Annexure - I
Bank of Baroda
Revised Application Form For
Baroda Kisan Credit Card
The Branch Manager
Bank of Baroda
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facility is liable to be cancelled/withdrawn forthwith by you without any notice to me/us.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
I / We hereby undertake to operate upon / maintain our accounts within the sanctioned limits.
1. X________________________________ ___________________________________
2. X________________________________ ___________________________________
3. X________________________________ ___________________________________
4. X________________________________ ___________________________________
Annexure to Application for BKCC
Information to be furnished by the A