Note: All fields are mandatory and require to be filled up. If any of the fields are not applicable to you then fill it up with "NA".

APPLICATION FORM FOR ALLAHABAD BANK
EDUCATION LOAN SCHEME

Place :

Date   :

Chief Manager - Retail Credit Division,
Allahabad Bank,
Head Office,
2 N S Road,
Calcutta-700001

1.       APPLICATION :

I hereby apply for a term loan of Rs being amount of tuition fees, hostel and canteen charges, library fees and other fees and charges payable to the Institute to enable me pursue studies in

Name of the Institute :

Institute Admission Reference No. , Dated

2. PERSONAL BACKGROUND OF THE STUDENT :
    
a) Name in full :
b) Sex : Male    Female
c) Date of Birth and Age :
d) Nationality :
e) Pan No (if any) :
f) Passport No: :
g) Marital Status :
h) If married, the number of children :
i) Father's name in full :
j) Guardian's name in full and relationship with him/her :
k) Address of Father/Guardian :
           
3. EDUCATIONAL QUALIFICATIONS (From S.S.C. onwards upto date) :
     

Examination
passed

Institution/
University

Year of
passing

Percentage
of marks

Class
obtained

4.
FATHER'S/GUARDIAN'S FINANCIAL STATUS/FAMILY PARTICULARS :
    
a) Occupation
(Give full particulars)		 :
b) Permanent residential address :
c) Income per month from all sources       : Rs
d) Age :
e) If in service, the age of retirement :
f) Number of dependants :
g) Details of income of any other member of family, if earning :
h) Pan No (if any) :
g) Passport No :

5.
PARTICULARS OF THE COURSE FOR WHICH LOAN IS REQUIRED :
    
a) Name of the course :
b) Duration of the course :
c) Name of the Institution & Place
 
d) Details of the fees and charges payable to the Institute :
     
  Tuition Fees

Hostel & Canteen Charges

 Library Fees Other
Fees & Charges		 Total
  (Rs.) (Rs.) (Rs.) (Rs.) (Rs.)
1st year of the course/
semester
2nd year of the course/
semester
3rd year of the course/
semester
4th year of the course/
semester
5th year of the course/
semester
6th year of the course/
semester
7th year of the course/
semester
8th year of the course/
semester
TOTAL:

6.
SOURCES OF FINANCE APART FROM BANK LOAN  :
(now applied for)
    
a) Non-repayable scholarship / studentship / fellowship or other financial assistance
@ Rs p.a. for years commencing from 		: Rs.
b) Repayable loan scholarship or other financial assistance (state terms of payment) : Rs.
c) Fund available from family sources
@ Rs. per year for years.		 : Rs.
d) TOTAL : Rs.
e) Whether availed Education Loan or any other loan from any Bank or Financial Institution. If "Yes", please give brief particulars of loan availed, i.e. Date, Amount, Name of Bank, Name of Branch and the amount outstanding. :  

7.
REQUIREMENT OF BANK FINANCE
[ 5 (d) - 6 (d) ]		 :      

8.

EXPECTED REPAYMENT CAPACITY AFTER COMPLETION OF THE COURSE:
  
a) Expected income per month
Less:		 : Rs .
b) Anticipated monthly expenses : Rs.
c) Amount available for loan repayment : Rs.
9.
NAME OF THE CITY FROM WHERE LOAN WILL BE DISBURSED/AVAILED:
(Please fill one option only and mark the other with "NA")
  
a) Branch nearest to the
place of residence		 :
    :
    :
   
b) City where the institution is located :
I hereby give my option to become a member of Group Life Insurance Plan under Allahabad Bank Educational Loan Scheme (in tie-up with LICI) and irrevocably authorise the Bank to realise the premium amount as applicable from my Savings Bank account or include the premium amount in the Project Cost of my Educational Loan.
I certify that, to the best of my knowledge and belief, the information furnished herein is true and correct. I promise to abide by terms and conditions governing the grant of loan.

                                                                                             Yours faithfully,

Name of the applicant :
Address :
Telephone Number :
Email :
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