I
ALPHA CODE:
Borrower Number: -------
I/Werequest you to grant me/us a loan facilityfor
To enable you to consider the proposal,
'
I/We submit the following particulars.
Please complete all sections in BLOCK LETTERS and.tickm
boxes wherever applicable
Name
--------------------------
Category
Residence Address
. SC/ST/OBC/OTHERS/MINORITY COMMUNITY
PAN/GIR No.: --------------------------------------------------------------------------------------------------------------------------------------------PIN: --------------
Telephone
Fax:
IT]
No. of Years at Residence:
Date of Birth
:
Permanent Address
Mobile No. : ---------------------
Changed Residence in past 3 years:
(DD)
(MM)
INotChanged I ~
(YYYY)
I More than Once I
IT]
Age:
---------------------------------------------------------------------------
PIN:
Tel.
Fax:
E-mail'
About Yourself
Sex
Marital Status
---------------------------------
Net worth
D
Male
D
Female
:D
D
D
D
Education:
B
§
Single
Married
IfP<o''''"o",' '
Divorced
Widowed
Annlicant
Metric
1. Total
UnderGraduate
Graduate
Post-Graduate
Doctorate
2. Total
Doctm
4. Total
Architect
CA
MBA
Engineer
Lawyer
Liabilities
5. Net
Assets 3-4
6. Amount of Collaterals
No. of Dependents: -----(Excluding spouse)
Others -------------No. of Children:
Credit Card Details:
Credit Cards Owned: -----Card Issuer: ------Card No.: ------------------------------------Bank of Baroda Account No. ---------------- CA / SB
Branch Name: ----------------------------------Salaried:
--------------
Guarantor
3. Total
Assets 1+2
7.
Presence of Guarantor:
Yes / No
(If yes, give details in above column)
Other Assets
0 Color TV 0 Refrerator
0 Car
0 Two Wheeler
Telephone
D Cellular Phone 0 PC
0 Washing Machine
Please tell us about your Work:
I]
Name
of Organi~ation
:
Designation:
Executive
Managerial rl Clerk
Department:
----------------------------------
OfficeAddress: --------------------------------------------------------------------------PIN: ------------Tel.:
Extn. No. :
Fax: ---------E-mail:
Working With~[j-Go~~iP-u-biiC-sect;r
ITpublicLtd.
0 Pvt. Ltd. 0 Partnership
0 Proprietorship
0 MNC
WorkingSince:
Years at Current Job:
Greater than 5 Years
Between 3 to 5 Years
Between 1 to 3 Years
Less than 1 Year
'
Retirement Age: -------
D
0
0
0
Gross MonthlyIncome: Rs.____---------------
I
Self Emploved / Professional/Business:
about your Work:
Please tell us
Name of Company:
----------------------------Office Address: --------------------------------PIN : ----------------Tel.:
Fax: -----------------E-mail: ---------------------------------------
Business Details: D Pvt. Ltd.
0 Proprietorship D Others
Established Since:
Designation:
D Partnership
'-----
-------------------------------
0 Executive 0 Managerial
I 3 - 51 G:.::.:i]GJ
(Greater)
(Less)
Gross MonthlyIncome: ----------------------
Years in Current Business:
G;]
(
-'....-.
Prop"sed
Loan
Branches/Offices)
Details:
Income
(To be filled bv
Tenure Months:
'}
Purpose:
Purchase Price(Rs):
Loan Amount(Rs):
Details:
1. Gross Monthly Income (Rs.)
-----------------------
2. Salaried Person
(I) Monthly Basic (Rs.)
(ii) % of PF deduction
-----------------------
3.
-----------------------
-----------------------
Annual Professional Tax
4.
For Tax Purpose
(i) Total Annual Savings under s/88: ------------------------------------------(ii) 100% Rebate Amount
(iii) Deduction under chapter VI A :
(iv) Other Rebate IDeduction claime£======================
Rate ofInterest %:
Margin %:
5. Total Monthly house hold expenses: ----------------------6. Monthly other loan amount
----------------------7. Net Income of other Family members: ----------------------
1. Make / Model.
-----------------------2. Name of the dealer (For New Car) : ------------
FOR CAR LOANS ONLY (CAR DETAILS):
----------------------------------------------
Type of Vehicle:
3.
Age of Vehicle:
For Second Hand Car
(I) Approx. serviceable age of car' ---------------(ii) Valuationas per garage certificate:------------(iii) Nameand addressof Seller(Attachcopyof RC) :
------------------------------------------
(iv) Engine I Chassis No. . ------------------
About Your Bank Account
----------------
-----------------
----------------
Default IOverdue
Since
----------------
----------------
---------------------------------
-------------------------------
----------------
Amount of Loan
Outstanding Loan
Details Source/Type
1)__--__-----------2)_____------------3)_____--------------
---------------
(including
Name of the Bank
EMI
Outstanding
----------------
credit facilities if any)
Branch &
Telephone No.
Ale. Type
Ale No.
No. of years account
held
-----------------------------
---------------------------------
-------------------------------
---------------------------------
Main Bank --------Others:
1)
2)
-----------------------------------
out your
Name
Qouse :
-----------------------
ouf
Name
uaranfor :
---------------------
Address
---------------------------------------------
Address
Occupation
-----------------------
Occupation
-----------------------------------------------------------
Phone/Fax
Email
PAN/GIR Number
-----------------------
Phone/Fax
Email
PAN/GIR Number
-----------------------------------------------------------
----------------------------------------------
Net Annual Income IRs.) :
Net Annual Income IRs.
I/We hereby declare that all the particulars and information furnished in the application form are true, correct and complete and up-to-date in all
respects. I/We have not withheld any information. I/We confirm that I/We have had no insoivency proceedings initiated against me/us nor have I/We
ever been adjudicated insolvent. I/We also authorize Bank of Baroda or its agent to make references and enquiries relative to information in this
application which Bank of Baroda considers necessary. I/We also authorize Bank of Baroda to exchange, share, part with all information relating to
mylour loan details and repayment history information to other Banks/Financial institutionsl Credit Bureaus/Agencies as may be required and shall not
hold Bank of Baroda liable for use of this information. I/We undertake to inform Bank of Baroda regarding any change in mylour
residence/employmenUOccupationlTransfer
and to provide any other information that Bank of Baroda may require. I/We further agree that mylour loan
shall be governed by the rules of Bank of Baroda which may be in force from time to time. Bank of Baroda reserves the right to reject any application
without providing any reason.
I/we under take to bear processing, service, documentation charges etc. stipuiated by the bank from time to time. I/we agree, note and understand that
Bank of Baroda shall be entitled at its sole discretion to call back, the entire loan/advance whether due and payable or not at any time without
assigning any reason and enforce its rights, remedies and securities.
Yours faithfully,
Place
Date
-------------------------------------------------------------------
Signature of the Applicant
I am willing to stand as guarantor.
Place
Date
----------------------------------------------------------
Signature of the Guarantorls