Moveable Immoveable Total Value Signature S No

Moveable Immoveable Total Value Signature S No. INTENSIVE ENQUIRY PROFORMA NAME OF MEMBER FATHER'S/HU SBAND'S NAME CASTEAGEPROFESSIONPRESENT ADDRESS PROPERTY (in Lac) Solvent or Insolvent Encumbered or not Wheather member of any other Co- op. Society of the same type or Loan (if any) (Extractive summary — verify with official source.)