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Home Loans - Additional Co-Applicant FormPlease fill information in capital letters and black ink
House type Owned Leased Rented
Preferred Address for Communication
PAN Number
Marital Status Single Married Widow Divorcee Separated
Religion Hindu Muslim Sikh Christian Zoroastrian Buddhist Jain Other
Category SC ST OBC General Others
UID No. Date of Issue
VID No. Date of Issue
Mobile No
Pin code
Nature of Employment Self Employed Salaried Wage worker Contract worker Farming
Permanent Address
Landmark
District
City
State
House number
Street/Area
Same as applicant
Highesh Academic Qualification
Personal Details (Individual)
Name
Gender Male Female Third Gender
Father's Name
Mother's Name
Spouse's Name
Date of Birth D D M M Y Y Y Y
Pincode
Mobile No
House type Owned Leased Rented Years of stay
State
District
City
Street/Area
Present Address
House number
Same as applicant
Relationship with Applicant
Person with Disability
Date of ExpiryPassport No.
Date of ExpiryDriving licence.
Co
-Ap
pli
ca
nt’
s P
ho
to
Signature
Date
Name
(Paste photo here and signacross such that your
signature is on the photoas well as on the form)
Declaration
“I/We, ____________________________________________________________________________________________________________________, hereby declare that
the particulars furnished above are true and correct to the best of my/our knowledge and that no information has been withheld/suppressed. I/we understand that the
sanction of the loan is at the sole discretion of Ujjivan Small Finance Bank upon fulfilment of the other terms and conditions as required by Ujjivan .Small Finance Bank
I/we agree that Ujjivan shall be entitled to reject my application without giving any reason therefore. I/we confirm that the loan shall be used for the stated purpose and
will not be used for any speculative or anti-social purpose. I/we declare that I/we will not take loan from any other bank for the purpose as stated in the application form without permission from Ujjivan Small Finance Bank. I/we authorize Ujjivan Small Finance Bank to conduct such credit checks, references and make enquires in respect
of the application as it may consider necessary in its sole discretion and also authorize Ujjivan Small Finance Bank without any notice to me/us to share and disclose the
information relating to the loan to any credit bureau, financial institution or any other authority for proper verification and other administrative services. I/we undertake
to inform Ujjivan Small Finance Bank regarding any change in my/our occupation/postal address/telephone number and to provide any further information that may be
I/we confirm that Ujjivan Small Finance Bank may call for additional documents other than those already submitted along with the application form. I/we confirm that I/we have read the terms and conditions applicable to this loan and/or they have been read to me/us
in_____________________________________ (vernacular language) by ______________________________________________________________________Mr./Ms.
son/daughter of _____________________________ and I/we understand, accept and acknowledge the contents herein, and hereby accept the terms and conditions herein.
I/we agree that these terms and conditions may be changed by Ujjivan at any time. Small Finance Bank Ujjivan Small Finance Bank reserves the right to retain the photograph and the documents submitted with the application and may not return the same to the applicant. I/we acknowledge that information given in the loan
application shall form the basis of any loan Ujjivan may decide to grant to me/us.Small Finance Bank Ujjivan Small Finance Bank may use the services of agents in
sales/marketing/service etc. and the promotional/service/transactional calls/messages may be sent by such agents on behalf of Ujjivan Small Finance Bank.”
Yes No
required. I/we hereby give my consent to Ujjivan Small Finance Bank Ltd to carry out my/our Aadhar EKYC authentication and to fetch EKYC data from Aadhar data base.
Emp. ID UJJ
Emp. ID UJJ
Emp. ID UJJ
Loan Officer
Credit Officer
Cluster/Program Manager
Signature D D M M Y Y
D D M M Y YSignature
Signature D D M M Y Y
Note: This form is an addendum to the Home Loan Application Form