BORROWER'S BASIC FACT SHEET- FOR CORPORATE PRESCRIBED UNDER REGULATION R-3 Date of Request (TO BE COMPLETED IN CAPITAL LETTERS OR TYPEWRITTEN) 1
BORROWER'S PROFILE: Name
Phone # Res. National Identity Card # Computerized National Identity Card # Import Registration/Export Registration #
Address Fax #
E-mail Address
Off:
National Tax #
Sales Tax #
Date of Establishment
Opening of A/C
-
2 - A) DETAILS OF DIRECTORS / OWNERS / PARTNERS Name
Off:
Phone # Res. National Identity Card #
Address
Fax #
E-mail Address CNIC #
Share holding Amount
%of shareholding
2 - B) DETAILS OF DIRECTORS / OWNERS / PARTNERS Name
Off:
Phone # Res. National Identity Card #
Address Fax #
E-mail Address CNIC #
Share holding Amount
Phone # Res. National Identity Card #
Address Fax #
E-mail Address CNIC #
Share holding Amount
Phone # Res. National Identity Card #
Address Fax #
E-mail Address CNIC #
Share holding Amount
Phone # Res. National Identity Card #
Address Fax #
E-mail Address CNIC #
Share holding Amount
3 MANAGEMENT A. EXECUTIVE DIRECTORS / PARTNERS Name 1 2 B. NON EXECUTIVE DIRECTORS / PARTNERS Name 1
National Tax # %of shareholding
2 - E) DETAILS OF DIRECTORS / OWNERS / PARTNERS Name
Off:
National Tax # %of shareholding
2 - D) DETAILS OF DIRECTORS / OWNERS / PARTNERS Name
Off:
National Tax # %of shareholding
2 - C) DETAILS OF DIRECTORS / OWNERS / PARTNERS Name
Off:
National Tax #
National Tax # %of shareholding
Address
NIC#
Phone #
Address
NIC#
Phone #
2
4
5
6
CORPORATE STATUS Sole Proprietorship
Partnership
NATURE OF BUSINESS Industrial Commercial
Agricultural
Private /Public Limited Company
Services
Any Other
REQUESTED LIMITS Amount
Tenor
Fund Based Non.Fund Based 7
8
BUSINESS HANDLED /EFFECTED WITH ALL FINANCIAL INSTITUTIONS DURING THE LAST ACCOUNTING YEAR Imports
Exports
Remittances effected (if any)
EXISTING LIMITS AND STATUS Limit
Amount
Status
Expiry Date
Regular
Amount Over due(if any)
Fund Based Non Fund Based 9
ANY WRITE OFF, RESCHEDULING / RESTRUCTURING AVAILED DURING THE LAST THREE YEARS Name of Amount during 1st Year Financial Write Off Rescheduled Institution Restructured
Amount during 2nd Year Write Off Rescheduled Restructured
10 DETAILS OF PRIME SECURITIES MORTGAGED / PLEDGED A). AGAINST EXISTING FACILITIES Name of Financial Institution Nature of Security 1 B). AGAINST REQUESTED / FRESH / ADDITIONAL FACILITIES Name of Financial Institution Nature of Security 1 2 3 4
11 DETAILS OF SECONDARY COLLATERAL MORTGAGED / PLEDGED A) AGAINST EXISTING FACILITIES Name of Financial Institution Nature of Security 1 2 3 B) AGAINST REQUESTED / FRESH/ ADDITIONAL FACILITIES Name of Financial Institution Nature of Security 1 2 12
13
Amount during 3rd Year Write off Rescheduled Restructured
Total Amount
Rank of Charge
Net realizable value
Total Amount
Rank of Charge
Net realizable value
Total Amount
Rank of Charge
Net realizable value
Total Amount
Rank of Charge
Net realizable value
CREDIT RATING WHERE APPLICABLE Name of Rating Agency
DETAILS OF ASSOCIATED CONCERNS ( AS DEFINED IN COMPANIES ORDINANCE) Name of concern
Rating
Name of Directors
Share holding
% of Total Share Capital
14
15
16
FACILITIES TO ASSOCIATED CONCERNS BY THE CONCERNED FI. Name of Concern Nature & Amount of limit O/S. as on
DETAILS OF PERSONAL GUARANTEES PROVIDED BY THE DIRECTORS / PARTNERS ETC. TO Fis TO SECURE CREDIT; Names of the Institutions/persons to Amount of validity Guaranters whom guarantee given guarantee period
Nature & Value of securities
NIC#
NTN
DIVIDEND DECLARED (AMOUNT) DURING THE LAST THREE YEARS During the 1st Year During the 2nd Year
Over dues
Defaults
Net worth
During the 3rd Year
17
SHARE PRICES OF THE BORROWING ENTITY Listed Company Current Price Preceding 12 months average
18
19
NET WORTH (PARTICULARS OF ASSETS OWNED IN THEIR OWN NAMES BY THE DIRECTORS / PARTNERS / PROPRIETORS ) Owner's name Particulars of assets
Break up value of the shares in case of Private Limited Company
Market value
DETAILS OF ALL OVER DUES (IF OVER 90 DAYS) Name of Financial Institution
Particulars of liabilities
Amount
20
Details of payment schedule if term loan sought
21
Latest Audited Financial Statements as per requirements of Regulation R-3 to be submitted with LAF ( Loan Application Form)
22
Memorandum and Articles of Association , By Laws etc to be submitted by the borrower along-with request I certify and undertake that the information furnished above is true to the best of my knowledge.
CHIEF EXECUTIVE'S / BORROWER'S SIGNATURE & STAMP COUNTER SIGNED
Thank you for interesting in our services. We are a non-profit group that run this website to share documents. We need your help to maintenance this website.