APPLICATION FORM

Contract No. 3901073951 POS Code 011260FOR SA Code OpenAPI_User Date 13/02/2019
APPLICANT DETAILS
Name PANCHANAN SAHOO Gender Male
Father's Name LOCHAN SAHOO Date of Birth 01/01/1993
APPLICANT CONTACTS Mobile 8249972335 e-mail address
Correspondence Address PLOTNO -307, GANGA NAGAR PALLI, floor 0, 0
UNIT6 bhubneshwer, NR-OUAT kharbal HOSTEL CAMPUS, Khorda, Kordha, Orissa, 751003
Residential Address PLOTNO -307, GANGA NAGAR PALLI, floor 0, 0
UNIT6 bhubneshwer, NR-OUAT kharbal HOSTEL CAMPUS, Khorda, Kordha, Orissa, 751003
REFERENCES Contact Relation Name Contact phone numbers
Close family person LOCHAN SAHOO 9776292267
Friend/Colleague/Relative SIBA NANDA SAHOO 7008721131
I hereby confirm that I have the permission from the aforesaid persons for providing their contact details to HCIN for calling them in respect of verification of my details provided
in this application form. I authorize HCIN to share my details provided in this application form with aforesaid persons from time to time for verification and updating purposes.

DOCUMENTS TO PROVIDE WITH LOAN APPLICATION

Identity & Address Proof: PAN/ Form 60 (as applicable), Aadhaar (masked), Bank Statement, Bank Passbook, Passport, Driving Licence, Voter ID, Utility Bill,
NREGA Job Card, Letter issued by National Population Register containing name & address, Government House Allotment Letter,
Property/ Municipal Tax Receipt
Income proof (where applicable): Income tax return, Salary slip, Salary credit in bank account
Document Type ID
PAN Card (OVD) GTTPS4932K
Latest 2 months gas bills (OVD)
Cancelled cheque
I understand and confirm that the Application Form, photograph and all other documents submitted by me to HCIN shall not be returned to me and
HCIN shall have the right to retain the same. Further, I undertake to inform HCIN within 7 days of any change in any of the details mentioned herein.

WORK EXPERIENCE
Total Experience 0 Employment Type Economical Status Salaried - Other
Ext. Profession Other Industry

MONTHLY INCOME & EXPENSES Occupation Income Rs. 22,000.00 Additional Income
Household Income Household Expenses Amount of debt null
Financial Situation Salary Day 0

LOAN DISBURSAL DETAILS

I hereby submit the details of my bank account for the purpose of transferring Loan Amount in case the loan application is approved by HCIN.
Bank Account No. 20283434388 Bank's Branch FOREST PARK Account Type SA
Bank Name STATE BANK OF INDIA Account Holder's Name PANCHANAN SAHOO
LOAN DETAILS
I declare that I have applied for the loan as per following details which is as per my requirements.

Loan Amount (Rs.) 60,000.00 Flat Interest Rate 33.68 % p.a. Term of the Loan 18 months
EMI (Rs.) 5,017.00 Monthly Customer Care Fee (Rs.) 0 Monthly Instalment (Rs.) 5,017.00
Processing Fee (Rs.) 1,800.00 Documentation Fee (Rs.) 0 Credit Assessment Fee (Rs.) 0
Number of Monthly Instalment 18 Number of advance instalment 0 Advance Instalment (Rs.) 0
Due Date 15th of every month Payment frequency Monthly Date of 1st payment 15/03/2019
CONSENT FOR AVAILING CONTACT OPTIONS
Yes, I would like to obtain the facility for applying and obtaining Loan from HCIN over the phone, e-mail, sms, HCIN's customer portal (i.e.
Contact Options) as per the terms and conditons of HCIN issued from time to time.
Mobile Number of the Applicant for Contact Option 8249972335
e-mail address of the Applicant for Contact Option
DECLARATION
1. I hereby confirm that I am a citizen of India and competent to give this declaration/ undertaking and to execute and submit this Application Form and all other documents for the purpose of availing
loan, creation of security and representing generally for all the purposes mentioned/required to be done for these presents.
2. I confirm that all the particulars and information given in the application form and otherwise in writing or over the Contact Options by me, are true, correct and complete and no information has been
withheld/suppressed.
3. I confirm that I am submitting this application form after having read and fully understood the terms and conditions of availing loan from Home Credit India Finance Private Limited (HCIN), including
those provided in the General Terms and Conditions for obtaining Personal Loan and POS loan from HCIN registered with the Sub-Registrar of Assurances at Gurgaon (Haryana) under Deed of
Declaration having Registration No. 23050 dated 18.12.2015 ("GTC"). I confirm that HCIN shall be entitled to reject my application without assigning any reason.
4. I have no insolvency proceedings against me nor have I ever been adjudicated insolvent. I confirm that no suit for recovery of outstanding dues or monies whatsoever and/or criminal proceedings
have been initiated and/or pending against me. There is no restriction on me in respect of availing the loan from HCIN and no person's consent is required by me for availing the loan from HCIN.
Further, I undertake and confirm that loan amount shall not be used for purposes of any gambling, lottery, or races, or for any purpose prohibited by RBI/ other regulatory body from time to time or any
other illegal purposes of similar nature. I confirm that I have been informed that the loan would be subject to Pre-payment Penalties and other charges.
5. I understand that HCIN offers different interest rate to the different borrowers based on loan amount, tenor, down payment, payment history with HCIN, credit score provided by credit information
companies, borrower's age, income, type of documents provided by the borrower and any other information as may be required for the purpose of credit evaluation. I understand that HCIN offers and
charges different rate of interest to different borrowers based on the aforesaid rationales and I agree to abide by such [Link] has confirmed that any changes in the rate of interest and fee/
charges shall take effect only prospectively. I further confirm that HCIN shall be entitled to categorise me under High, Low, Medium or any other risk category based on the aforementioned factors and
the loan performance.

Date 13/02/2019 Applicant's Signature

Place BUBANESHWAR