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Loan Application FormPlease fill information in capital letters and in black ballpoint pen only(Note:- All field in "*" are mandatory)
Open Market Existing Customer Staff
Co-Applicant
Relationship with Applicant
Individuals Non Individuals
Mr. Ms. Mrs. M/s.
Father’s Name OR Spouse Name
General OBC SC* ST* NT
Others Minority*
Male Female Transgender
S.S.C H.S.C Graduate / Diploma
Post Graduate Others
Married Single Widowed Divorced
(Including Children)
Owned Family Rented Company Leased
If Rented, Rent P.M.
Indian NRI Other
Hindu Muslim Sikh ChristianZoroastrian Buddhist Jain Other
Home Improvement Loan Composite Loan
Staff Loan
-
-
Last Name*
Requested Loan DetailsProduct Name Home Loan Ready Purchase
Home Self Construction Loan
Home Top-up Loan
Home Equity Loan
Category Semi-Formal Informal
Loan Purpose
Loan Amount Applied for (In Rs.)
Tenure (In Months) Preferred EMI (In Rs.)
Date
Customer ID
Branch Name
Branch Code
Lead Type
Applicant’s Details(in block letter)
Applicant Type
Salutation*
First Name*
Middle Name
Mother’s MaidenName (If any)
First Name*
Last Name*
Category*
Gender*Date of Birth/Incorporation*
Incorporation*Qualification*
Marital Status*
No. of Dependents
Applicant
Individuals Non Individuals
Mr. Ms. Mrs. M/s.
Father’s Name OR Spouse Name
General OBC SC* ST* NT
Others Minority*
Male Female Transgender
S.S.C H.S.C Graduate / Diploma
Post Graduate Others
Married Single Widowed Divorced
(Including Children)
Current Residential Address*
Address line 2
Address line 1*
Address line 3
Area Name
City/Town/Village*
District*
State*
Pincode*
Mobile No.*
(+91)Alternate Mobile No.
Phone No. (with STD Code)
E-mail ID* (Personal)
Current Residence
Period of Stay
Permanent Address
Owned Family Rented Company Leased
If Rented, Rent P.M.
Address line 2
Address line 1*
Address line 3
Area Name
City/Town/Village*
District*
State*
Pincode*
Phone No. (with STD Code)
Home Under Construction Purchase
Religion Hindu Muslim Sikh ChristianZoroastrian Buddhist Jain Other
Nationality Indian NRI Other
Nationality Indian Non Resident Indian Person of Indian Origin
Others
- -
Occupation Details
Occupation Category*
Employer / BusinessName*
Address line 2
Address line 1*
Address line 3
Area Name
City/Town/Village*
District*
State*
Pincode*
Phone No. (with STD Code)
E-mail ID* (Official)
Salaried
Farmer
Business
Others
Professional Retired Salaried
Farmer
Business
Others
Professional Retired
If Salaried*
If Business*
If Professional*
Entity Type*(Business / Professional)
Central / State Govt.
Public Sector Undertaking
MNC
Pvt. Ltd. Public Ltd.
Educational Inst.
Proprietor / Partnership Others
Designation
Current Work Experience
Total Work Experience
Trader Manufacturer Wholesaler
Service Provider Others
Doctor CA/CWA/CS Architect Lawyer
Others
Date of Commencementof Business / Profession
Proprietary
Public Ltd.
Partnership LLP Pvt. Ltd.
Trust Society HUF Individual
Central / State Govt.
Public Sector Undertaking
MNC
Pvt. Ltd. Public Ltd.
Educational Inst.
Proprietor / Partnership Others
Designation
Current Work Experience
Total Work Experience
Trader Manufacturer Wholesaler
Service Provider Others
Doctor CA/CWA/CS Architect Lawyer
Others
Date of Commencementof Business / Profession
Proprietary
Public Ltd.
Partnership LLP Pvt. Ltd.
Trust Society HUF Individual
CorrespondenceAddress*
Current Permanent Office
Yes No
Current Permanent Office
Yes NoRegistered with GST
If yes, GSTIN
Loan and Property Details.
Land Area (Sq. Mtr.)
Ownership
Property Address
City / Town
District
State
Sole Joint
Built up Area (Sq. Mtr.)
Land Type Freehold Leasehold .Carpet Area Sq.Mtr.
(`)(`)
Pincode Landmark
Agreement Value Cost of Plot & Construction
ApplicantProof of Identity* Co - Applicant
PAN No.*
Aadhaar No.
Passport No.
Driving License No.
Voter ID
NREGA Job Card
Others (Any document notified
by the Central Government)
ID No.
KYC Document
Proof of Address*
Voter ID
Passport
NREGA Job Card
AadhaarDriving License
Others
Voter ID
Passport
NREGA Job Card
AadhaarDriving License
Others
Bank Account Details
Applicant Co - Applicant
Bank Name
A/C Type
A/C No.
Savings Current Over Draft Savings Current Over Draft
*Has/Have applicant(s) given Guarantee to any loan with USFB
Loan Repayment Mode NACH/SI Post Dated Cheque Cash
Yes No
Family Information & Household Income Declaration
Name AgeRelationship with
ApplicantID
TypeID
NumberEducation
LevelNGP* Occupation Income/
ContributionHealth
(H/U/D)**
For office use only
Application Through Direct Sales Team Connector Customer Referral USFB Staff
Referrer ID:Referrer Name
Login Fees
Amount in Rs. Cheque OnlineCash Cheque No. Date
Others
Employ ID: UJJ DesignationLoan Officer
Employ ID: UJJ DesignationApprover from Business
Employ ID: UJJ DesignationApprover from Credit
Employ ID: UJJ DesignationLoan Officer
Connector Name Connector Code
Acknowledgement of Loan Application
Ujjivan Small Finance Bank Ltd. (USFB) acknowledge the receipt of loan application form (Applicant’s Name).
We shall convey our decision on this application within 30 days from here off.
Name of Loan Officer Signature Date
Applicant’s Name
Applicant’s Signature
DateApplic
ant’s
Photo
Co-A
pplic
ant’s
Photo
Co-Applicant’s Name
Co-Applicant’s Signature
Date
“I/we authorize Ujjivan Small Finance Bank Ltd. to use my/our contact number mentioned in the form for transactional/promotional/service calls/massages.”
Declaration
Co-Applicant / Guarantor
-
Occupation Category*
Employer / BusinessName*
Address line 2
Address line 1*
Address line 3
Area Name
City/Town/Village*
District*
State*
Pincode*
Phone No. (with STD Code)
E-mail ID* (Official)
Extension No.
Salaried
Farmer
Business
Others
Professional Retired
If Salaried*
If Business*
If Professional*
Entity Type*(Business / Professional)
Central / State Govt.
Public Sector Undertaking
MNC
Pvt. Ltd. Public Ltd.
Educational Inst.
Proprietor / Partnership Others
Designation
Current Work Experience
Total Work Experience
Trader Manufacturer Wholesaler
Service Provider Others
Doctor CA/CWA/CS Architect Lawyer
Others
Date of Commencementof Business / Profession
Proprietary
Public Ltd.
Partnership LLP Pvt. Ltd.
Trust Society HUF Individual
Guarantor Co-Applicant
Guarantor / Additional Co-Applicant FormPlease fill information in capital letters and in black ballpoint pen only
Personal Details (Individual)Relationship with Applicant
Name
Gender Male Female Transgender
Father’s Name
Mother’s Name
Spouse Name
Date of Birth
Marital Status
Religion Hindu Muslim Sikh Christian
Zoroastrian Buddhist Jain Other
Category SC ST OBC General Other Person with Disability
Highest Academic Qualification
PAN Number
UID No.
VID No.
Passport No.
Driving Licence
Date of Issue
Date of Issue
Date of Expiry
Date of Expiry
Occupation Details
Present Address
House No.
Street/Area
City
District
State
Pin code
House Type
Mobile No.
Owned Leased Rented Years of saty
Permanent Address
Same as applicant
Same as applicant Preferred Address for Communication
House No.
Street / Area
Landmark
City
District
State
Pin code
House Type
Mobile No.
Owned Leased Rented
Nature of Employment Self Employed
Wage Worker
Salaried
Contract Worker Farming
Nationality
Single Married Widow Divorced Separated
Indian NRI Other
Mother’s MaidenName
Name of Loan Applicant
Co-Applicant / Guarantor
Savings Current Over Draft
Bank Account Details.
CorrespondenceAddress*
Current Permanent Office
Yes No
Current Permanent Office
Yes NoRegistered with GST
If yes, GSTIN
Bank Name
Account Type
Account No.
IFSC Code
Co-A
pplic
ant’s
Photo
Name
Date
Signature
Loan Officer
Cluster/Program Manager
Credit OfficerNote: This form is an addendum to the Home Loan Application form.
Emp. ID UJJ
Emp. ID UJJ
Emp. ID UJJ
Declaration
“I/we authorize Ujjivan Small Finance Bank Ltd. to use my/our contact number mentioned in the form for transactional/promotional/service calls/massages.”
Loan Applicant Form - AnnexurePlease fill information in capital letters and in black ballpoint pen only
Any litigation and Disputes on the Property
Loan Purpose
Loan Amount Requirement:
Cost of Estimate (For Home Improvement, Under-Const., Self-Const.)
Cost of Home Purchase
Details of the Property offered as Security
CompleteAddress of theProperty
House No.
Property Type
Street / Area Name
Landmark
City / District
State
PIN Code
Approximate value of the property (Rs.)
Is the Property Mortgaged / Held as Security at Present
No
No
Yes (Pls Specify )
Yes (Pls Specify )
Property Type
Residential
Commercial Others (Pls Specify )
Mixed (Residential and Commercial)
Name of the Property Owner
Relationship of the Property Owner with the major income earning member
Will the property be offered as security to Ujjivan Yes No
List of document submitted in support of ownership of the property
Applicant’s Signature
Name of the main applicant
Signature
Signature
Name of property owner (if different from main Applicant)
Date
Composite LoanStaff Loan
Home Top-up LoanHome Equity Loan
Home Improvement Loan
Home Loan Ready PurchaseHome Self Construction Loan
Home Under Construction Purchase
Flat Individual House Vacant Site Plot
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DECLARATION FOR SIGNING IN VERNACULAR LANGUAGE
I, Son/Daughter of
residing at do hereby state and declare on solemn affirmation as under:
I have read out and explained the contents of the loan application and all other documents incidental to availing the loan
from Ujjivan Small Finance Bank L td. to M r./Mrs Mr./Mrs.
and Mr./Mrs. in the language known to him/her/there and
he/she/they have understood the same and agreed to abide by all the terms and conditions of the loan and the clause
He/she/they have affixed his/her/there signature/ thumb impression here in below pursuant to the same.
I declare that whatever I have stated herein above is true and correct to the best of my knowledge and belief the same.
Solemnly affirmed at on this day of
Witness
Name:
Name:
Signature:
Date:
Borrower (Sig) Co-Borrower (Sig) Co-Borrower (Sig)
Borrower Name Co-Borrower Name Co-Borrower Name
For Ujjivan Small Finance Bank Ltd.
of the same
Emp. ID:
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PROPERTY VISIT REPORT
Visit Date
Applicant Name:
Co - Applicant Name:
Property Owner Name (as per property document):
Loan Type:
Loan Amt:
Property Address (as per property document):
Tenor: Months
Property Address (as per visit):
Property Land Mark:
Proximities of Civic Amenities:
Development in the Area:
Property Description:
Remarks:
Opinion:
(Property Visited By)
Employee Name: Employee ID:UJJ
Signature with Date:
Property photographs along with the customer (one each - out side with street and in side)
MAP
Login Cum Customer Screening Sheet
Basic Details
Branch Name:
Applicant Name:
Product Name:
Date of Visit:
Contact Number:
Applied Loan Amount:
Login Checklist
Document
Guideline for filling the checklist: Y - Yes, N - No. NA - Not Applicable
Loan Officer Credit Officer
HL Application Form
Application Form Annexure
2nd Co-Borrower and Guarantor Sheet (If Applicable)
ID Proof for Applicant and Co-Applicants (2 Copies including 1 for Insurance)
Residence Proof for Applicant and Guarantor (2 Copies including 1 for Insurance)
Signature Proof Applicant, Co-Applicant and Guarantors
Passport Size Color Photos (1 each for Applicant, Co-Applicant and Guarantors)
Business Address Proof (If applicable)
Uptaded Passbook or Bank Statement Showing Transactions of the past 06 months. Borrower / Co-Borrowers
Proof of Income - Business / Salary for Applicant, Co-Applicant and Guarantors
Photograph of the Borrower with Business Unit in the background
Photograph of the Borrower with property (to be mortgaged) in the background
Photocopy of Property Document (Title/Chain/Revenue documents)
Cost Estimate (for Self-Construction / Home Improvement Loan)
Guarantor Details if applicable (KYC / Application / Income Documents)
Product Feature Slip
Customer Screening Details
Income Details
Name Relation with Applicant Income Source Monthly Net Income Experience (Years)
Existing Loan Details
Total Household Income
Lender Name Loan EMI Total Loan Amount Tenor Outstanding Loan Amount Tenor
Is there any closed loan? If yes, Loan Amount of closed loans
Is there any late payment in existing or closed loan? If yes mention reason:
Loan Purpose Details
Loan Purpose:
Total Estimated / Purchase Cost:
Work Start / Registration date - Planned:
Loan Amount Required
Margin Money
Source of Margin Money
Boundry Matching? (Yes / No):
Title Chain Availability (Years):
Road width to the House (Feet)
Property Owner Name
Relation with Applicant
Building Plan Approval (Yes/No)
Legal / Technical Aspects
Other Details
Assets created in last 10 years
Amount invested in asset creation in last 10 years
How much EMI can this applicant pay comfortably after factoring all expenses
Is property owner ready to mortgage property with USFB?
Reference Checks (to be done by Loan Officer)
Response from Reference Check
Neighbour Reference Check
Employment/Business Reference Check
LO Name:
Credit Visit Report Date of visit
If the details provided by LO does not match with credit assessment/checks, mention the same as below
Mismatch Details Reason for mismatch
CO/CM Name CO/CM ID CO/CM Signature
PRODUCT FEATURE - HOME LOANS
Ujjivan Small Finance Bank LimitedHome Loan Product Features:
Ujjivan Small Finance Bank LimitedHome Loan Product Features:
Acknowledgement
Date & Place:Customer’s Signature:
I hereby acknowledge that
the entire features of the loans described above & the cost and charges associated with the
same have been explained to me by USFB official.
2,00,000- 30,00,000
Product TypeLoan Amount(In Rs Lakhs)
Other Cost & Charges(Non - Refundable)
Home Improvement Loan(Secured)
Home Purchase Loan
Home Construction Loan
Home Equity Loan(Non - Housing Loan)
Composite Loan
2,00,000- 25,00,000
2,00,000- 75,00,000
2,00,000- 75,00,000
3,00,000- 25,00,000
36 - 240
36 - 240
36 - 240
36 - 180
36 - 120
Tenure (In Months)
Log in Fees,Rs 3000 + GST (Informal) &
Rs 2000 + GST (Semi - Formal)
Interest rate and Legal & Documentation Charges
as per sanction letter issued tocustomer
Life insurance premium asApplicable
Stamp duty as appliacble inState / UT
CERSAI Charges
Rs.50 5 Lakhs (Ex. GST)Rs.100 5 Lakhs (Ex. GST)
2,00,000- 30,00,000
Product TypeLoan Amount(In Rs Lakhs)
Other Cost & Charges(Non - Refundable)
Home Improvement Loan(Secured)
Home Purchase Loan
Home Construction Loan
Home Equity Loan(Non - Housing Loan)
Composite Loan
2,00,000- 25,00,000
2,00,000- 75,00,000
2,00,000- 75,00,000
3,00,000- 25,00,000
36 - 240
36 - 240
36 - 240
36 - 180
36 - 120
Tenure (In Months)
Log in Fees,Rs 3000 + GST (Informal) &
Rs 2000 + GST (Semi - Formal)
Interest rate and Legal & Documentation Charges
as per sanction letter issued tocustomer
Life insurance premium asApplicable
Stamp duty as appliacble inState / UT
CERSAI Charges
Rs.50 5 Lakhs (Ex. GST)Rs.100 5 Lakhs (Ex. GST)
CUSTOMER COPY
OFFICE COPY
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CLSS - Eligibility Form
Applicant Name:
Property Owner Name:
Relationship between the Applicant and the Property Owner:
Product:
Loan Amount:
Tenure: ROI:
Eligibility Criteria for CLSS
1. How many members are there in the family of the applicant ? (A family consists of Husband, Wife and unmarried children)
Ans.
2. Is there any adult female member in the family ?
Yes No
3. The property comes under which area ?
Municipal Limits
Grampanchayat Limits
Any other (Mention here)
4. Does the applicant or any member of his/her family (viz., spouse or unmarried children) own a pucca house in any part of India ?
Yes No
5. Family Income of the applicant (per annum) ?
Up to Rs. 3,00,000
Rs. 6,00,001 to 12,00,000
Rs. 3,00,001 to Rs. 6,00,000
Rs. 12,00,001 to Rs. 18,00,000
6. Whether the Beneficiary Family has availed central assistance under any Housing Scheme from Government of India ?
Yes No
7. Expected Carpet area of the property ?
Up to 30 Sq. Mtr (323 Sq. Ft.)
Up to 160 Sq. Mtr (1722.23 Sq. Ft.)
Up to 60 Sq. Mtr (646 Sq. Ft.)
Up to 200 Sq. Mtr (2152.78 Sq. Ft.)
8. Copy of Identity proof of all the adult family members have been collected: (Aadhar Card, PAN Card, Voter ID Card, Passport for
any other please mention type and number in blank space)
Member - 1
Member - 2
Member - 3
Member - 4
Proof Type UID No.
9. Is the customer eligible for CLSS ? (to be verified by CO)
Yes No
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To,Ujjivan Small Finance Bank Ltd., Branch.
I/We,
1_________________, aged _________years, son / wife of______________________(“the Borrower” or “the Beneficiary”)
2_________________, aged _________years, son / wife of______________________
3_________________, aged _________years, son / wife of______________________ (“the family members”)4_________________, aged _________years, son / wife of______________________ (“the Guarantor”) all residing at________________________, ________________________, ________________________state, declare undertake and agree as follows:
1)
2)3)
SL. No.Name of family
membersAge Sex
Relationship with
the beneficiary
Aadhaar Number
Source of Income
Annual Income (In Rupees)
Self
Total
4)
5)
6)
7)
8)
9)
10)11)
12)
13)
This Letter/Undertaking shall be treated as part and parcel of the loan documents executed/to be executed by me/us in favour of the Bank in connection with the loan sanctioned/to be sanctioned under the Scheme.
Names & Signatures of the Beneficiary, his Family Members and the Guarantor
Place :
Date : We state that the above statements are true and correct.
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