Schedule- 3 (Relating to Sub rule (1) of Rule 18)

Format of Application for Requesting Loans
The Welfare Officer,
Land Revenue Office……………………..
Subject: Request for Loan
Dear Sir/Madam,
As I/we are in a need of Rupees …………………………………to do …………………work, I/we have submitted this application with the following details with a request to make avail of the amount as a loan.
1. Of the freed bonded labour or Group:-
(a) If a person, Name Surname:-
(b) No. of Identity Card and Class:-
(c) Address:-
(d) If included in a Group, name of the Group:-

2. Purpose of Loan Request,-
(a) If going to purchase land,-
(1) Whether land has been acquired or not pursuant to these Rules:-
(2) Region of the land intending to purchase and the area of the land:-
(b) If going to do business,-
(1) Name of Business:-
(2) Location of business operation:-
(3) Estimated Cost:-
(4) Market that will consume produced goods:-
(5) Time required for profit earning from the produced goods:-
(6) Estimated profit in a year:-
(c) If requesting loan to purchase an aero plane ticket for going to foreign
employment,-
(1) Country Intending to Go for Employment:-
(2) The Company Working with and Description of Work:-
(3) Remuneration to Receive for the Work:-

3. If taken loan before to run business a business,-
(1) Amount of loan taken:-
(2) For what business purpose the loan was taken:-
(3) Date of loan paid off:-
4. Period of loan recovery and method (to propose a period of loan recovery and method)
Applicant’s,-
Signature:-
Name Surname:-
Date Documents
to be submitted with the Application:-
(1) Copy of Identity Card of the freed bonded labour,
(2) Copy of Nepali Citizenship Certificate,
(3) Copy of the training certificate, provided one has received such training,
(4) If intending to run a business on behalf of a Group, recommendation from the
Group,

(5) If intending to go to foreign employment, the proof of Visa receipt from the
concerned country.