16
CONSUMER FINANCE LOAN APPLICATION FORM Business Location: AC Application No. VER : 18.0/0316 FIELDS WITH * (STAR) ARE MANDATORY 1. BASIC INFORMATION – BORROWER (INDIVIDUAL) Constitution* Partnership Club Pvt. Ltd. Co. Society Listed Public Ltd. Foundation Trust Body of Individuals Proprietorship Association Others (please specify) Name of the Concern* Please collect your MID / Schedule of charges Shop & Establ. Regn. No. Beneficial Ownership Declaration given CST / VAT No. BORROWER - (NON INDIVIDUAL) 3. IDENTITY PROOF DETAILS (One Identity Proof is Mandatory) CV CE SCV LCV PASSENGER VEHICLES TRACTORS 4. PRIORITY SECTOR CATEGORY – As per RBI Requirement* Farming Sector: Agricultural / allied activity including farming, dairy, piggery, fishery, animal husbandry, poultry, bee-keeping, sericulture, cattle feed, poultry feed, fertilizers, pesticides, seeds and / or purchase of agricultural implements / machinery for spraying, weeding, harvesting, sorting, grading, transporting etc. PAN No. AADHAAR No. (UID) Voter ID No. Passport No. Driving License No. Photo Ration Card Expiry Unlisted Public Co. (Please tick appropriate category) Manufacturing Sector MICRO (investment in P&M does not exceed 25 lakhs) SMALL (investment in P&M between `.25 lakhs and `.5 crore) MEDIUM (investment in P&M between `.5 crore and `.10 crore) `. Landless Labourer/Tenant Farmer Small Farmer holding Land <2 hectares Other Farmer holding Land >2 hectares Engaged in allied agricultural activities as above Having fleet of tractors, bull-dozers, well-boring lqpt, threshers, harvestors, combines etc. Marginal Farmer holding Land <1 hectare Services Sector * MICRO (investment in P&M does not exceed `. 10 lakhs) SMALL (investment in P&M between `.10 lakhs and `.2 crore) MEDIUM (investment in P&M between `.2 crore and `.5 crore) 2. ADDRESS Preferred Mailing Address Present Permanent Office Regd. Office Post Off. Iden. No. PAN Holder OFFICE/BUSINESS REGD. OFF. (NON INDIVIDUAL) Name of the organization* Office/Business Address* PIN* Landmark* E-mail ID* City* District* Phone No.* Fax No. State* Is it a PP No.?* Yes No Is it a PP No.?* Yes No Name of the organization* Office/Business Address* PIN* Landmark* E-mail ID* City* District* Phone No.* Fax No. State* * includes Small Business, Road / Water Transport Operators If there are more details please use a separate sheet No. of Kids* No. of Dependents* Religion* Caste* Actual Subsect & Sub Caste name as per Govt. Classification* Date of Birth* Single Married Gender* Marital Status* TG M Educational Qualification* 10 + 2 Graduate Post Graduate and above Professional Others 10th or below (please specify) Christian ST Muslim MBC Buddhist BC Sikh OBC Others Others Hindu SC FC Zorastrian Jain (please specify) (please specify) Type of Residence* Parent Owned Co Leased Rented Owned Others (please specify) Years Number of years in this City Months Nationality* Occupation* Residential Status* Non-Resident Others Monthly Rental Payable : `. Resident Indian Years Number of years in this house Months Person with disability No Yes Whether applicant is a director of any Bank or IBL* Yes Others (please specify) Business Salaried Agriculture Services Preferred Verbal Communication Language Sur Name Name* Mr / Ms / Mrs / Dr / M/s Mother Maiden Name* Father Name* Spouse Name* Are you a shareholder in this Bank? Yes No Profession No Nature of Account Current Savings Details of Investment / Bank Accounts F (please specify details) (please specify) Amount of deposit . ` IBL Bank Account No. If existing customer, code Non Earning PERMANENT Flat / Door No. & Building Name* Road Number / Road Name* PIN* City* District* Is it a PP No.?* Yes No Ph / Mob 1* Fax No. State* PRESENT Flat / Door No. & Building Name* Road Number / Road Name* Is it a PP No.?* Yes No PIN* Landmark* City* District* Ph / Mob 1* Alternate Mobile 2 Fax No. State* E-mail ID* Mob 1 is ISP: Others___________ Pre paid Post paid Aircel Airtel BSNL Idea MTNL MTS Reliance TATA Vodafone Mob 2 is ISP: Others___________ Pre paid Post paid Aircel Airtel BSNL Idea MTNL MTS Reliance TATA Vodafone Address is as in (Address proof) Date of Incor. / Date of PS Deed* Certificate No. (For Co. only)

consumer finance application cv - IndusInd Bank · PDF fileCONSUMER FINANCE LOAN APPLICATION FORM Business Location: Application No. AC VER : 18.0/0316 FIELDS WITH * (STAR) ARE MANDATORY

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Page 1: consumer finance application cv - IndusInd Bank · PDF fileCONSUMER FINANCE LOAN APPLICATION FORM Business Location: Application No. AC VER : 18.0/0316 FIELDS WITH * (STAR) ARE MANDATORY

CONSUMER FINANCE LOAN APPLICATION FORM

Business Location: ACApplication No.VER : 18.0/0316

FIELDS WITH * (STAR) ARE MANDATORY

1. BASIC INFORMATION – BORROWER (INDIVIDUAL)

Constitution* Partnership ClubPvt. Ltd. Co. SocietyListed Public Ltd.

Foundation

Trust

Body of Individuals

Proprietorship Association

Others (please specify)

Name of the Concern*

Please collect your MID / Schedule of charges

Shop & Establ. Regn. No. Beneficial Ownership Declaration givenCST / VAT No.

BORROWER - (NON INDIVIDUAL)

3. IDENTITY PROOF DETAILS (One Identity Proof is Mandatory)

CV CE SCV LCVPASSENGER VEHICLESTRACTORS

4. PRIORITY SECTOR CATEGORY – As per RBI Requirement*

Farming Sector: Agricultural / allied activity including farming, dairy, piggery, fishery, animal husbandry, poultry, bee-keeping, sericulture, cattle feed, poultry feed, fertilizers, pesticides, seeds and / or purchase of agricultural implements / machinery for spraying, weeding, harvesting, sorting, grading, transporting etc.

PAN No.

AADHAAR No. (UID) Voter ID No.

Passport No.

Driving License No.

Photo Ration CardExpiry

Unlisted Public Co.

(Please tick appropriate category)

ManufacturingSector

MICRO (investment in P&M does not exceed 25 lakhs)

SMALL (investment in P&M between `.25 lakhs and `.5 crore)

MEDIUM (investment in P&M between `.5 crore and `.10 crore)

`.

Landless Labourer/Tenant Farmer

Small Farmer holding Land <2 hectares Other Farmer holding Land >2 hectares

Engaged in allied agricultural activities as above Having fleet of tractors, bull-dozers,well-boring lqpt, threshers, harvestors,combines etc.

Marginal Farmer holding Land <1 hectare ServicesSector *

MICRO (investment in P&M does not exceed `. 10 lakhs)

SMALL (investment in P&M between `.10 lakhs and `.2 crore)

MEDIUM (investment in P&M between `.2 crore and `.5 crore)

2. ADDRESS Preferred Mailing Address Present Permanent Office Regd. Office

Post Off. Iden. No.PAN Holder

OFF

ICE/

BU

SIN

ESS

REGD

. OFF

. (NON

INDIV

IDUAL

)

Name of the organization*

Office/Business Address*

PIN*

Landmark* E-mail ID*

City* District*

Phone No.* Fax No.

State*

Is it a PP No.?* Yes No

Is it a PP No.?* Yes No

Name of the organization*

Office/Business Address*

PIN*

Landmark* E-mail ID*

City* District*

Phone No.* Fax No.

State*

* includes Small Business, Road / Water Transport Operators

If there are more details please use a separate sheet

No. of Kids* No. of Dependents*

Religion*

Caste*

Actual Subsect & Sub Caste name as per Govt. Classification*

Date of Birth* Single Married Gender* Marital Status*TGM

Educational Qualification* 10 + 2 Graduate Post Graduate and above Professional Others10th or below (please specify)

Christian

ST

Muslim

MBC

Buddhist

BC

Sikh

OBC

Others

Others

Hindu

SC FC

Zorastrian Jain (please specify)

(please specify)

Type of Residence* Parent Owned Co Leased RentedOwned Others (please specify)

Years Number of years in this City MonthsNationality*

Occupation*

Residential Status* Non-Resident

Others

Monthly Rental Payable : `.Resident

Indian

Years Number of years in this house Months

Person with disability No Yes

Whether applicant is a director of any Bank or IBL* Yes Others (please specify)

Business Salaried Agriculture Services Preferred Verbal Communication Language

Sur Name

Name* Mr / Ms / Mrs / Dr / M/s

Mother Maiden Name*

Father Name*

Spouse Name*

Are you a shareholder in this Bank? Yes

No

Profession

No Nature of Account Current SavingsDetails of Investment / Bank Accounts

F

(please specify details)

(please specify)

Amount of deposit .`IBL Bank Account No. If existing customer, code

Non Earning

PE

RM

AN

EN

T Flat / Door No. & Building Name*

Road Number / Road Name*

PIN*City* District*

Is it a PP No.?* Yes NoPh / Mob 1* Fax No.

State*

PR

ES

EN

T

Flat / Door No. & Building Name*

Road Number / Road Name*

Is it a PP No.?* Yes No

PIN*

Landmark*

City* District*

Ph / Mob 1*

Alternate Mobile 2

Fax No.

State*

E-mail ID*

Mob 1 is ISP: Others___________Pre paid Post paid Aircel Airtel BSNL Idea MTNL MTS Reliance TATA Vodafone

Mob 2 is ISP: Others___________Pre paid Post paid Aircel Airtel BSNL Idea MTNL MTS Reliance TATA Vodafone

Address is as in (Address proof)

Date of Incor. / Date of PS Deed* Certificate No. (For Co. only)

Page 2: consumer finance application cv - IndusInd Bank · PDF fileCONSUMER FINANCE LOAN APPLICATION FORM Business Location: Application No. AC VER : 18.0/0316 FIELDS WITH * (STAR) ARE MANDATORY

10. FAMILY INCOME DETAILS

11. CREDIT CARD / BANK DETAILSCredit Card Details (Please note if you have more than one credit card then give details of the major credit card)

Do you have a credit card? Yes No

Name of bank

Account type

Card issued by Credit Limit `.

Other Bank Details (2)Repayment Bank Details (1)NUMBER OF BANK ACCOUNTS

Credit card expiry dateCard Number

Branch Name

Branch Address

Relationship with Applicant Number of earning members other than applicant

Gross Earnings p.m. .`

Net Earnings p.m. .` Gross Profit p.a. .`

Turnover p.a. .`

Total Family Income p.m. (excluding applicant’s income)`.

Net Profit p.a. .`

Income from: Business Profession

6. INCOME DETAILS BUSINESS / PROFESSION

7. DIRECTOR / PARTNER DETAILS

8. OTHER BUSINESS IN WHICH THEY ARE DIRECTOR / PARTNER

9. INCOME DETAILS – SALARIED

Phone No.Sl.No.

Name of the Director / Partner / Trustees/ Managing Comittee Members / Karta

Designation Date of Birth Address (Residence)DIN & PAN No.

D D M M Y Y Y Y

D D M M Y Y Y Y

D D M M Y Y Y Y

D D M M Y Y Y Y

Sl. No. Address Business activityName of Institution

Department

Address of Previous employer

Name of Previous employer

Gross Income . p.m. `

Rental Income . p.m.`

Proprietorship PS Firm

Total years of Service Years Months Total income of the applicant . p.a.`

Deduction . p.m.` Net . p.m.`

Other Income . p.a. (please specify)`

MonthsYearsDesignation

Public Ltd. MNC Govt. Military Others

Years of Service in current job

Pvt. Ltd. T.A.S.C. (please specify)

Ty

pe

of

Org

an

isa

tio

n

Type of organisation Number of Partners / DirectorsProprietorship PS Firm Pvt. Ltd. Public Ltd. MNC

Whether Business / Profession owned by the family

Others

Total Years in Business / Profession Years Months

Yes No RentedBusiness Premises Ownership Self Owned Parent Owned Others

Years in current Business / Profession Years Months

Networth . (Capital + Reservesexcluding revaluation reserves)

`

Nature of Business / Profession

Annual turnover .`

Gross Profit `. p.a.

Depreciation `. p.a.

Net profit before tax `. p.a.

Net profit after tax `. p.a.

NOTE : Details as per latest P&L, BS, ITR.

Rental Income . p.a.`

Other Income . p.a. (please specify)`

(please specify)

(please specify)

Total debts `. (All secured &unsecured loans)

5. INCOME DETAILS – AGRICULTURE

Sl.No.

LandOwnership*

LandOwner

Relationship Areain Acres

Taluk, Village & Pincode Survey/Patta No.

Free/Encumbered

MarketValue (`.)

Land Taxp.a. (`.)

IrrigationSource $

* Land Ownership : Self Owned / Parent Owned / Lease / Rented / Family Owned $ Irrigation Source : Pond / River / Lake / Well Pumpset / Govt. supplied / Rainfed** Type of Crop : Food Crops / Fruit Crops / Root & Tubers / Pulses / Cash Crops / Vegetables / Decorative Flowers / Cereals ▲ Soil Type : Red / Black / Sandy / Marshy / Alluvial / Others (please specify)7/12, 8A, 6D, Khasra, Khatavani, Pahani, Chitti, Adangal, EC, Ebill, Saledeed, Land book – Documents should be verified for these lands.

Soil Type ▲Type of Crop** Name of CropHarvesting Cycles

Per AnnumYield/Acre

(in quintals)Market Price(`.per quintal)

Cost / Expensesper Acre per Cycle (`.)

Tractor RentalsSpent p.a. (`.)

Net Income (`.)/Harvesting Cycle

Since how long you are into Agriculture years

Are you a member of any Primary Agricultural Co-op Society No YesTax Return Filed Yes No Saral dated

Sl.No.

Do you own tractor(s) No Yes Free Nos. On Loan Nos.

Agriculture type: Farmer Landlord Poultry Piggery Animal Husbandary

Others (please specify)

Fishery Aquaculture

Bee Keeping Sericulture Plantation Seeds Pesticide

Dairy Farm

Making of: Animal feed Poultry feed Fertilizer

Page 3: consumer finance application cv - IndusInd Bank · PDF fileCONSUMER FINANCE LOAN APPLICATION FORM Business Location: Application No. AC VER : 18.0/0316 FIELDS WITH * (STAR) ARE MANDATORY

14. LOAN VEHICLE DETAILS (PROPOSED) *If Used / Refinance – Valuation Certificate to be attachedParticulars New Used Topup Refn New Used Topup Refn New Used Topup Refn New Used Topup Refn New Used Topup Refn

Make & Model

Year of Manufacture

Dealer Name

Present Market Value (for Used/Existing Loan) (`.)

Registration Number (for Used/Refinance)

Existing IBL Loan No.

CREDIT CARD / BANK DETAILS (Contd...)

State

City

Pin code

Phone with STD code

Account Number

Account opened on

Opening Balance as of Opening Balance `.

Closing Balance `.Closing Balance as of

Place where the land or building is situated(Please furnish details of Survey Nos.,

Door No., Name of Street etc.)Ancestral or self-acquired If encumbered to

what extent

a. Immovable Assets :

Sq. Feet / AcreUsed for Agri/

Residential/Official/Commercial Purpose

Market Value `.

b. Liquid Assets :

Particulars

1. Cash and Bank balance

2. Govt. Securities (give details)

3. Shares

4. Life Insurance Polices (Sum assured)

5. Jewellery (_______________grams)

6. Investment in business

7. Investment in Associate firms, if any

8. Others (please specify)

Book value (`.) Encumbered Y/N Loan O/S (`.)

Loan taken from(Banks/Private

Finance/Relatives/Others

Type of loan(OD/CC/Personal Loans/

Business Loans/Gold Loans/KCC)

AgreementValue

(`. in lacs)

PresentOutstanding(`. in lacs)

No. ofInstalments

paid

TotalInstalments(Payable)

EMIAmount

(`.)

Proof givenRepayment Track/

Bank Debits/Receipt copies

c. Liabilities (Mention all liabilities other than vehicle loans)

Total

13. VEHICLE OWNED DETAILS (Use additional sheet if required)

54321Registration No.

Make / Manufacturer

Model

Year of Manufacture

Present Market Value (`.)

Financier’s Name / Free

If financed by IBL Contract No./Customer Code

Date availed

Agreement Value (`.)

EMI Amount (`.)

Contract Period (in months)

Present Outstanding (`.)

Instalment Serviced (Nos.)

Overdue Amount (`.)

Insurance Company

Comprehensive / TP Insurance

Policy No.

12. ASSET & LIABILITY DETAILS

IFS code

MICR

IFS code

MICR

Page 4: consumer finance application cv - IndusInd Bank · PDF fileCONSUMER FINANCE LOAN APPLICATION FORM Business Location: Application No. AC VER : 18.0/0316 FIELDS WITH * (STAR) ARE MANDATORY

LOAN VEHICLE DETAILS (PROPOSED) *If Used / Refinance – Valuation Certificate to be attached (Contd...)

15. VIABILITY ESTIMATION

Vehicle 5Vehicle 4Vehicle 3Vehicle 2Vehicle 1UnitsParticulars

1. Initial / Margin Money

2. Usage of machine / vehicle

5a. Fuel consumption per unit

3. Rate per unit of measurement

4. Estimated income per month (2x3)

5b. Fuel cost per litre

6. Fuel cost

7. Salaries (Driver, Conductor, etc.)

8. Maintenance, parts etc.

9. Other expense

10. Estimated expense (6+7+8+9) p.m.

11. Gross surplus (4-10)

12. Average Monthly Installment

13. Net surplus (11-12)

14. Viability ratio (11/12)

`.

`.

`.

`.

`.

`.

`.

`.

`.

`.

`.

Ratio

Hour/Day/Month/Kms/Others...........

Hour/Day/Month/Kms/Others...........

Inc

om

e P

er

Mo

nth

Ex

pe

ns

es

Pe

r M

on

th

Invoice Amt. - Chassis (`.)

Invoice Amt. - Body/Trolley (`.)

Finance Amt. - Chassis (`.)

Finance Amt. - Body/Trolley (`.)

Finance Amt. MI/IH/FH/Combo (`.)

Margin Money a+b – (c+d) (`.)

Advance EMI (No.)

1st year Motor Insurance Premium (`.)

Processing Fee (`.) -Non refundable #

Document Charges (`.) -Non refundable #

Loan Handling Charges (`.) -Non refundable

Rate of Interest (Flat) %

Stamping Charges at actuals (`.)

IRR % *

GPA / IH / FH / Combo : Upfront (`.)

Agreement Period (in months)

Mode of Repayment

No. of Installments (in months)

Adv. Ins. Premium 3 Year (Motor INS+FH+IH)#

Adv. Ins. Premium 4 Year (Motor INS+FH+IH)#

Adv. Ins. Premium 5 Year (Motor INS+FH+IH)#

EMI (`.)

Repayment Pattern: Mon/Qua/Hyr/Yry.

Purpose (Own use / Agri Hiring /Non-Agri Hiring / Commercial use)

Vehicle Proposed is (New addition for startof Business / Replacement for Old Vehicle/ Others specify / Purpose for top-up)

Vehicle registered withIBL Lien and if "Yes" date of Lien

RTO (Where the vehicle is registered (or)would be registered)

Insurance Valid upto (for Used Vehicle)

Adv. Ins. Premium 2 Year (Motor INS+FH+IH)#

N Y/ N Y/ N Y/ N Y/ N Y/

# #

* Inclusive of Volume Incentive if any, Wherever applicable

# Either Family Health (or) Individual Health can be chosen and not both

Inclusive of Service Tax andS.B. Cess as may be applicable

Exclusive of Service Tax andS.B. Cess as may be applicable

#

Cash ACH ECS IBL SI PDC from Borrower's Bank A/c Co-Borrower's Bank A/c

Particulars New Used Topup Refn New Used Topup Refn New Used Topup Refn New Used Topup Refn New Used Topup Refn

Engine Number

Chassis Number

If Pre-delivered (mention hour meter for tractor)

Banner/Business/Transport Co. Name

Permit Type

Permit Ref. No.

Permit Date

Permit Valid Upto

Permit Holder Name

Replacement to be registered in the name of

Valuer Report Reference No. / Date

Permit Issued by

Page 5: consumer finance application cv - IndusInd Bank · PDF fileCONSUMER FINANCE LOAN APPLICATION FORM Business Location: Application No. AC VER : 18.0/0316 FIELDS WITH * (STAR) ARE MANDATORY

OFF

ICE/

BU

SIN

ESS

REGD

. OFF

. (NON

INDIV

IDUAL

)

Name of the organization*

Office/Business Address*

PIN*

Landmark* E-mail ID*

City* District*

Phone No.* Fax No.

State*

Is it a PP No.?* Yes No

Is it a PP No.?* Yes No

Name of the organization*

Office/Business Address*

PIN*

Landmark* E-mail ID*

City* District*

Phone No.* Fax No.

State*

Constitution* Partnership ClubPvt. Ltd. Co. SocietyListed Public Ltd.

Foundation

Trust

Body of Individuals

Proprietorship Association

Others (please specify)

Name of the Concern*

Shop & Establ. Regn. No. Beneficial Ownership Declaration givenCST / VAT No.

Unlisted Public Co.

16. DETAILS OF WORK ORDER

Valid tillDate of Contract awarded Status (Completed / in hand)Quantum of Contract ( .)`Sl. No. Name of Principal

D D M M Y Y Y Y

D D M M Y Y Y Y

D D M M Y Y Y Y

D D M M Y Y Y Y

D D M M Y Y Y Y

D D M M Y Y Y Y

D D M M Y Y Y Y

D D M M Y Y Y Y

CO-BORROWER (NON INDIVIDUAL)

(Details of Work Order Present / Completed. NOTE : If more than 4, kindly get the details in Borrower’s letter head)

17. BASIC INFORMATION

CO-BORROWER – (INDIVIDUAL) Related to Borrower: Yes No Relationship:

PAN No.

AADHAAR No. (UID) Voter ID No.

Passport No.

Driving License No.

Photo Ration CardExpiry

19. IDENTITY PROOF DETAILS (One Identity Proof is Mandatory)CO-BORROWER

Post Off. Iden. No.PAN Holder

If there are more detailsplease use a separate sheet

No. of Kids* No. of Dependents*

Religion*

Caste*

Actual Subsect & Sub Caste name as per Govt. Classification*

Date of Birth* Single Married Gender* Marital Status*TGM

Educational Qualification* 10 + 2 Graduate Post Graduate and above Professional Others10th or below (please specify)

Christian

ST

Muslim

MBC

Buddhist

BC

Sikh

OBC

Others

Others

Hindu

SC FC

Zorastrian Jain (please specify)

(please specify)

Type of Residence* Parent Owned Co Leased RentedOwned Others (please specify)

Years Number of years in this City MonthsNationality*

Occupation*

Residential Status* Non-Resident

Others

Monthly Rental Payable : `.Resident

Indian

Years Number of years in this house Months

Person with disability No Yes

Whether applicant is a director of any Bank or IBL* Yes Others (please specify)

Business Salaried Agriculture Services Preferred Verbal Communication Language

Sur Name

Name* Mr / Ms / Mrs / Dr / M/s

Mother Maiden Name*

Father Name*

Spouse Name*

Are you a shareholder in this Bank? Yes

No

Profession

No Nature of Account Current SavingsDetails of Investment / Bank Accounts

F

(please specify details)

(please specify)

Amount of deposit .`IBL Bank Account No. If existing customer, code

Non Earning

PE

RM

AN

EN

T Flat / Door No. & Building Name*

Road Number / Road Name*

PIN*City* District*

Is it a PP No.?* Yes NoPh / Mob 1* Fax No.

State*

PR

ES

EN

T

Flat / Door No. & Building Name*

Road Number / Road Name*

Is it a PP No.?* Yes No

PIN*

Landmark*

City* District*

Ph / Mob 1*

Alternate Mobile 2

Fax No.

State*

E-mail ID*

Mob 1 is ISP: Others___________Pre paid Post paid Aircel Airtel BSNL Idea MTNL MTS Reliance TATA Vodafone

Mob 2 is ISP: Others___________Pre paid Post paid Aircel Airtel BSNL Idea MTNL MTS Reliance TATA Vodafone

Address is as in (Address proof)

18. ADDRESS Preferred Mailing Address Present Permanent Office Regd. Office

Date of Incor. / Date of PS Deed* Certificate No. (For Co. only)

Page 6: consumer finance application cv - IndusInd Bank · PDF fileCONSUMER FINANCE LOAN APPLICATION FORM Business Location: Application No. AC VER : 18.0/0316 FIELDS WITH * (STAR) ARE MANDATORY

21. INCOME DETAILS BUSINESS / PROFESSIONCO-BORROWER

25. FAMILY INCOME DETAILSCO-BORROWER

26. CREDIT CARD / BANK DETAILSCO-BORROWER

23. OTHER BUSINESS IN WHICH THEY ARE DIRECTOR / PARTNERCO-BORROWER Sl. No. Address Business activityName of Institution

24. INCOME DETAILS – SALARIEDCO-BORROWER

Credit Card Details (Please note if you have more than one credit card then give details of the major credit card)

Do you have a credit card? Yes No

Name of bank

Account type

Card issued by Credit Limit .`

Other Bank Details (2)Repayment Bank Details (1)NUMBER OF BANK ACCOUNTS

Credit card expiry dateCard Number

Branch Name

Relationship with Applicant Number of earning members other than applicant

Gross Earnings p.m. .`

Net Earnings p.m. .` Gross Profit p.a. .`

Turnover p.a. .`

Total Family Income p.m. (excluding applicant’s income)`.

Net Profit p.a. .`

Income from: Business Profession

20. INCOME DETAILS – AGRICULTURECO-BORROWER

22. DIRECTOR / PARTNER DETAILSCO-BORROWER

Type of organisation Number of Partners / DirectorsProprietorship PS Firm Pvt. Ltd. Public Ltd. MNC

Whether Business / Profession owned by the family

Others

Total Years in Business / Profession Years Months

Yes No RentedBusiness Premises Ownership Self Owned Parent Owned Others

Years in current Business / Profession Years Months

Rental Income . p.a.`

Networth . (Capital + Reservesexcluding revaluation reserves)

`

Nature of Business / Profession

Annual turnover .`

Gross Profit `. p.a.

Depreciation `. p.a.

Net profit before tax `. p.a.

Net profit after tax `. p.a.

NOTE : Details as per latest P&L, BS, ITR.Other Income . p.a. (please specify)`

(please specify)

(please specify)

Total debts `. (All secured &unsecured loans)

Department

Address of Previous employer

Name of Previous employer

Gross Income . p.m. `

Rental Income . p.m.`

Proprietorship PS Firm

Total years of Service Years Months Total income of the applicant . p.a.`

Deduction . p.m.` Net . p.m.`

Other Income . p.a. (please specify)`

MonthsYearsDesignation

Public Ltd. MNC Govt. Military Others

Years of Service in current job

Pvt. Ltd. T.A.S.C. (please specify)

Ty

pe

of

Org

an

isa

tio

n

Sl.No.

LandOwnership*

LandOwner

Relationship Areain Acres

Taluk, Village & Pincode Survey/Patta No.

Free/Encumbered

MarketValue (`.)

Land Taxp.a. (`.)

IrrigationSource $

* Land Ownership : Self Owned / Parent Owned / Lease / Rented / Family Owned $ Irrigation Source : Pond / River / Lake / Well Pumpset / Govt. supplied / Rainfed** Type of Crop : Food Crops / Fruit Crops / Root & Tubers / Pulses / Cash Crops / Vegetables / Decorative Flowers / Cereals ▲ Soil Type : Red / Black / Sandy / Marshy / Alluvial / Others (please specify)7/12, 8A, 6D, Khasra, Khatavani, Pahani, Chitti, Adangal, EC, Ebill, Saledeed, Land book – Documents should be verified for these lands.

Soil Type ▲Type of Crop** Name of CropHarvesting Cycles

Per AnnumYield/Acre

(in quintals)Market Price(`.per quintal)

Cost / Expensesper Acre per Cycle (`.)

Tractor RentalsSpent p.a. (`.)

Net Income (`.)/Harvesting Cycle

Since how long you are into Agriculture years

Are you a member of any Primary Agricultural Co-op Society No YesTax Return Filed Yes No Saral dated

Sl.No.

Do you own tractor(s) No Yes Free Nos. On Loan Nos.

Agriculture type: Farmer Landlord Poultry Piggery Animal Husbandary

Others (please specify)

Fishery Aquaculture

Bee Keeping Sericulture Plantation Seeds Pesticide

Dairy Farm

Making of: Animal feed Poultry feed Fertilizer

Phone No.Sl.No.

Name of the Director / Partner / Trustees/ Managing Comittee Members / Karta

Designation Date of Birth Address (Residence)DIN & PAN No.

D D M M Y Y Y Y

D D M M Y Y Y Y

D D M M Y Y Y Y

D D M M Y Y Y Y

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b. Liquid Assets :

Particulars

1. Cash and Bank balance

2. Govt. Securities (give details)

3. Shares

4. Life Insurance Polices (Sum assured)

5. Jewellery (_______________grams)

6. Investment in business

7. Investment in Associate firms, if any

8. Others (please specify)

Book value (`.) Encumbered Y/N Loan O/S (`.)

Loan taken from(Banks/Private

Finance/Relatives/Others

Type of loan(OD/CC/Personal Loans/

Business Loans/Gold Loans/KCC)

AgreementValue

(`. in lacs)

PresentOutstanding(`. in lacs)

No. ofInstalments

paid

TotalInstalments(Payable)

EMIAmount

(`.)

Proof givenRepayment Track/

Bank Debits/Receipt copies

c. Liabilities (Mention all liabilities other than vehicle loans)

Total

28. VEHICLE OWNED DETAILS (Use additional sheet if required)CO-BORROWER

54321

Registration No.

Make / Manufacturer

Model

Year of Manufacture

Present Market Value (`.)

Financier’s Name / Free

If financed by IBL Contract No./Customer Code

Date availed

Agreement Value (`.)

EMI Amount (`.)

Contract Period (in months)

Present Outstanding (`.)

Instalment Serviced (Nos.)

Overdue Amount (`.)

Insurance Company

Comprehensive / TP Insurance

Policy No.

27. ASSET & LIABILITY DETAILSCO-BORROWER

Place where the land or building issituated (Please furnish details

of Survey Nos., Door No. Name ofStreet etc.)

Ancestral or self-acquired If encumbered towhat extent

a. Immovable Assets :

Sq. Feet / AcreUsed for Agri/

Residential/Official/Commercial Purpose

Market Value `.

City

Pin code

Phone with STD code

Account Number

Account opened on

Opening Balance as of Opening Balance `.

Closing Balance `.Closing Balance as of

CO-BORROWER CREDIT CARD / BANK DETAILS (Contd...)

IFS code

MICR

IFS code

MICR

Branch Address

State

Page 8: consumer finance application cv - IndusInd Bank · PDF fileCONSUMER FINANCE LOAN APPLICATION FORM Business Location: Application No. AC VER : 18.0/0316 FIELDS WITH * (STAR) ARE MANDATORY

I / WE THE PROPOSED BORROWER / CO-BORROWER / GUARANTORS IS / ARE ASSESSED

For Income Tax : No Yes PAN As per ITR : A.Y. 20......... - 20......... `...................................................

For Wealth Tax : No Yes As per WTR : A.Y. 20......... - 20......... `...................................................

Form 60/61 declaration (to be filled in by those who do not have PAN) Reason for not having PAN No. : ........................................................ I/We, .........................................................do hereby declare that what is stated is true to the best of my/our knowledge and belief.

I/We also certify that the vehicle will be operated under our direct supervision and control and that I/We shall utilise the asset/funds only for the purpose(s) mentioned / declared in the loan application/agreement. The vehicle will be registered as a Private/Public carrier with the Regional Transport Authority at........................................................................................................... If the proposal is accepted by you and vehicle is released to me/us, I/We undertake to produce the vehicle for inspection at the place to be specified by you every six months or at such Intervals as required by you. I / We also agree and confirm that the said vehicle will be insured comprehensively including riot/civil commotion and unlimited third party risks until all dues on the contract are paid and the vehicle is released to me/us. I/We also agree and confirm that the said vehicle will be registered in the state of ..................................................................and will be kept so registered until all the dues under the contract are paid to you and the vehicle is released to me/us. I/We agree specifically agree not to transfer, pledge or otherwise the Vehicle/Assets. I/we further declare that the company shall have the direct charge on the vehicle. I/We warrant that the properties mentioned herein are our exclusive properties and will not in any way be transferred or alienated until the obligations arising out of the agreement are fulfilled and I / We agree that this proposal shall be the basis of the contract between us. I/We further state that we are aware and agree that the company shall further repossess the Assets/Vehicle in case of default without notice and I/We agree to surrender the Asset / Vehicle in case of default.

In submitting the above application, I/We the undersigned, solemnly affirm that the information above set forth are in all respects true, accurate, complete and the same may be relied upon by you; I/We hold ourselves liable for any mis statement. It correctly states our true and real condition on the date hereof and we have not knowingly withheld any information that might affect the acceptance of our proposal. I/We expressly agree to notify immediately to you in writing of any material change that may occur in our financial and other condition.

I / We agree and acknowledge that only direct telephone numbers (not board / general telephone numbers of offices / corporates / employers) will be accepted for registration of "Do not call". I / We note that, I / We may receive call(s) from the Bank to verify the correctness of the request for registration. I / We also note that, the Bank may use my / our contact details to contact me / us and offer carefully selected products and services from time to time either directly or through its agents or authorised representatives.

I/We / to receive information on product / services etc for Marketing purpose through Telephone / Mobile / SMS / Email by the Bank / its agents.

I/We confirm that :

*NO SIGNATURE PROOF : my/our proof of identity submitted to the Bank does not contain my/our signature(s) and have requested the Bank to treat my/our signature as signed by me/us herein asvalid and accept it for all transactions which I/We may have with the Bank in future.

*SIGNATURE DIFFERENCE : my/our present signature differs from my/our old signature as appearing in proof of identity submitted to the Bank and have requested the Bank to treat the signatureas signed by me/us herein as valid and accept it for all transactions which I/We may have with the Bank in future.

*VERNACULAR SIGNATURE : I/We have signed in a Vernacular language and that, contents of this form, loan sanction letter, agreement etc, were explained to me/us in my/our language andfurther that I/We have understood and/accepted the same in its entirety.

*THUMB IMPRESSION : I/We being illiterate(s) have affixed my/our thumb impression(s) in the form/agreement, DPN etc. and that, contents of this form, loan sanction letter, agreement etc. wereexplained in my/our language and further that, I/We have understood and accepted the same in its entirety.

I/We declare that all the particulars and information given in the application form are true, correct and complete and upto date in all respects and I/We have not withheld any information. I/We confirm that I/We had no insolvency proceedings initiated against me/us nor have I/We ever been adjudicated insolvent. I/We have read the application form and brochures and am/are aware of all the terms and conditions of availing finance from IndusInd Bank Ltd. I/We authorise IBL or its agent to make references and deduping / verification / validation / checking enquiries relating to information in this application which IBL considers necessary. I/We also authorise IBL to exchange, share, part with all information relating to my/our finance details and repayment history information to other banks/FIs/Credit bureaus/agencies as may be required and shall not hold IBL liable for use of this information. I/We undertake to inform IBL regarding any change in my/our residence/employment and to provide any further information that IBL may require. I/We further agree that my/our finance shall be governed by the rules of IBL which may be in force from time to time. IBL reserves the right to reject an application without providing any reason.

consent do not consent

29. REFERENCE INFORMATION (Please give the Name of a Relative / Friend in your City who does not stay with you as Reference)

Name of the person

Address

Phone (with STD code)

If existing customer, code

Relationship with applicant

31. SIGNATURE AND PHOTOGRAPH OF THE BORROWER / CO-BORROWER / GUARANTOR *

SIGNATURE SIGNATURE SIGNATURE

Affix a RecentPassport Size Photograph

duly signed across

Borrower

Affix a RecentPassport Size Photograph

duly signed across

Co - Borrower(if any)

Affix a RecentPassport Size Photograph

duly signed across

Guarantor(if any)

* In case a guarantor is also taken in, use a separate application form for filling the details. In case the application is signed by an authorised POA holder kindly mention the POA holder name also. In case of non individuals, the authorised representative who is signing the application must sign so, along with affixing of the official rubber stamp of the firm, Company etc.

Name ______________________________________________

Designation _________________________________________

Date ___________ Place ______________________________

Name ______________________________________________

Designation _________________________________________

Date ___________ Place ______________________________

Name ______________________________________________

Designation _________________________________________

Date ___________ Place ______________________________

PIN PIN

30. DECLARATION

32. INSURANCE – GPA, HEALTH, COMBO, MOTOR

ParticularsBorrower / Non Individual Borrower

Entity's Owner/Representative Co-BorrowerGenderM / F / TG

GenderM / F / TG

Date of BirthDD/MM/YYYY

Date of BirthDD/MM/YYYY

Self(GPA and/or Health)

Spouse(Health)

Child 1(Health)

Child 2(Health)

Page 9: consumer finance application cv - IndusInd Bank · PDF fileCONSUMER FINANCE LOAN APPLICATION FORM Business Location: Application No. AC VER : 18.0/0316 FIELDS WITH * (STAR) ARE MANDATORY

$ Includes Personal Accident Death Cover & Accidental Hospitalisation Benefit as per GPA Certificate.

1 lakh 2 lakhs 3 lakhs 4 lakhs 5 lakhs 6 lakhs 7 lakhs 8 lakhs 9 lakhs 10 lakhs 11 lakhs 12 lakhs 13 lakhs 14 lakhs 15 lakhs 20 lakhs 25 lakhs

Prem `.** Prem `.** Prem `.** Prem `.** Prem `.** Prem `.** Prem `.** Prem `.** Prem `.** Prem `.** Prem `.** Prem `.** Prem `.** Prem `.** Prem `.** Prem `.** Prem `.**

B¡CB¡B¡CB¡B¡CB¡B¡CB¡B¡CB¡B¡CB¡B¡CB¡B¡CB¡B¡CB¡B¡CB¡B¡CB¡B¡CB¡B¡CB¡B¡CB¡B¡CB¡B¡CB¡B¡CB¡

1 year 151 302 402 412 463 513 623 668 784 824 925 1035 1115 1176 1226 1849 2592

2 years 252 528 704 764 774 930 1080 1216 1387 1597 1688 1839 2009 2145 2265 3370 4731

3 years 352 754 1015 1030 1105 1306 1517 1768 1944 2135 2371 2587 2803 3024 3184 4746 6665

4 years 452 1005 1231 1316 1361 1628 1899 2150 2436 2682 2963 3265 3506 3782 3998 5921 8837

5 years 623 1417 1618 1718 1894 2260 2647 3014 3405 3742 4149 4515 4902 5279 5590 8287 11702

Cover $

Year

`.

_ If Customer is different than that of the Consumer Finance Application Form, then KYC norms should be complied with separately for each insured.

Health Business Number Existing Health Customer No Yes

** Inclusive of Service Tax and S.B. Cess# (@ 14.50%) as may be applicable. s This nominee is the 2nd nominee in order of "Claim Settlement Priority" Exit Age: Age of the Borrower at the time of loan expiry; it cannot exceed 65 years i.e. Borrower Current Age + Loan period in months (total rounded off to nearest year) not to exceed 65 years. Combo (GPA+Health) and normal GPA cannot be combined however (1) Combo and Group Health Cover can be combined and (2) GPA and Group Health Cover can be combined. *** Minimum Entry = 18 years and Maximum Entry = 69 years. IT Benefits as applicable

#

No manual receipts are issued by the Bank. Hence do not pay any dues (any time) without a valid Hand Held Machine generated receipt being issued to you; Note that the Bank would not be responsible for any money remitted / given by you to any executive / representative of the Bank, without obtaining a valid money receipt. Also do not accept any receipt with corrections / alterations. Always ask the Executive to show his Bank-issued Identity Card and in case of any doubt, we request you to visit our local Office and pay the dues.

For Bank use only

Nominee 1

Nominee 2 s

Relationship

Address

INDUSIND BANK LIMITED INDUSIND BANK LIMITED

Borrower Co-Borrower

Indus Health Care (IH) (`.1 lakh)

Min Entry = 18 years & Max. Entry = 69 years

Not Applicable

Not Applicable

Self Only (Individual)

Premium Amount `. 4008 ** per insured

IT Benefits as applicable

Indus Family Health Care (FH) (`.2 lakhs)

Min Entry = 18 years & Max. Entry = 54 years

Unmarried & Dependent Male Child Min = 90 days & Max = 26 yearsUnmarried & Dependent Female Child Min = 90 days & Max = 36 years

Self+Spouse+2 Dependent Children (Floater)

Premium Amount `. 5478 ** per family

IT Benefits as applicable

GROUP PERSONAL ACCIDENT SCHEME Yes Paid upfront Initial Premium

Yes Paid upfront EMI funding

Yes Paid upfront EMI funding

DOB**:

PIN:

DOB**:

PIN:

** If nominee is a minor on this date, I/we appoint _________________________________________________________________________ as Legal Guardian

GROUP HEALTH INSURANCE SCHEME

If yes, Health Policy No. ________________________

Category

Combo

Combo 1

Combo 2

Coverage

Chola PA = `.1 lakh for 3 yrs;Chola Health = 0.50 lakhs for 1 yr

Chola PA = `.1 lakh for 3 yrs;Chola Health = 0.50 lakhs for 3 yrs

Chola PA = `.3 lakhs for 3 yrs;Chola Health = 0.50 lakhs for 3 yrs

Yes Paid upfront EMI fundingSCV COMBO SCHEME

MOTOR INSURANCE 1st Year Premium `.

Renewal Required

Yes

upto 2nd year

upto 3rd year

upto 4th year

B CB B CB

M F M F

B CB

Premium #Health Renewal

Required2nd year3rd year

Yes Paid upfront EMI funding

Coverage

Birla Sun Life Insurance `.__ lakh for __ yrs;Chola PA = `.5 lakh for 4 yrs

Birla Sun Life Insurance `.__ lakh for __ yrs; Chola PA = `.5 lakhfor 4 yrs; Chola Health (Individual) = `.1 lakh for 1 yr

Birla Sun Life Insurance `.__ lakh for __ yrs; Chola PA = `.5 lakhfor 4 yrs; Chola Health (Family Floater) = `.2 lakh for 1 yr

TRACTOR COMBO SCHEME

`. 2160** BCB

`. 4178** BCB

`. 5885** BCB

Premium #

`. ______** BCB

`. ______** BCB

`. ______** BCB

Page 10: consumer finance application cv - IndusInd Bank · PDF fileCONSUMER FINANCE LOAN APPLICATION FORM Business Location: Application No. AC VER : 18.0/0316 FIELDS WITH * (STAR) ARE MANDATORY

Sourcing Code : Bank Contact Person :_______________________________________________________________________

33. DECLARATIONGroup Personal Accident / Group Health Insurance/Insurance/Combo/Life Insurance Covers :

1. I / We desire to be a part of the Group Insurance with Cholamandalam MS General Insurance Company Limited/Birla Sun Life Insurance Company Limited and in this regard hereby declare that the statements made by me / us in this Proposal Form are true and complete to the best of my / our knowledge and belief. I/We am/are aware that this is a Insurance product from respective insurance companies and the risk is borne only/Solely by the Insurance company.

2. I / We understood the covers being offered under this policy / these policies and am/we are aware of the applicable terms and conditions and are aware that any omission or incorrect statement will invalidate the cover.

3. I / We hereby agree that IndusInd Bank Ltd is at free to obtain / share any information about me / us to any organization – as the Bank may deem fit. I/We agree to the Bank taking appropriate measures to capture the voice log on all such telephonic transactions carried out by me / us , in accordance with procedures / regulations

4. I am / We are aware that mere consent / signing the proposal form does not guarantee start of the Insurance coverage applied for. In the event of rejection of my/our proposal form by the Insurance Company for any reason whatsoever, I / We shall not hold the bank responsible for the same.

5. I / We have decided to subscribe to the products on my / our own decision. I / We have not relied upon or influence by any suggestion by the bank and / or any of its employees on the merit of suitability of this / these product(s). I/We will not hold the Bank responsible for any losses that I / We may suffer in connection with my/our selection.

6. I / We understand provisions relating to Know Your Customers and Anti Money Laundering. I / We confirm having complied with and completed the requirements.

7. I / We hereby agree that this declaration shall form the basis of the contract between me/us and the Chola MS/Birla Sun Life (as the case may be) in case of Group Coverage. I / We agree to abide by and be bound by the terms, conditions rules and regulations of the contract.

8. I / We understand that in case of any claim under the policy, IBL will not undertake any responsibility or will not accept any correspondence and the same have to be pursued only with the Insurance Company.

9. I / We also note that in the event of any claim under GPA/Life Insurance cover, the claim will be directly paid to IBL. I/We nominate IBL for the same and on receipt of claim amount IBL will release the document of deletion of hypothecation of the vehicle subject to full and final settlement of loan.

10. In case of cancellation of insurance for any reason whatsover, I/ We authorize IBL to receive funds of premium, (if any, paid by IBL on my/our behalf) from the insurer upon such cancellation and I/We further note that, such refunds would be on “short scale basis” only.

11. I / We desire to do the renewals of Individual Health / Family Health / Insurance (as opted) and agree to pay the contribution towards renewal premium by way of monthly installments (alongwith regular loan installments) on due dates. I/We understand that if I/We are not able to avail cashless treatment facility, (where applicable) then I/We shall submit all the bills to the insurance company for reimbursement within 30 days from the date of discharge.

12. I / We have opted to avail funding against Life/Group Health/Combo insurance premium (s) and pay applicable interest there on (as part of the loan availed) over the loan period.

13. I / We note that, IndusInd Bank acts as a Corporate Agent of Cholamandalam MS General Insurance Company Limited.

Motor Insurance:

1. I / We confirm that on my / our volition, have opted to give advance insurance premium to IBL to enable effecting of insurance cover for the vehicle for 1st year / subsequent years/ until all dues are settled in the loan.

2. If Cholamandalam MS Insurance Co. rejects insurance then we confirm to get the vehicle / asset insured through some other company.

3. I / We have noted that, the said advance insurance premium would be paid by me/us along with periodical installment payments and that the actual premium paid by IBL would be based on my/our vehicle(s) accident track record and bonus/malus/applicable tariff as may be prescribed by the insurance company from time to time.

4. I / We confirm that IBL has disclosed to me/us, details of all commission receivable by IBL towards the above said insurance premium payments.

5. I / We agree to authorize IBL to debit the difference of premium in my loan account, if the insurance premium paid is more than the advance insurance premium amount paid by me for the year.

6. In case of cancellation of insurance for any reason whatsover, I/ We authorize IBL to receive funds of premium, (if any, paid by IBL on my/our behalf) from the insurer upon such cancellation and I/We further note that, such refunds would be on “short scale basis” only.

7. I/ We have opted to avail funding against 1st year Motor insurance premium and pay applicable interest there on (as part the loan availed) over the loan period.

I / We note that, basis our requirement, IBL has offered to effect insurance and that, we are responsible for ensuring timely renewal by following up with IBL. In case, where insurance has been done by me / us, we agree to provide to IBL, copy of the comprehensive insurance policy with hypothecated lien marking, atleast 15 days in advance to risk start date (or) renewal due date and also formally request, IBL to take note of such insurance cover in their records.

I / We confirm that the IBL has disclosed to me / us the rates of commissions / other fee chargeable on the transactions made by me / us on the group enrollment / General Insurance products.

I / we hereby authorize IBL / its tele marketer to make calls / send sms / write to me / us on / for informing / soliciting insurance products / process / services and this may be construed as my / our enquiry and I / we hereby agree to abide with all the processes connected with this activity notwithstanding any registration made by me / us in National Do Not Call Registry.

* Insurance is a subject matter of solicitation

Signature ofCustomer(s)

CB:B:

This has reference to your application in respect of ………….............… facility to be availed from Consumer Finance Division of our Bank and we are pleased to appreciate your interest for availing the same. We have evaluated your application and the other documents submitted by you on the following parameters of the bank:

(a) Purpose for which the credit facility will be utilized (b) Eligibility norms of Induslnd Bank. (c) Track record of past borrowings of the applicant (d) Exposure of the applicant relating to the field for deployment of the credit (e) Statutory and regulatory provisions applicable to Induslnd Bank On perusal of the information / documents furnished by you on the above criteria, we regret to inform you that we are not in a position to sanction you the above credit facility under the present circumstances. Please note that the above criteria and the conclusion do not in any way reflect the credit worthiness of the applicant. We thank you for approaching our bank and the interest shown by you for availing credit facility from us.

Yours sincerelyFor Induslnd Bank Ltd.

Name : Designation :

Date: Application No. ACREJECTION SLIP

Received Proposal Form and details towards coverage under GPA Scheme for B CB Group Health Scheme

Vide Cash / Cheque / DD number ________________ dated _____________ Insured _____________________________

Premium Amount `. __________________ ** Receipt Number _________________

Lo

an

GP

A / H

ea

lth

Date:

The status of the loan would be known to the applicant within 7 working days from the date of receipt of application along with the required documents. The Bank may require any additional information / documents for evaluating the credit worthiness of the applicant. For knowing the status of your loan application, please contact our Branch at which the application was submitted.

ACKNOWLEDGEMENT SLIP

Name of the Applicant:_________________________________________________ Co-Applicant:__________________________________________________________

CV CE SCV PV LCV

ACApplication No.

Signature of CustomerFor IndusInd Bank Ltd. (Sign and Seal)

** Inclusive of Service Tax and S.B. Cess as may be applicable.

IH FH Combo

Renewal years

Renewal option

TRACTORS

Place : _____________________________________

Page 11: consumer finance application cv - IndusInd Bank · PDF fileCONSUMER FINANCE LOAN APPLICATION FORM Business Location: Application No. AC VER : 18.0/0316 FIELDS WITH * (STAR) ARE MANDATORY

FOR B

ANK'S

USE O

NLY

O

CUST

MER C

OPY

3IBL reserves the right to reject any application without assigning any reasons.3IBL reserves the right to retain the photograph and documents submitted along with the application

form and shall not return the same to applicant.3IndusInd Bank (IBL) will decide quantum of the loan at its sole discretion.

3 _________

3All post dated cheques are to be issued favoring "Indusind Bank Limited" and duly crossed and you also need to fill the EMI amount and the due date on all cheques.

3The loan is sanctioned on fixed rate of interest basis and the said ROI is arrived at by adding Risk / Tenor / Product markups on currently declared Base Rate (BR) of the bank. The applicable ROI would be revised subject to terms as specified in the loan sanction letter / loan agreement.

The Monthly Installments (EMI) in connection with the loan will be due on of every month.

FOR B

ANK'S

USE O

NLY

CUSTO

MER C

OPY

MOST IMPORTANT DOCUMENT ACApplication No.

Dear Customer,This is to confirm receipt of your application form along with below mentioned documents.

Pre-sanction documents As Borrower As Co-borrower Date

Application form

Recent Passport size Photograph (signed across)

Proof of Age (specify)

Proof of Identity (specify)

Proof of Residence (specify)

Proof of Qualification (specify)

Proof of Business / Office address (specify)

Proof of Continuity of current job (specify)

Latest 3 months' salary slip

Proof of COI / COCB / MOA / AOA

Proof of Partnership Deed

Proof of Property Deed

Proof of Permit Copies

Proof of Work Order

Proof of Audited Financials

Proof of Valuation Certificate

Proof of SOA of Other Financial Exposure

Proof of Turnover (Latest sales / service tax returns)

Latest 3 years' ITR with computation of income / certified financials

Latest 6 months' bank statements (where salary income is credited)

Loan Account Statements for Repayment track record

Signature verification

Other documents if any

PART OF CONSUMER FINANCE – APPLICATION FORM (CV)

IMPORTANT NOTE :Kindly ensure to properly check and self-attest all documents submitted with date.Kindly do not make any payment in cash, bearer cheque or kind to the Executive in connection with this loan application.Note that :3The receipt of your application form for the loan does not imply automatic approval of your loan by IBL.3Incomplete / defective application will not be processed and IBL shall not be responsible in any manner

for the resulting delay or otherwise.3IBL may request for additional documents other than those collected in connection with the application.3IBL shall not be liable for loss or delay in the receipt of documents.

SANCTION LETTER

To

Dear Sir(s),

Ref : Your Proposal dated..................................................... for .......................................................... Loan.

We, at the outset, thank you for your decision to avail Loan Facility for the purchase of new vehicle / top-up loan tagged to your existing loan (Loan No.____________) / refinance against the existing asset / vehicle. We hereby confirm our acceptance to extend the facility on terms referred herein and overleaf.

Quantum of finance (`.)

Chassis _________ Veh.Ins.1st yr Prm

Body/Trolley _________ Group Health Prm _________

Combo Prm _________

_________ No. ofVehicles

Processing fee

(per vehicle)`.

StampingCharges(Actuals)

`.

Base . %

Margin . %

Customer IRR . %

Interest (Flat) . % $Collateral Details :Period

in monthsMoratorium

in days

Number ofInstalments

Instalment pattern**

1

2

3

4

Date :

We request you to carefully peruse the information/terms of our acceptance stated herein and, as a token of your consent, kindly sign the duplicate copy of this letter attached below and return the same to us. Interest rate given above is only indicative. Actual interest rate as on the date of delivery alone will apply. The loan would be offered at a ROI, which would be Bank's Base Rate + Margin as mentioned. This offer will expire if your acceptance is not received within 7 days from date.

Please note that cheques have to be drawn on Banks where our branch is located. For any delay in payment of instalments, Additional Interest Charges will accrue at the rates as specified in agreement. For cheques date of realisation at our end will only be taken as date of receipt. Outstation clearing charges if any will be debited to your account.

We once again thank you for availing our services.

Yours faithfully,for INDUSIND BANK LIMITED

AUTHORISED SIGNATORY

Visit us at : www.indusind.com

ACCEPTED

Loan Handling Charges

(Per vehicle)`.

Fixed

Floating

4

Inst. from Inst. to Nos. Loan EMI (`.) Adv. Ins. Prm. (`.) IH/FH/Combo (`.) Amount per Instalment (`.) Total Amount (`.)

Docn. charges

(per vehicle)`.

Prem. (B) (`.)

Yrs Yrs

BORROWER & CO-BORROWER SIGNATURES

Application No. AC

Contract No.

New Used Topup Refinance

Prem. (CB) (`.)

#

$ Is mentioned for ease of computation & checking only

** Inclusive of portion of Advance Insurance Premium (Payable per month) along with instalments

Exclusive of Service Tax and S.B. Cess as may be applicable (IndusInd)

Inclusive of Service Tax and S.B. Cess as may be applicable (IndusInd)

s Inclusive of Service Tax and S.B. Cess as may be applicable (Chola/Birla Sun Life)#

1st year Motor Ins Prm `.Group Health IH FI (`.)

Product: CV

PV

CE SCV

TRACTORS

LCV

Total

B CB _____Years

GPA/Combos

Page 12: consumer finance application cv - IndusInd Bank · PDF fileCONSUMER FINANCE LOAN APPLICATION FORM Business Location: Application No. AC VER : 18.0/0316 FIELDS WITH * (STAR) ARE MANDATORY

I / WE CONFIRM THAT THE EXECUTIVE COLLECTING THE APPLICATION / DOCUMENTS HAS / HAVE INFORMED ME / US:3The applicable rate of interest - flat rate and the equivalent rate of interest on IRR terms.3The interest on this loan would be calculated on monthly diminishing basis.3Processing Fees, Admin Fees, Loan Handling Charges, Documentation Charges, Valuation Charges, RC Verification Charges and Stamping Charges (at actuals) etc. (non

$refundable) that will be charged towards loan application.3The other applicable charges such as : Outstation Cheque Collection Charges (upfront or otherwise); Part PDC Charges; Correction PDC Charges; PDC Exhaust

Charges; Repayment Dishonour / Rejection Charges; Collection Charges; Repayment Mode Change Charges; Repayment Swapping Charges (within the mode); Consecutive (two or more) Repayment Dishonour / Rejection and Related Pullout Charges; Closure of Bank account (without intiation) from which Repayment

$Cheque/ECS has been issued; Loan Cancellation/Re-booking Charges (Refer to latest Schedule of Charges for further details).

3The Service Tax and S.B. Cess as may be applicable that will be charged in connection with various categories fees / charges collected (either as inclusive or as exclusive).THAT:3Incomplete / defective application will not be processed and IBL shall not be responsible in any manner for the resulting delay or otherwise.3IBL will not be liable for any loss or delay in receipt of documents.3Documents / Photographs will not be returned under any circumstances, once submitted to IBL.3Approval of the application is at the sole discretion of IBL and the quantum of the loan will be finally decided by IBL.3In case of used / refinance / top-up loans, the finance amount / decision to finance would depend on valuation of asset.3Equated Monthly Installment (EMI) will be due on ______________________ of every month.3The Loan foreclosure charges are as per the Loan agreement and currently the same is at _________ %.3The Foreclosure charges are levied / calculated on the balance principal outstanding of the loan. (Subject to clauses governing part prepayments)3The loan terms as sanctioned are applicable for the specified product as indicated in the loan application and are Where for some

reasons, there is a delay in concluding the loan, IBL reserves the right to revise the loan terms as may be applicable at the time of actual loan availment.I / We also confirm that,a) The executive has not made any commitments to me / us regarding the loan quantum / sanction process (or) promised any deviation / waiversb) The executive has collected self attested copies of the documents mentioned on the front side and verified the same with originals produced by me / usc) We have not given / made any payment in cash, bearer cheque or kind along with or in connection with this loan application to the said executive (or) to any other

employee of the bank (or) to any other third partyd) The details of loan terms / conditions inclusive of all charges have been read by me / us in full / read out to me / us (in vernacular) and understood by me/ us.e) No cash/blank cheque has been given by me/us alongwith the application, nor have I/We been promised any free gifts/inducements to apply for this loan facility.f) The copy of applicable Schedule of Charges has been collected by me / us.

valid for a period of 7 days only.

For any queries / clarifications please contact :

Executive Name **

at Mobile No.

at Land Line No.

Applicant Name

Signature of the Executive whocontacted the applicant

Applicant Signature

** Original Verified: Executive representing IBL should verify & certify all copies of documents submitted by applicant (with originals) in his presence andsign with date.

$During the currency of the loan, the Bank reserves the right to modify any / all the charges / fees applicable, from time to time, with a formal communication addressed to you (sent to your registered address).

POINTS TO NOTE

Please note that, all the borrowers of the bank are scored /rated based on various risk / credit scoring parameters such as:

1. Age; Domicile and Profile

2. Track record with our own bank or other banks / financial institutions

3. Applicant's business experience and the experience of the Co-borrower and/or the Guarantor

4. Product for which the loan is sought – from type and nature of application; locality; operational area perspective

5. Product and Operational Viability

6. Fleet Strength (as may be applicable for each type of loan product)

7. Other income and financials; other assets owned

8. Strength of banking transactions

9. Work orders on hand

10. Market reputation

11. Loan to Value norms & Loan Period sought

12. Feedback from field investigation check

13. Data on your Credit Track - from CIBIL or such other Credit Rating Agency and the Credit Score as per their report etc.

The individual factors / parameters and the related ratings / score / weights ascribed would vary basis the product and borrower category; location; product specific norms etc. of the bank.

The Bank may use any additional specific norm or parameter as may be required to evaluate / rate an individual proposal and also is at liberty to add or delete or modify any of the norms at any point in time.

These Charges / Fees collected by the Bank are exclusive / inclusive of Service Tax & S.B. Cess as the case may be, at applicable rates, from time to time. Category of Service is : Banking & Financial Services / Regn. No. MIU / ST / BFN / 165 / 04 / Pan based Service Tax RegistrationNumber is : AAACI1314GST001.

No manual receipts are issued by the Bank. Hence do not pay any dues (any time) without a valid Hand Held Machine generated receipt being issued to you; Note that the Bank would not be responsible for any money remitted / given by you to any executive / representative of the Bank, without obtaining a valid money receipt. Also do not accept any receipt with corrections / alterations. Always ask the Executive to show his Bank-issued Identity Card and in case of any doubt, we request you to visit our local Office and pay the dues.

#

Page 13: consumer finance application cv - IndusInd Bank · PDF fileCONSUMER FINANCE LOAN APPLICATION FORM Business Location: Application No. AC VER : 18.0/0316 FIELDS WITH * (STAR) ARE MANDATORY

FOR B

ANK'S

USE O

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FOF

ICE C

OPY

FOR B

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USE O

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OFF

ICE C

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MOST IMPORTANT DOCUMENT ACApplication No.

Dear Customer,This is to confirm receipt of your application form along with below mentioned documents.

Pre-sanction documents As Borrower As Co-borrower Date

Application form

Recent Passport size Photograph (signed across)

Proof of Age (specify)

Proof of Identity (specify)

Proof of Residence (specify)

Proof of Qualification (specify)

Proof of Business / Office address (specify)

Proof of Continuity of current job (specify)

Latest 3 months' salary slip

Proof of COI / COCB / MOA / AOA

Proof of Partnership Deed

Proof of Property Deed

Proof of Permit Copies

Proof of Work Order

Proof of Audited Financials

Proof of Valuation Certificate

Proof of SOA of Other Financial Exposure

Proof of Turnover (Latest sales / service tax returns)

Latest 3 years' ITR with computation of income / certified financials

Latest 6 months' bank statements (where salary income is credited)

Loan Account Statements for Repayment track record

Signature verification

Other documents if any

PART OF CONSUMER FINANCE – APPLICATION FORM (CV)

IMPORTANT NOTE :Kindly ensure to properly check and self-attest all documents submitted with date.Kindly do not make any payment in cash, bearer cheque or kind to the Executive in connection with this loan application.Note that :3The receipt of your application form for the loan does not imply automatic approval of your loan by IBL.3Incomplete / defective application will not be processed and IBL shall not be responsible in any manner

for the resulting delay or otherwise.3IBL may request for additional documents other than those collected in connection with the application.3IBL shall not be liable for loss or delay in the receipt of documents.

3IBL reserves the right to reject any application without assigning any reasons.3IBL reserves the right to retain the photograph and documents submitted along with the application

form and shall not return the same to applicant.3IndusInd Bank (IBL) will decide quantum of the loan at its sole discretion.

3 _________

3All post dated cheques are to be issued favoring "Indusind Bank Limited" and duly crossed and you also need to fill the EMI amount and the due date on all cheques.

3The loan is sanctioned on fixed rate of interest basis and the said ROI is arrived at by adding Risk / Tenor / Product markups on currently declared Base Rate (BR) of the bank. The applicable ROI would be revised subject to terms as specified in the loan sanction letter / loan agreement.

The Monthly Installments (EMI) in connection with the loan will be due on of every month.

SANCTION LETTER

To

Dear Sir(s),

Ref : Your Proposal dated..................................................... for .......................................................... Loan.

We, at the outset, thank you for your decision to avail Loan Facility for the purchase of new vehicle / top-up loan tagged to your existing loan (Loan No.____________) / refinance against the existing asset / vehicle. We hereby confirm our acceptance to extend the facility on terms referred herein and overleaf.

Quantum of finance (`.)

Chassis _________ Veh.Ins.1st yr Prm

Body/Trolley _________ Group Health Prm _________

Combo Prm _________

_________ No. ofVehicles

Processing fee

(per vehicle)`.

StampingCharges(Actuals)

`.

Base . %

Margin . %

Customer IRR . %

Interest (Flat) . % $Collateral Details :Period

in monthsMoratorium

in days

Number ofInstalments

Instalment pattern**

1

2

3

4

Date :

We request you to carefully peruse the information/terms of our acceptance stated herein and, as a token of your consent, kindly sign the duplicate copy of this letter attached below and return the same to us. Interest rate given above is only indicative. Actual interest rate as on the date of delivery alone will apply. The loan would be offered at a ROI, which would be Bank's Base Rate + Margin as mentioned. This offer will expire if your acceptance is not received within 7 days from date.

Please note that cheques have to be drawn on Banks where our branch is located. For any delay in payment of instalments, Additional Interest Charges will accrue at the rates as specified in agreement. For cheques date of realisation at our end will only be taken as date of receipt. Outstation clearing charges if any will be debited to your account.

We once again thank you for availing our services.

Yours faithfully,for INDUSIND BANK LIMITED

AUTHORISED SIGNATORY

Visit us at : www.indusind.com

ACCEPTED

Loan Handling Charges

(Per vehicle)`.

Fixed

Floating

4

Inst. from Inst. to Nos. Loan EMI (`.) Adv. Ins. Prm. (`.) IH/FH/Combo (`.) Amount per Instalment (`.) Total Amount (`.)

Docn. charges

(per vehicle)`.

Prem. (B) (`.)

Yrs Yrs

BORROWER & CO-BORROWER SIGNATURES

Application No. AC

Contract No.

New Used Topup Refinance

Prem. (CB) (`.)

#

1st year Motor Ins Prm `.Group Health IH FI (`.)

Product: CV

PV

CE SCV

TRACTORS

LCV

Total

B CB _____Years

GPA/Combos

$ Is mentioned for ease of computation & checking only

** Inclusive of portion of Advance Insurance Premium (Payable per month) along with instalments

Exclusive of Service Tax and S.B. Cess as may be applicable (IndusInd)

Inclusive of Service Tax and S.B. Cess as may be applicable (IndusInd)

s Inclusive of Service Tax and S.B. Cess as may be applicable (Chola/Birla Sun Life)#

Page 14: consumer finance application cv - IndusInd Bank · PDF fileCONSUMER FINANCE LOAN APPLICATION FORM Business Location: Application No. AC VER : 18.0/0316 FIELDS WITH * (STAR) ARE MANDATORY

INSTRUCTIONS FOR FILLING UP SANCTION LETTER

1. Every Field Officer who is responsible for the business should complete and forward the sanction letter within two days of approval.

2. Every sanction letter handed over to the customer to carry the Application reference and the contract number allotted and should be suitably dated.

3. Under reference column, enter the proposal date i.e., the date on which the customer was met/discussed and specify the vehicle model sought.

4. Under Quantum of finance, enter the finance on chassis (per vehicle), finance on body (per vehicle) and the total finance amount per vehicle as per approved Proposal Evaluation Form (PEF).

5. Under “No. of Vehicles” column, specify the number of vehicles approved by the appropriate authority.

6. Under “other charges per vehicle” column, specify the processing fee, documentation charges etc. as may be applicable.

7. Enter the Interest Charges rate (flat p.a. & customer IRR % p.a.) based on approved PEF.

8. Specify the collateral security details for the contract as specified in approved PEF.

9. Specify the Insurance Deposit amount per annum, period of the contract in months and the number of instalments as applicable.

10. Under ‘others’, indicate the security deposit if any payable and if interest bearing, the security deposit simple interest rate % p.a. In case the proposal is approved subject to collection of Post Dated Cheques, the same also to be indicated in this column.

11. Under instalment pattern, enter the instalment numbers and the amount per instalment.

12. Sign the Sanction letter in both Office copy and in Customer copy. Hand over the Customer copy of signed sanction letter to the Borrower and Co-Borrower and ensure to take his signature as a taken of acceptance of all terms indicated there in.

These Charges / Fees collected by the Bank are exclusive / inclusive of Service Tax & S.B. Cess as the case may be, at applicable rates, from time to time. Category of Service is : Banking & Financial Services / Regn. No. MIU / ST / BFN / 165 / 04 / Pan based Service Tax Registration Number is : AAACI1314GST001.

I / WE CONFIRM THAT THE EXECUTIVE COLLECTING THE APPLICATION / DOCUMENTS HAS / HAVE INFORMED ME / US:3The applicable rate of interest - flat rate and the equivalent rate of interest on IRR terms.3The interest on this loan would be calculated on monthly diminishing basis.3Processing Fees, Admin Fees, Loan Handling Charges, Documentation Charges, Valuation Charges, RC Verification Charges and Stamping Charges (at actuals) etc. (non

$refundable) that will be charged towards loan application.3The other applicable charges such as : Outstation Cheque Collection Charges (upfront or otherwise); Part PDC Charges; Correction PDC Charges; PDC Exhaust

Charges; Repayment Dishonour / Rejection Charges; Collection Charges; Repayment Mode Change Charges; Repayment Swapping Charges (within the mode); Consecutive (two or more) Repayment Dishonour / Rejection and Related Pullout Charges; Closure of Bank account (without intiation) from which Repayment

$Cheque/ECS has been issued; Loan Cancellation/Re-booking Charges (Refer to latest Schedule of Charges for further details).

3The Service Tax and S.B. Cess as may be applicable that will be charged in connection with various categories fees / charges collected (either as inclusive or as exclusive).THAT:3Incomplete / defective application will not be processed and IBL shall not be responsible in any manner for the resulting delay or otherwise.3IBL will not be liable for any loss or delay in receipt of documents.3Documents / Photographs will not be returned under any circumstances, once submitted to IBL.3Approval of the application is at the sole discretion of IBL and the quantum of the loan will be finally decided by IBL.3In case of used / refinance / top-up loans, the finance amount / decision to finance would depend on valuation of asset.3Equated Monthly Installment (EMI) will be due on ______________________ of every month.3The Loan foreclosure charges are as per the Loan agreement and currently the same is at _________ %.3The Foreclosure charges are levied / calculated on the balance principal outstanding of the loan. (Subject to clauses governing part prepayments)3The loan terms as sanctioned are applicable for the specified product as indicated in the loan application and are Where for some

reasons, there is a delay in concluding the loan, IBL reserves the right to revise the loan terms as may be applicable at the time of actual loan availment.I / We also confirm that,a) The executive has not made any commitments to me / us regarding the loan quantum / sanction process (or) promised any deviation / waiversb) The executive has collected self attested copies of the documents mentioned on the front side and verified the same with originals produced by me / usc) We have not given / made any payment in cash, bearer cheque or kind along with or in connection with this loan application to the said executive (or) to any other

employee of the bank (or) to any other third partyd) The details of loan terms / conditions inclusive of all charges have been read by me / us in full / read out to me / us (in vernacular) and understood by me/ us.e) No cash/blank cheque has been given by me/us alongwith the application, nor have I/We been promised any free gifts/inducements to apply for this loan facility.f) The copy of applicable Schedule of Charges has been collected by me / us.

valid for a period of 7 days only.

For any queries / clarifications please contact :

Executive Name **

at Mobile No.

at Land Line No.

Applicant Name

Signature of the Executive whocontacted the applicant

Applicant Signature

** Original Verified: Executive representing IBL should verify & certify all copies of documents submitted by applicant (with originals) in his presence andsign with date.

$During the currency of the loan, the Bank reserves the right to modify any / all the charges / fees applicable, from time to time, with a formal communication addressed to you (sent to your registered address).

Page 15: consumer finance application cv - IndusInd Bank · PDF fileCONSUMER FINANCE LOAN APPLICATION FORM Business Location: Application No. AC VER : 18.0/0316 FIELDS WITH * (STAR) ARE MANDATORY

FOR B

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USE O

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PROPOSAL EVALUATION FORM *If Used / Refinance – Valuation Certificate to be attached

Asset - Model / Variant

Invoice Amount - Chassis (`.)

Invoice Amount - Body (`.)

Total (`.)

Finance amount - Chassis (`.)

Finance amount - Body (`.)

Funding of 1st MIP / GPA / Health / Combo (`.)

Total (`.)

LTV %

Agreement period (in months)

Moratorium (in months)

No. of Installment (in months)

Rate of Interest (Flat) % *

Repayment Pattern: Mon/Bim/Qua/Hyr/Yry.

ROI Diminishing (CRM) %

Gross IRR & Net IRR (%)

Credit Period / Credit Amount (`.)

Subvention (`.)

Dealer / DSM / Referrer payout (% & `.)

Processing Fee (`.)

Document Charges (`.) + STC

Loan Handling Charges (`.) incl. STC

Stamping Charges (`.) + STC

Security Deposit (`.) / Terms

Collateral if any (Description of Collateral & its value)

Asset Category

Purpose (Own use / Agri Hiring /Non-Agri Hiring / Commercial use)

Viability ratio (as in point 15) *

Total Present Exposure (`.)

Adv. Insurance Premium (Yes / No & Amt.)* Years

IH / FH / Combo Deposit Amount (`.)

Approving Authority (No. / Ref.)

Credit Score / Rating / History IBL (Internal)

Score (Rating sheet & CIBIL Score Report

Rating

De

via

tion

s 1.

2.

3.

Particulars

Borrower

Co-borrower / Guarantor

Exis.

Exis.

New

New

Cust. Code

Cust. Code

Customer (SWOT)

Co-borrower (SWOT)

CIBIL Overall Remarks / Deviations / Justification / Approvals

I confirm that : (a) the applicant / co-borrower / guarantor were met at their business / residential premises, information furnished verified and found to be correct (b) the above information / recommendation are based on my personal evaluation

Recommendations / BE / FO **

BIC

attached)

Evaluation Executive

New Used Topup Refn New Used Topup Refn New Used Topup Refn New Used Topup Refn New Used Topup Refn

Top-up loan against Veh. No.________________

Loan No.______________________

4.

5.

6.

#

GPA / Health / Combo Upfront (`.)

Page 16: consumer finance application cv - IndusInd Bank · PDF fileCONSUMER FINANCE LOAN APPLICATION FORM Business Location: Application No. AC VER : 18.0/0316 FIELDS WITH * (STAR) ARE MANDATORY

FO

RB

AN

K'S

U

SE

ON

LY

FINANCIAL DETAILS OF BORROWER / CO-BORROWER / GUARANTOR (Attach copies of P&L, B/s & Tax return for Last 3 years)* If audited financials are not available fill the estimated financials as declared by the Borrower

Signature

Name & Emp. No.

* SWOT : Strengths; Weaknesses; Opportunities & Threats of the Proposal ** In case of more details, please attach separate sheet.

Date Field Officer / Business Exec. BIC SCM SH PH / EVP

Equity Capital

Reserves & Surplus

Secured loan

Unsecured loans

Deferred tax liability

Current liabilities and provision

Fixed Assets

Investments & others

Current assets, Loans and Adv.

Return on capital employed

Return on share holders fund

PAT / Income (%)

PAT / Assets employed (%)

Earning per shares

Book value per share

Interest coverage

Debt equityL

iab

ilit

ies

As

se

tsR

ati

os

SCM’s Comments

SH’s Comments

Other Sanction Conditions (if any)

(`. in Lakhs)

Yr 20____ - 20____

Yr 20____ - 20____

Yr 20____ - 20____Particulars

Sales

Other Income

Cost of goods

Direct expenses

Administration expenses

Selling and distribution expenses

Financial expenses

Deferred revenue expenditure

Depreciation

Profit before tax (PBT)

Provision for tax

Profit after tax (PAT)

Preference dividend (including tax)

Profit available for equityshareholders

Total

Total

Inc

om

eE

xp

en

se

s

PROFIT AND LOSS ACCOUNT*(`. in Lakhs)

Yr 20____ - 20____

Yr 20____ - 20____

Yr 20____ - 20____Particulars

BALANCE SHEET*

Total

Total

Audited / Estimated

NE