M/s. Centrum Microcredit Ltd. FCU -Centre VIsit Questionnaire * Required State Name*Option 1Option 2Option 3State NameName Of The Visitors* Name Of The VisitorsDesignation*Option 1Option 2Option 3DesignationEmployee ID* Employee IDDate of Visit* MM slash DD slash YYYY Date of VisitBranch Name* Branch NameLoan Officer(Name)* Loan Officer(Name) Center ID* Center IDCenter Name Center NameReason of centre selection* Zero Collection Maximum clients in moratorium Un-Touched center PAR Clients Others Reason of centre selection Client Name (Met at the centre).*Client Name (Met at the centre). Client ID.* Client ID. Total no. of clients in the center.* Total no. of clients in the center. Total no. of OD clients* Total no. of OD clientsCross checking :Due demand v/s Collected amount by the clients* Yes NO Cross checking :Due demand v/s Collected amount by the clientsAny Discrepancy/ mismatch.* Yes NO Any Discrepancy/ mismatch.Remark on Discrepancy*Remark on DiscrepancyLoan card is updated and signed by the LO.* Yes NO Loan card is updated and signed by the LO.Has anyone visited this center earlier or follow up was taken?* Yes NO Has anyone visited this center earlier or follow up was taken? No. of client paid the OD amount during the visit.* No. of client paid the OD amount during the visit.Total OD amount collected during the visit* Total OD amount collected during the visitNext PTP date (Promise to pay date). MM slash DD slash YYYY Next PTP date (Promise to pay date).Declaration : I declare that I/We have visited the centre and reporting the best of my/our information about the visit* Yes No Declaration : I declare that I/We have visited the centre and reporting the best of my/our information about the visit Δ
