** Before filling up the form please read UCO Education Loan Scheme given in the website.
Please fill up the fields with your relevant information, as applicable, and those fields which are 'Not Applicable', please fill up as 'NA'.

I am desirous of pursuing my studies in (Give Course Name) in India / Abroad and apply for a term loan under UCO Education Loan Scheme. I give below the particulars necessary for consideration of my application.

First Name Middle Name Last Name Mr. Miss. Mrs.

Date of Birth dd 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 / mm January February March April May June July August September October November December / yyyy 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 Gender MaleFemale

Category -- Select -- General OBC SC ST Marital Status UnmarriedMarried

Passport No. PAN No.

Permanent Address City State -- Select -- Andaman & Nicobar Andhra Pradesh Arunachal Pradesh Assam Bihar Chandigarh Chhattisgarh Daman & Diu Delhi Goa Gujarat Haryana Himachal Pradesh Jammu & Kashmir Jharkhand Karnataka Kerala Madhya Pradesh Maharashtra Manipur Meghalaya Mizoram Nagaland Orissa Pondicherry Punjab Rajasthan Sikkim Tamil Nadu Tripura Uttar Pradesh Uttarakhand West Bengal Pin (enter digits only) Mobile (enter digits only) Landline / Fax No. STD Code Number (enter digits only)

Please note that your loan will be processed at the branch near to the place of your permanent residence. In order to facilitate prompt service, please select your district and nearest UCO Bank branch from the lists below :- -- Select District -- -- Select Branch --

Present Address      Same as above City State -- Select -- Andaman & Nicobar Andhra Pradesh Arunachal Pradesh Assam Bihar Chandigarh Chhattisgarh Dadra & Nagar Haveli Daman & Diu Delhi Goa Gujarat Haryana Himachal Pradesh Jammu & Kashmir Jharkhand Karnataka Kerala Lakshadweep Madhya Pradesh Maharashtra Manipur Meghalaya Mizoram Nagaland Orissa Pondicherry Punjab Rajasthan Sikkim Tamil Nadu Tripura Uttar Pradesh Uttarakhand West Bengal Pin (enter digits only) Mobile (enter digits only) Landline / Fax No. STD Code Number (enter digits only) Email

Academic Qualification Examination University / Institution Year of Passing (YYYY) Faculty of Studies Division / Distinction % of Marks Obtained Honour / Scholarship / Prizes Won 10+2 Graduation Post-graduation

Parent's / Guardian's Financial Status / Family Particulars   Father Mother Husband (in case of married women only) Guardian (in absence of parents) Name Age Years Years Years Years Occupation -- Select -- Business Service Self - Employed Retired Agriculture Others -- Select -- Business Service Self - Employed Retired Agriculture Housewife Others -- Select -- Business Service Self - Employed Retired Agriculture Others -- Select -- Business Service Self - Employed Retired Agriculture Housewife Others Passport No. PAN Card No. Loan availed, if any, from Banks / FIs? YesNo YesNo YesNo YesNo Annual Income (Approx) Rs. Rs. Rs. Rs.

Particulars of Family Members Name(s) of Members of family excluding the parents / Husband and the applicant Age in years Relationship Annual Income (In Rs. Lacs) Source of Income -- Select -- Salary Business Others -- Select -- Salary Business Others -- Select -- Salary Business Others -- Select -- Salary Business Others -- Select -- Salary Business Others

Particulars of Course of Studies Name of the College / Institution / University -- Select -- All India Institute of Medical Sciences (AIIMS),Delhi Armed Forces Medical College, Pune Bangalore Medical Collge, Bangalore Bengal Eng and Science University , Shibpur Birla Institute of Technology & Science, Pilani Birla Institute of Technology , Mesra Campus Law Centre, Delhi University , Delhi Christian Medical College, Vellore College of Engg , Anna University Delhi College of Engineering, New Delhi Faculty of Engg & Tech, Jadavpur University ,Kolkata Faculty of Management Studies, Delhi University (FMS) , New Delhi Govt College of Law, University of Mumbai, Mumbai Indian Institute of Management, Ahmedabad Indian Institute of Management, Bangalore Indian Institute of Management, Indore Indian Institute of Management, Joka, Kolkata Indian Institute of Management, Kozhikode Indian Institute of Management, Lucknow Indian Institute of Technology, Chennai Indian Institute of Technology, Delhi Indian Institute of Technology, Guwahati Indian Institute of Technology, Kanpur Indian Institute of Technology, Kharagpur Indian Institute of Technology, Mumbai Indian Institute of Technology, Roorkee Indian School of Mines, Dhanbad Institute of Technology , Banaras Hindu University,Varanasi Jamnalal Bajaj Institute of Management Studies, Mumbai JIPMER, Pondicherry Kasturba Medical College, Mumbai King Edward Medical College, Mumbai Lady Edward Medical College, Delhi Madras Medical College, Chennai Maulana Azad Medical College, Delhi Motilal Nehru National Inst. of Technology, Allahabad NALSAR University of Law , Hyderabad Narsee Monjee Institute of Management Studies, Mumbai National Institute of Fashion Technology (NIFT), New Delhi National Institute of Fashion Technology, Ahmedabad National Institute of Fashion Technology, Banglore National Institute of Fashion Technology, Calcutta National Institute of Fashion Technology, Chennai National Institute of Fashion Technology, Hyderabad National Institute of Fashion Technology, Mumbai National Institute of Technology, Suratkal National Institute of Technology, Trichy National Institute of Technology, Warangal National Law School of India University (NlSIU), Bangalore Punjab Engineering College, Chandigarh SP Jain Institute of Management & Research, Mumbai Thapar Inst of Engineering & Technology, Patiala University College of Law, Bangalore Xavier Labour Research Institute (XLRI) , Jamshedpur Others (Specify below) Complete Address of the College / Institution / University Name of the Course Duration of the Course -- Select -- 0 1 2 3 4 5 6 Years -- Select -- 0 1 2 3 4 5 6 7 8 9 10 11 Months Whether Admission Secured or Not? YesNo   Mode of securing admission -- Select -- Common Entrance Test Management Quota Others Type of Course Full TimePart Time Level of Course -- Select -- Under Graduate Certificate Diploma Graduation Post-Graduation Research Stream -- Select -- Engineering Medical Management Agriculture Research Humanities Commerce Others Part-time employment (campus employment) in case of studies abroad, if any YesNo Expected monthly income from part-time employement during the study period, Rs. since when (mm/yyyy)

Total Expenses of studies (in Rupees) A Tution Fees Books, Stationary, Equipment / Computer Examination Fees Hostel Rents / Board Air Passage / Others Total 1st 2nd 3rd 4th 5th 6th Total

Total Other Sources of finances Per annum (in Rupees) B Scholarships / Stipend Part-time employment Any financial assistance Family Sources Total 1st 2nd 3rd 4th 5th 6th Total

C Loan Amount Required (A - B)

Prospect for employment after completion of studies NA Expected Income Rs. per month Less, monthly expenses for self and family Rs. per month Balance amount available for Repayment Rs. per month

Guarantor's Details, if any Name Address City State -- Select -- Andaman & Nicobar Andhra Pradesh Arunachal Pradesh Assam Bihar Chandigarh Chhattisgarh Dadra & Nagar Haveli Daman & Diu Delhi Goa Gujarat Haryana Himachal Pradesh Jammu & Kashmir Jharkhand Karnataka Kerala Lakshadweep Madhya Pradesh Maharashtra Manipur Meghalaya Mizoram Nagaland Orissa Pondicherry Punjab Rajasthan Sikkim Tamil Nadu Tripura Uttar Pradesh Uttarakhand West Bengal Pin (enter digits only) Mobile (enter digits only) Landline / Fax No. STD Code Number (enter digits only) Worth of the Guarantor (in Rupees) Name of parents who will stand as co-applicant Father      Mother Name of parent who will stand as surety for the loan

Whether the applicant's life is insured? if so, please state the following particulars about the policy Policy Number Sum Assured (in Rs.) Date of Maturity (dd/mm/yyyy) Last Premium Paid on (dd/mm/yyyy)

Securities proposed, if any Value Rs. Any other information which the applicant like to give

I / We hereby declare that I / We have not applied for nor am I / are we availing of any financial assistance for pursuing the applicant (student)'s studies from any other Bank/s or financial institutions or persons and have no financial liabilities whatsoever. I / We certify that to the best of my / our knowledge and belief, the information furnished above are true and correct. I / We promise to abide by the terms and conditions of the Bank governing the grant of loan. I / We confirm that I have read through the terms and conditions of requesting an education loan through this online facility. Please sanction the aforesaid loan in my / our favour.

Enter Image Verification Code (Case Sensitive) I accept the Terms and Conditions

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