Application Form for Seeking Venture Capital Assistance
1.Bank Details
Bank Name Complete Postal Address(with pin-code) : Pin Code:
Branch Name
Branch Code IFSC Code
Phone No. with STD : Fax No.: E-Mail Address.:
Name of the Branch Head Designation Mobile no. E-Mail Address
Name of Borrowal Unit : Constitution: Proprietor/Partners/Directors belong to
Registered Office Address (with pin-code): Pin Code: Phone No. Fax No.:
E-Mail Address.:
Site Office Address (with pin-code): Pin Code: Phone No. Fax No.:
E-Mail Address.:
2.d) 2.e)
Name of Incharge of Factory : Mobile No. Nature of Activity :
2.f) 2.g)
Date of Establishment : Date of Registration with DIC : Registration no. with DIC.
2.h) 2.i)
Category : Total Investment in P&M ( Rs in Lakhs) :
Banking Facilities Sanctioned by sanctioning authority (in Lakhs): (i). Term-Loan(in Lakhs) : (ii).Cash Credit (in Lakhs):
3.b) 3.c)
Sanctioning Office (Branch ZO / RO HO / CPC/ Committee): Designation of Sanctioning Authority
3.d) 3.e)
Bank Appraisal Note No : Dated Agenda No. / Minutes conveying sanction No: Dated
4.a)Name and Address of Controlling Office of the Branch 4.b)
Name Address of Controlling Office of the Branch (with pin-code): Pin Code: Name of Controlling Authority :
4.c) 4.d 4.e)
Mobile No.: Fax. No. : E-Mail Address. :
5.a) 5.b 5.c)
Present status of Unit : Status of civil construction : Arrival of Machineries and Equipments :
5.d) 5.e 5.f)
Status of Installation : Expected date of trial production : Expected date of commercial production (as per implementation plan approved by the sanctioning Authority):
Comments on delay in start of production. (if any) :
6. Status of Accounts
Term-Loan (in Lakhs): Amount of Disbursement till date : Outstanding as on date :
First installment due on (date) : Last Installment due on (date) :
Cash Credit (in Lakhs) : Limit : Drawing Power: Outstanding:
Comments on Irregularity ( if any): Any adverse comments on the unit by inspecting official in last inspection report:
A. Cost of Project ( as accepted by sanctioning authority) In Lakhs B. Means of Finance(as accepted by Sanctioning Authority) In Lakhs
a. Land Cost (if not owned) : a. Term loan of Bank :
b. Civil work including building construction.: b. Promoter Equity :
c. Plant and Machinery.: c. Unsecured loan :
d. Pre-Operative Expenses etc.: d. VCA
e. Working Capital Margin (if CC is sanctioned): e. Others if any :
f. Other if any (specify) : (up front subsidy / GAP etc.)
Total Total
A. Forward Linkages with following marketing Agencies B. Backward Linkages with Small / Marginal farmers

Tie-up with     No. of farmers for providing raw material

Details of Primary and Collateral Securities taken by the bank
a. Primary Securities
b. Collateral Securities
( Please enclose details separately )
C. D.
No. of Employment Generation through this project : Installed Capacity of the project :
Name of the Consultant/Consortium associated with the project with complete address, contact details and email :
Name Address (with pin-code) : Pin Code: Contact No:

Email Address :

Specific recommendation of Branch Head for Venture Capital Assistance :-

In view of the above information as well as assessment made in the process and Appraisal Note by Sanctioning Authority, we recommend the Venture Capital Assistant of Rs    Lakh   to M/s   to meet the funding gap indicated at item No.7-B(d) under Means of Finance above.(copy of sanction letter along with appraisal / process note of competent authority is enclosed for your perusal and record ).

Further we confirm / undertake that :

1. The KYC norms in respect of the Promoters have been complied by us.

2. We here by undertake that primary and collateral securities ( including the fixed deposit's) accepted by the Bank as primary / collateral security against the financial assistance sanctioned by the bank to the aforesaid promoters will not be released till VCA component is also repaid to SFAC. (Separate undertaking on bank's letter head is mandatory) as such enclose the separate undertaking on bank's letter head while forwarding the VCA application.

3. Techno-feasibility and economic viability aspect of the project has been taken care of by the sanctioning authority and the branch.

The unit has been inspected by Shri     (designation) on     and observed satisfactory progress as per implementation schedule.

5. There is a direct/indirect social/potential benefit to small and marginal farmers by setting up of the unit and there will be no negative environmental impact by this project.

6. On quarterly basis, bank will apprise the SFAC about progress of unit, recovery of bank's dues and present status of account to SFAC.

Has the bank separately discussed the amount of VCA in its process note.?

Date :

Signature of Branch Manager with branch seal

Name:    Designation:  

1.Signature should be in image file format(jpeg, jpg,'png, gif).
2. Image size should not exceed 25 KB.
3. Image Dimension of Signature should be 140(Width) * 60(Height) Pixel only.
Please upload the following enclosures in the next step
S.No List of Enclosures
1 Promoter’s request letter addressed to the Managing Director SFAC, New Delhi on original letterhead of firm/company
2 Sanction letter of Sanctioning authority addressed to recommending branch
3 Bank’s approved Appraisal/Process note bearing signature of sanctioning authority with terms of sanction of term loan
4 Up-to-date statement of account of Term loan and Cash Credit (if sanctioned)
5 Equity Certificate: a)C.A. certificate in case of Partnership or Proprietorship firms. b)Form-2(PAS-3), FORM-5(SH-7) and other documents in lieu of FORM-23 filed with ROC for Company
6 Farmer’s list/backward linkage duly supported by agreement
7 Affidavit of promoters that they have not availed VCA in the past
8 Unsecured loans raised by the promoters (If any). CA Certificate to be enclosed
9 Copy of last Bank's inspection report
10 Bank’s confirmation that they will not release primary & collateral security without SFAC consent
11 Justification for margin on working capital taken in the project cost
Note: Hard copies along with enclosure to be submitted separately to SFAC registered office NCUI Auditorium Building, 5th Floor, 3, Siri Institutional Area, August Kranti Marg, Hauz Khas, New Delhi - 110016. (T) +91-11- 26966017, 26966037, 26862365 (F) +91-11- 26862367
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