Settlement Form A

Toll Free Helpline

Application Form for One Time Settlement (OTS) / Write Off

1. Name of the PWCS with Registration No

and Date

2. Complete Address with Telephone No / Mobile No of the Manager / Contect Person:

3. Account No

4. Amount

and Date of cc limit sanctioned

5. Date of NPA:

6. Net Worth,Net Deposable Resources (NDR),Sales,Rotation of Credit Limit as per Defination (Certificate of D.O is to be attached):

7. Audit Completed up to 31 March 2024 (A copy of the audited report along with statement of A/C etc. to be attached):

8. Receivable from Govt:

9. Loan Due from Members (Asset Side) & Dues to Members (Liability Side):

10. Sundry Debtors as on 31.3.2024

11. Sundry Creditors as on 31.3.2024

12.Valuation of Land & Building as on 31.3.2024

13.Valuation at Fixed Asset as on 31.3.2024

I Agree & Submit