jnthU khw;wj;ijAk; cq;fsJ epWtdj;Jf;F vOj;J %yk; mwptpg;gjw;fhd nghWg;ig ehd;$ehq;fs; Vw;Wf; nfhs;Sfpd;Nwd;$Vw;Wf; nfhs;Sfpd;Nwhk; vdTk; NkYk; njuptpj;Jf; nfhs;Sfpd;Nwd;$nfhs;Sfpd;Nwhk;.

wheÿïlref.a w;aik $Signature of the applicant $tpz;zg;gjhuupd; xg;gk;

wheÿïlref.a w;aik $Signature of the applicant $tpz;zg;gjhuupd; xg;gk;