Annexure - I

Bank of Baroda Revised Application Form For

Baroda Kisan Credit Card

Photographs

The Branch Manager Bank of Baroda _____________ Branch _____________ Dear Sir Re. : Availment of Baroda Kisan Credit Card facility from your bank I / We the undersigned Mr. / Miss / Mrs. __________________________________ son / daughter / wife of ________________________ belonging to village ______________ Taluka ___________ District ___________________ hereby apply for sanction and issuance of Baroda Kisan Credit Card facilities for my / our farming activities. For the purpose, I / We furnish the required information in the format enclosed which is correct as per my / our knowledge and belief. I am/ we are aware that in case any of the information furnished by me/us in this respect is proved to be incorrect, false or incomplete, my /our BKCC facility is liable to be cancelled/withdrawn forthwith by you without any notice to me/us. I / We have read the latest rules and regulations of Baroda Kisan Credit Card scheme of your Bank and undertake to abide by / adhere to the same. I / We hereby authorise you to debit our account for the material purchased / payment made through cheques / charge slip in case of material purchased by me/us from authorised Member Establishment dealers. I / We hereby undertake to operate upon / maintain our accounts within the sanctioned limits. Yours faithfully, Signature Name 1. X________________________________ ___________________________________ 2. X________________________________ ___________________________________ 3. X________________________________ ___________________________________ 4. X________________________________ ___________________________________

Annexure to Application for BKCC

Information to be furnished by the Applicants for Baroda Kisan Credit Card

1. Applicant Details

Sr. No.

Name of the Applicant

Age Educational Qualification

Present Activity

Annual Income

(Rs.)

Residential Address

(1) (2) (3) (4) (5) (6) (7)

I / We belong to following categories.

SC _____ ST ______ Minority Community (Please specify) ____________ Small Farmers ___________ Marginal Farmers _____________ Tenant _________

Share Croppers ___________ 2. Details of agricultural land cultivated by the applicants Name of Revenue Village

Survey No.

Types of Ownership

Irrigated A. G.

Un- irrigated

A . G.

Type of Irrigation

facility

Market Value of

Agri. land per

acre

Total value of

Agri. Land

(1) (2) (3) (4) (5) (6) (7) (8)

Total

Latest Revenue abstracts 8A, 7/12 and No. 6 / Khasara,Khatauni are enclosed. 3. Details of crop cultivated by the applicants (Last year or average)

Season Name of crop

Irriga-ted

A G

Unirriga-ted

A G

Crop cultivation expenses incurred

(Rs.)

Annual Crop

Production in

quintal

Value of crop per quintal (Rs.)

Total value of crop

received (Rs.)

Profit / Income

(Rs.)

(1) (2) (3) (4) (5) (6) (7) (8) (9=8-5)

Total

4 At present I am / we are enjoying credit facilities from Banks / Co-operative Societies / Private Money Lenders as under :

Sr. No.

Name of Creditor Place Purpose of Finance

Balance Outstanding

Overdue if any,

1

2

3

4

5

Total

5 Our application / requirements of credit facilities from your Bank are given below :

Sr. No. Purpose Amount required

Likely date of availment

Total

Place : Date : Signature of applicant/s ---------------------------------- ----------------------------------- ----------------------------------

Operational Instruction in respect of Baroda Kisan Credit Card (To be obtained on a separate sheet)

We are having Composite Agriculture Cash Credit Account No. ______________ in our joint names. Therefore, we hereby authorise one of amongst us Mr./ Mrs _________________________ son / daughter / wife of Mr. _______________________________ residing at _________________ to operate upon our said composite cash credit account (Production Credit Account) sanctioned to us jointly under Baroda Kisan Credit Card Scheme. Sr. No. Names of Joint Borrowers Signature

=x=