Loan Application Form

Branch Name :      Loan Officer :

Center Name :      MemberId :

Reg Date :      Member Name :

DOB / Age :      Gender :      Religion :      Category :      Marital :      Date Of Marriage :      Spouse Name :      MobileNo :      Education :       Occupation :      Annual Income :      Annual Expence :

Nominee Name :      DOB / Age :      Gender :      Relation :      Education :      MobileNo :      Occupation :      Annual Income :

Bank Account Type :      AccountNo :      IFSC Code :      Bank Name :      Bank Branch :

Postal Address :

Permanent Address :

Latitude / Longitude :

Ration Card :      Electricity Bill :      Loan Purpose / Amount :

Member Aadhar :      PAN :      VoterId :      D.L. :

Nominee Aadhar :      PAN :      VoterId :      D.L. :

Nominee Identity Proof :      Address Proof :

Member Identity Proof :      Address Proof :

Income Detail :- Family Business Income :      Salary Pension Income :      Government Scheme :      Wages Income :      Rent :      Scholarship :      Other Income :     Agriculture :      Salary :

Expence Detail :- Electricity :      Education :      Party / Fucntion :      EMI Of Loan :      House Rent :      Food :      Water :      Health :      Cloth :      Other :      Total Expenses :

Children Detail :-

Form No :   Loan Term :-   Loan Name :/

ApplicationId :   Amount :   Date :   Loan Cycle :

Purpose :   SanctionId :   Amount :    Date :

Expected Date :   Processing :   Security :   Insurance :

Other :      Total :

Interest Type :   First EMI Date :   EMI Amount :

B. M. Signature Loan Officer Signature Member Signature Nominee Signature

I hereby declare that:- My annual household income is as per extant RBI guidelines. My total indebtedness does not exceed as per extant RBI guidelines. I/we have not availed loan from more than two MFIs or Institutions. I am not a defaulter to any Bank/MFI. Bank is authorized to verify my business activities and my family’s borrowing details and free to furnish details about the same to any Credit Information Bureau agency. Loan will be utilized for the specific purpose as mentioned in the form and bank is free to verify as and when desired. I hereby undertake to abide by terms and conditions that the Bank may stipulate while sanctioning the loan. I hereby declare that the information /particulars given are true and correct to the best of my knowledge and belief. I/We hereby agree, confirm and give consent that any sum remaining due to the Bank with accrued interest thereon in respect of any of the aforesaid advance/loan and any other monies payable by me/us under any of the documents executed/to be executed in future in connection with the said advance/loan or the repayment thereof, may be recovered by the Bank from me/us jointly or severally as a ‘public demand’ as specified or referred in any extant legislation relating to recoveries thereof. As per our request, if the Bank considered the loan application and sanction loan, I request you to kindly disburse the loan amount and credit the same to my saving account maintained at other Bank.

Member Photo Member POI Front Member POI Back Member Signature Member POA Front Member POA Back Nominee Photo Nominee POI Front Nominee POI Back Nominee Signature Nominee POA Front Nominee POA Back

Member Bank Passboo Member Nominee Joint Photo

B. M. Signature Loan Officer Signature Member Signature Nominee Signature