6/10/25, 11:32 AM Loan Against Gold Jewellery - Application Form

Bajaj Finance Limited ("BFL") - Loan Against Gold Jewellery Application Form

Application No. : PGOL00004550461

Date : 10-Jun-2025

Purpose of Loan : Personal

Branch Code : 12500

Branch Name : FATEHABAD - ANAJ MANDI

Customer ID (for existing customers) : 246577376

Loan Variant : Non Flexi

PERSONAL DETAILS

Name of Applicant (as in ID Proof) : Santosh Devi

Gender : Female

Date of Birth : 01-Jan-1977

Current Address Line 1 : W/O KAILASH SINGH 109 GALI NO 3

Current Address Line 2 : AGRRWAL COLONY WARD NO 18 FATEHABAD

Current Address Line 3 : FATEHABAD FATEHABAD FATEHABAD HARYANA INDIA

Landmark :

Pin Code : 125050

City : FATEHABAD

State : HARYANA

Mobile : 9253601517

PAN (Mandatory for loan amount above ₹: 5 NA

lakh)

Form 60 (in case PAN is not allotted)

Preferred Language : ENGLISH

CKYCR/ KYC Identification No. (KIN) :

Father/Spouse Name : kailash singh

Mother Name : brijbati devi

Occupation Type : HOUSE WIFE

Consent Details : Accepted IP Address : 2402:8100:2b79:efac:fa0b:9f0e:def1:d3d1 Language Name : English Application Number : PGOL00004550461 Date & Time : 2025-06-10 11:31:12 Mobile Number : 9253601517 Email ID :

1 of 13
6/10/25, 11:32 AM Loan Against Gold Jewellery - Application Form

Sector : NA

Education : Others

Annual Income : Less than 5 lakhs

Email ID : NA

Nationality : Indian

Identity Proof Submitted : OVD-Aadhaar

Current Address Proof : OVD-Aadhaar

ID - : 6634

Expiry: : NA

Officially Valid Document (OVD) : OVD-Aadhaar

ID - : 6634

Expiry: : NA

I hereby declare I have carried out my E – KYC and that I am providing Current Address which is different from the Address details available in the Identity Information
under the Central Identities Data Repository maintained by the Unique Identification Authority of India (UIDAI).

Officially Valid Documents (OVDs)

Passport, Driving License, Aadhaar (First Eight Digits of Aadhaar number to be redacted/masked), Voter's Identity Card issued by the Election Commission of India, Job Card issued by NREGA
duly signed by an officer of the State Governmenty, Letter issued by the National Population Register containing details of name and address

Deemed to be OVDs (in case address mentioned on OVDs is not the current address, Applicant shall submit OVD updated with current address within a period of three months of loan
application date)

1. Utility bill which is not more than two months old of any service provider (electricity, telephone, post-paid mobile phone, piped gas, water bill)
2. Property or Municipal tax receipt
3. Pension or family pension payment orders (PPOs) issued to retired employees by Government Departments or Public Sector Undertakings, if they contain the address
4. Letter of allotment of accommodation from employer issued by State Government or Central Government Departments, statutory or regulatory bodies, public sector undertakings,
scheduled commercial banks, financial institutions and listed companies and leave and licence agreements with such employers allotting official accommodation

FORM NO. 60

Income-tax Rules, 1962

FORM NO. 60
[See second proviso to rule 114B]

Form for declaration to be filed by an individual or a person (not being a company or firm) who does not have a permanent account number
and who enters into any transaction specified in rule 114B

1. Name of Individual

First Name : Santosh

Middle Name :

Last Name : Devi

2. Father's/ Spouse's Name (In case of Individual)

First Name : kailash

Middle Name :

Last Name : singh

3. Date of Birth/ Incorporation of declarant : 01-Jan-1977

Consent Details : Accepted IP Address : 2402:8100:2b79:efac:fa0b:9f0e:def1:d3d1 Language Name : English Application Number : PGOL00004550461 Date & Time : 2025-06-10 11:31:12 Mobile Number : 9253601517 Email ID :

2 of 13
6/10/25, 11:32 AM Loan Against Gold Jewellery - Application Form

4. Current Residence Address : W/O KAILASH SINGH 109 GALI NO 3,AGRRWAL COLONY WARD NO 18 FATEHABAD,FATEHABAD FATEHABAD
FATEHABAD HARYANA INDIA

5. Town/ City : FATEHABAD

6. Pin Code : 125050

7. State : HARYANA

8. Mobile Number : 9253601517

9. Telephone Number (with STD code) : NA

10. Amount of transaction (Rs.) : ₹ 15,550.00

11. Date of transaction : 10-Jun-2025

12. Mode of transaction : Cash Cheque Card Draft/Banker’s Cheque Online Transfer


Other

13. In case of transaction in joint names, number of persons involved : NA

in the transaction

14. Aadhaar Number issued by UIDAI (if available) : NA

15. If applied for PAN and it is not yet generated enter date of : NA
application and acknowledgement number

16. If PAN not applied, fill estimated total income (including income of : ₹ Less than 5 lakhs
spouse, minor child etc. as per section 64 of Income-tax Act, 1961) for
the financial year in which the above transaction is held

17. Details of document being produced in support of identify OVD-Aadhaar ID - 6634

Expiry:

18. Details of document being produced in support of address OVD-Aadhaar ID - 6634

Expiry:

Verification

I, Santosh Devi do hereby declare that what is stated above is true to the best of my knowledge and belief. I further declare that I do not have a Permanent Account Number and my/ our
estimated total income (including income of spouse, minor child etc. as per section 64 of Income-tax Act, 1961) computed in accordance with the provisions of Income-tax Act, 1961 for the
financial year in which the above transaction is held will be less than maximum amount not chargeable to tax.

Verified on 10-Jun-2025

Place: FATEHABAD - ANAJ MANDI

Note:

1. Before signing the declaration, the declarant should satisfy himself that the information furnished in this form is true, correct and complete in all respects. Any person making a false
statement in the declaration shall be liable to prosecution under section 277 of the Income-tax Act, 1961 and on conviction be punishable,
(i) in a case where tax sought to be evaded exceeds twenty-five lakh rupees, with rigorous imprisonment which shall not be less than six months but which may extend to
seven years and with fine;
(ii) in any other case, with rigorous imprisonment which shall not be less than three months but which may extend to two years and with fine.
2. The person accepting the declaration shall not accept the declaration where the amount of income of the nature referred to in item 16 exceeds the maximum amount which is not
chargeable to tax, unless PAN is applied for and item 15 is duly filled.

LOAN DETAILS

For New Loan

Loan amount : ₹ 15,550.00

In case of Top up/Renewal loan

Consent Details : Accepted IP Address : 2402:8100:2b79:efac:fa0b:9f0e:def1:d3d1 Language Name : English Application Number : PGOL00004550461 Date & Time : 2025-06-10 11:31:12 Mobile Number : 9253601517 Email ID :

3 of 13
6/10/25, 11:32 AM Loan Against Gold Jewellery - Application Form

Existing Loan A/c No. : NA

Existing Outstanding Loan Amount (A) : NA

Top up Loan Eligibility Amount (B) : NA

Total Loan Amount (A+B) : NA

Amount payable by customer upfront for : NA

renewal of existing Loan

New Loan Amount basis current Gold value

: NA

Net Disbursement Amount : ₹ 15,051.00

Disbursement Mode : CASH

Loan-To-Value (LTV) (in %) : 75.00%

Scheme Type : Monthly

Loan Tenure (in Months) : 12

Loan Maturity Date : 10-Jun-2026

Type of Interest : Fixed

Method of Calculation of Interest : Written Down Value Method

Compounding Type# : NA

APPLICABLE RATE OF INTEREST (AS PER SCHEME SELECTED BY THE APPLICANT)

Please note that, a rebate in interest rate may be provided for encouraging timely repayment of interest or closure of the loan on or before the specified tenure as per
different slabs built into each scheme. No rebate in the rate charged shall be offered in the event Applicant fails to pay the interest and/or repay the loan on or before
the Loan Maturity Date.

Rate of Interest Net Rate of Interest

Date Period (days) Rebate (%)
per annum (% p.a.) per annum (% p.a.)

10-Jun-2025 1 - 30 24.00 % 2.00 % 22.00 %

10-Jul-2025 1 - 60 24.00 % 1.00 % 23.00 %

09-Aug-2025 1 - 90 24.00 % 0.50 % 23.50 %

08-Sep-2025 1 - 365 24.00 % 0.00% 24 %

Applicable rate of interest will vary depending on the due date of interest and actual date of payment of interest, as per the above slab.

JEWELLERY DETAILS

Standard
Jewellery No. of Gross weight Stone Weight Net Weight
Karat deduction Remarks
Description items (In Grams) (In Grams) (In Grams)
(In Grams)

STUD WITH DROPS (PAIR) 1 22 3.58 0.500 0.100 2.98 sldr+stone

Total 1 3.58 0.500 0.100 2.98

(If the purity of the gold is less than 22K, the grams and valuation of the gold will be shown by translating the gold into 22K on a best effort basis.)

Consent Details : Accepted IP Address : 2402:8100:2b79:efac:fa0b:9f0e:def1:d3d1 Language Name : English Application Number : PGOL00004550461 Date & Time : 2025-06-10 11:31:12 Mobile Number : 9253601517 Email ID :

4 of 13
6/10/25, 11:32 AM Loan Against Gold Jewellery - Application Form

DEDUCTIONS FROM LOAN AMOUNT (INCLUSIVE OF APPLICABLE TAXES)

PROCESSING FEE : ₹ 99.00

HDFC Life Group Jeevan Suraksha : ₹ 350.00

CASH HANDLING CHARGES : ₹ 50.00

APPLICANT’S BANK DETAILS

Account Holder Name : NA

Account Number : NA

Bank Name : NA

IFSC : NA

GOLD OWNERSHIP

How was the gold acquired? : Self-purchased

NOMINATION

I, Santosh Devi, hereby nominate the following person (“Nominee”) to whom in the event of my death, the Gold Jewellery deposited with Bajaj Finance Limited, against
the loan availed by me, shall be returned. Bajaj Finance Limited shall hand over the Gold Jewellery to the Nominee to the exclusion of all other persons upon payment of
all outstanding dues to Bajaj Finance Limited and on such return Bajaj Finance Limited shall stand released and discharged.

Name of the Nominee : vikas kumar

Relationship with borrower : SON

Address of the Nominee : W/O KAILASH SINGH 109 GALI NO 3 , AGRRWAL COLONY WARD NO 18 FATEHABAD , FATEHABAD FATEHABAD FATEHABAD
HARYANA INDIA , 1 , 125050 , HARYANA , FATEHABAD ,

Age of the Nominee : 22 Years 10 Months 0 Days

In case nominee is a minor on this date, I/We appoint below guardian to receive the Gold Jewellery placed as security on behalf of the nominee in the event of
my/our/minor's death during the minority of the nominee.

Name of the Guardian : NA

Guardian's Relationship with Nominee : NA

Address of the Guardian : NA

Age of the Guardian : NA

Place : FATEHABAD - ANAJ MANDI

Date : 10-Jun-2025

Santosh Devi

(Name of Borrower)

Signature of Borrower

INSURANCE PRODUCTS - HDFC LIFE GROUP JEEVAN SURAKSHA

Consent Details : Accepted IP Address : 2402:8100:2b79:efac:fa0b:9f0e:def1:d3d1 Language Name : English Application Number : PGOL00004550461 Date & Time : 2025-06-10 11:31:12 Mobile Number : 9253601517 Email ID :

5 of 13
6/10/25, 11:32 AM Loan Against Gold Jewellery - Application Form

Sum Insured : ₹ 50,000.00

Premium (Inclusive of applicable taxes) : ₹ 350.00

Tenure in months : 12

Plan Option : NA

Sum Assured Type : Level

Authorization - I do hereby declare that I have received a loan from M/s Bajaj Finance Limited ("Master Policyholder"). In order to secure the said loan, I have taken the above reference
cover from HDFC Life Insurance Company Ltd. In consideration of receiving the said loan, I hereby authorize HDFC Life to make payment of Outstanding Loan Balance amount to the
Master Policyholder by deducting from the claim proceeds payable on happening of the contingent event covered by the Group Life Insurance Scheme/Policy referenced above.

#Conditions Apply - Please refer to the 'Insurance Disclaimer and Customer Declaration' section below before concluding a Sale.
Product Name: HDFC Life Group Jeevan Suraksha | UIN: 101N113V05

Date : 10-Jun-2025

Place : FATEHABAD - ANAJ MANDI Applicant Signature

INSURANCE NOMINEE DETAILS - HDFC LIFE GROUP JEEVAN SURAKSHA

Name : vikas kumar

Date of Birth : 10-08-2002

Relationship with Applicant : SON

Mobile : 7494905696

Email ID : NA

Appointee Name (in case Nominee(s) is a : NA

Minor)
:
Appointee's Relationship with Nominee NA

Appointee Date of Birth : NA

Appointee Mobile : NA

HEALTH DETAILS OF INSURED

Health details of Proposed Insured (Please use in boxes to indicate choice)

1. Are you in sound state of health?  Yes No

2. Have you ever undergone, or expect to undergo any surgical procedure for any illness, ailment, disease or disability? Yes  No

3. Have you ever suffered from, or are suffering from any disease/ailment requiring any form of medication for more than 7 consecutive days, or Yes  No
been absent from work for more than 7 days?

4. Do you engage or intend to engage in any business, sport or occupation of a hazardous nature? Yes  No

5. Do you have any history of conviction under any criminal proceedings in India or abroad? Yes  No

6. Have any proposal for insurance, or revival of policy on your life to this company or any other insurance company been postponed/ declined/ Yes  No
accepted on terms other than proposed?

For FEMALE Lives Only

7. Are you pregnant now? Yes  No

8. If response to above question is Yes, please mention how many weeks NA

9. Have you ever suffered from any disease of the breast, uterus, cervix, ovaries or any other part of the reproductive system? Yes  No

Consent Details : Accepted IP Address : 2402:8100:2b79:efac:fa0b:9f0e:def1:d3d1 Language Name : English Application Number : PGOL00004550461 Date & Time : 2025-06-10 11:31:12 Mobile Number : 9253601517 Email ID :

6 of 13
6/10/25, 11:32 AM Loan Against Gold Jewellery - Application Form

COVID-19 Questionnaire (For HDFC LIFE)

Have you or any of your immediate family members

1. Travelled outside India in the last 45 days or do you plan to travel outside India during the next 6 months? Yes  No

2. Tested positive for COVID-19* or are awaiting results of such a test or been advised to be under quarantine due to COVID-19? Yes  No

3. Currently suffering from or in the last 2 months, have suffered from fever, persistent cough, sore throat, breathing difficulties, gastro-intestinal Yes  No
symptoms (vomiting/diarrhea)?

INSURANCE DISCLAIMER & CUSTOMER DECLARATION

Customer/Proposer/Life Assured's Declaration

1. I/We provide my/our consent voluntarily for enrolling as a member of group insurance offered to me by the above insurer under the master policy of Bajaj Finance Limited.
2. I/We understand, agree and confirm that these statements and this declaration are basis of the contract between the insurer and the policyholder. Subject to Section 45 of the
Insurance Act 1938 as amended from time to time, if any untrue statements are contained herein or there has been any non-disclosure of any material fact, the policy to be
issued by the insurer in the name of the policyholder may be treated as void as far as I/We am/are concerned.
3. I/We confirm that I/We have read and understood, the rules and any additional rules of the plan, the standard policy provisions and any additional provisions that govern the
policy to be issued by insurer in the name of the policyholder and on my/our life, and I/We agree and confirm that the same shall be binding on me/us. I/We authorize the
policyholder to disclose to the insurer such particulars as they may require including the details given above and any changes to the same, pay the premium payable on my/our
behalf /collected from me/us to the insurer. I/We understand that any statutory levy or charges including any indirect tax may be charged to me/us either now or in future by
the insurer and I/We agree to pay the same
4. I/We further agree that if after the date of submission of the proposal but before the issuance of Policy

there is an adverse change in my/our occupation, financial condition, health condition, which will affect the decision of the Insurer in underwriting risk or
if the proposal for assurance or an application for revival of the policy made to any insurer on my/our life or the Life to be assured is withdrawn or dropped, deferred,
declined or accepted on terms other than as proposed, I/We shall forthwith intimate the same to the insurer in writing and failure to do so shall lead to a decision as
per the applicable terms and conditions of the policy.
5. I/We understand that insurer has the right to reject a proposal without giving reasons thereto and confirm to give an undertaking that I/We shall not raise any claims thereof.
I/We understand the significance of the contract and that the contract will be governed by the provisions of the Insurance Act 1938 as amended from time to time and that the
same will not commence until written acceptance of this application issued by the insurer on its normal terms and conditions is received.
6. I/We hereby declare that the content of the form and document has been fully explained and given by me/us and I/We have fully understood the significance of the proposed
contract
7. I hereby declare that the above statements and/or particulars given by me are true and complete in all respects to the best of my knowledge
8. I understand that the information provided by me will form the basis of insurance policy, is subject to Board approved underwriting policy of the insurance company and that
the policy will come into force only after full receipt of premium chargeable.
9. I further declare that I will notify in writing any change occurring in the occupation or general health after the proposal has been submitted but before communication of the
risk acceptance by the Company
10. I declare and further consent to the Company seeking medical information from any doctor or hospital who/which at any time has attended me or from any past or present
employer concerning anything which affects my physical or mental health and seeking information from any insurer to whom an application for insurance has been made for
the purpose of underwriting the proposal and/or claim settlement.
11. I authorize the Company to share information pertaining to my proposal including the medical records for the sole purpose of underwriting the proposal and/or claim settlement
and with any Governmental and/or Regulatory Authority
12. I hereby provide my consent and authorize the Company to make welcome calls, service calls or any other commercial communication (electronic or otherwise and/or including
but not limited to SMS/WhatsApp) with respect to the proposed or existing policy of Company from time to time. I also authorize sending any communication for the purposes
of marketing and offering of various products and services of the Company through agent(s) and/or any third party(ies) or any of the product(s) of its affiliates, co-brand
partners etc. The said consent will over-ride any registration on DND registry.
13. I agree that this declaration shall be the basis of the decision by insurer to cover or not cover me under insurance.
14. I hereby authorize BFL to verify/ check/ obtain/ download my KYC details available with CERSAI/UIDAI/CKYC registry. I agree that the details/documents provided by me may be
shared by BFL with the insurer(s) and may be downloaded/verified by insurer(s) for processing of this application. In the event if I am found to be existing customer of BFL, I
confirm that there is no change in my existing KYC details and authorize BFL to use my existing KYC for this application.

Cancellation/ Termination

Once the Insured ceases to be a member or the policy is cancelled by the Master policyholder or the insurer for any reason whatsoever, the cover will automatically stand cancelled.
However, the Insured under this policy can port to a similar approved retail health policy available with the company as per 'Portability Guidelines', subject to the Company's medical
underwriting criteria.

Statutory Warning (Prohibition of Rebates) - Section 41 of Insurance Act 1938

Consent Details : Accepted IP Address : 2402:8100:2b79:efac:fa0b:9f0e:def1:d3d1 Language Name : English Application Number : PGOL00004550461 Date & Time : 2025-06-10 11:31:12 Mobile Number : 9253601517 Email ID :

7 of 13
6/10/25, 11:32 AM Loan Against Gold Jewellery - Application Form

(i) No person shall allow or offer to allow, either directly or indirectly, as an inducement to any person to take out or renew or continue an insurance in respect of any kind of risk
relating to lives or property in India, any rebate of the whole or part of the commission payable or any rebate of the premium shown on the policy, nor shall any person taking out or
renewing or continuing a policy accept any rebate, except such rebate as maybe allowed in accordance with the published prospectus or tables of the insurer.

(ii) Any person making any default in complying with the provisions of this section shall be punishable with fine which may extend to Ten Lakh Rupees.

Fraud, misrepresentation and forfeiture: Fraud, misrepresentation and forfeiture would be dealt with in accordance with provisions of Section 41 of the Insurance Act 1938 as amended
from time to time.

Disclaimer - Conditions apply - These products are offered under the Group Insurance scheme wherein Bajaj Finance Limited is the Master policyholder. The insurance coverage is
provided by our partner Insurance Company , Bajaj Finance Limited does not underwrite the risk. IRDAI Corporate Agency Registration Number CA0101. BFL does NOT hold any
responsibility for the issuance, quality, serviceability, maintenance and any claims post sale. Please refer insurer's website for Policy Wordings. Purchase of this product is purely
voluntary in nature. BFL does not compel any of its customers to mandatorily purchase any third party products.

I hereby consent and authorize Bajaj Finance Limited to share this application and all information and details as provided by me under this application with insurer for the purpose of
customer verification and claim settlement and I shall not hold Bajaj Finance Limited liable for the use/sharing of my application/information as stated above.
Date : 10-Jun-2025

Place : FATEHABAD - ANAJ MANDI

GENERAL APPLICATION TERMS

I hereby, acknowledge, consent and confirm that:

1. I am a resident Indian and have shared my savings bank account details which is neither NRO nor NRE account. All particulars, information and details provided by me for
availing this loan against gold Jewellery (“Loan”), including but not limited to my latest /existing KYC details, current address, mobile number and email address as displayed on
the digital platform through which I am applying for Loan from Bajaj Finance Limited (“BFL”) are true & correct and in case of any change, I undertake to proactively intimate
BFL promptly and without delay. I further confirm that there are no changes to the KYC details submitted while availing the existing gold loan on which the Top Up Loan is being
availed and/or which is being renewed by way of this Loan. I shall be obliged to submit to BFL, updated KYC documents within 30 days of such change/update, if any. I further
undertake to submit all documents, in such form and manner, as may be prescribed by BFL from time to time. Further, I hereby declare that my above-mentioned current
address as stated in this Application Form is true and correct, in the event such an address differs from the address updated as per Aadhaar fetched using e-KYC authentication
facility provided by the Unique Identification Authority of India (UIDAI).
2. The Loan availed by the Borrower from BFL by placing gold jewellery as security, shall be subject to and governed by the Terms and Conditions contained herein and as specified
in this application form, and Gold Deposit Receipt and the Standard Terms and Conditions (“Standard Terms”) accessible by visiting the Form Centre
[Link] ([Link] and selecting “Gold Loan" from the drop down box;
3. The RTGS/NEFT/DD/fund transfer of my Loan amount by BFL is subject to RBI regulations governing the same and that BFL shall not be liable for any consequence due to
erroneous details provided by me or delay in transfer of funds for reasons beyond the the control of BFL;
4. BFL may, at its sole discretion, accept or reject my Loan request;
5. In case of Top Up/Renewal –
1. The Nominee details registered with existing loan to be continued for this Loan;
2. For administrative/operational purposes, the existing loan account shall be closed and new loan account shall be opened, which shall be binding upon me;
3. The gold jewellery offered as security / collateral for previous gold loan and/or against this Top Loan / renewal, shall continue to remain as a security with BFL as
security for the purpose of this Loan until all outstanding dues under this Loan or under any other Finance Facility are fully paid by me to BFL;
6. BFL may, at its sole and absolute discretion, grant facility of Flexi Drawdown under the Gold Flexi Loan on below terms and conditions and Standard Terms:
a. I shall be eligible to make drawdown for an amount less than or equivalent to the amount of prepayment made by me.
b. For availing the Flexi Drawdown, I agree to the following conditions:
i. That I shall request for a Flexi Drawdown by sending a Communication through Acceptable means of Communication, or by raising request on Mobile/Web Application
of BFL, as per the process prescribed by BFL and as specifically detailed under the Standard Terms;
ii. to pay an additional charge at the rate prescribed by the BFL from time to time;
iii. that the rate of interest and other repayment terms may be revised at the sole discretion of the BFL and the same shall be as informed to me through Acceptable
means of Communication and
iv. BFL reserves the right to either accept or reject Flexi Drawdowns or disallow further Flexi Drawdowns, in accordance with BFL’s internal policy or for any other reason
deemed fit by BFL in its sole and absolute discretion.
7. Gold Flexi Loan: In case of Gold Flexi Loan, following conditions shall apply:
1. The roll over amount / Outstanding Dues shall be reduced on a monthly basis such that the Outstanding Dues shall be reduced to Rs.100 or 0.01% of the Borrower’s existing
Loan at the end of the Loan Tenure. Borrower must pay remaining Outstanding Dues at BFL’s loan branch to release the gold jewelry deposited by the Borrower;
2. The reduction of the roll over amount / Outstanding Amount as provided in Clause above, shall be either through:
i. the equated principal repayment method under which the rollover amount/Outstanding Amount will be reduced/ deducted on an equated basis during the Loan Tenure
(' Equated Principal Repayment Method'), or
ii. the written down value method under which the rollover amount/Outstanding Amount will be reduced/ deducted on reducing balance basis during the Loan Tenure ('
Written Down Value Method'), as prescribed by the BFL
3. The EMI may comprise of equal instalments or variable instalments or interest only instalments.

Consent Details : Accepted IP Address : 2402:8100:2b79:efac:fa0b:9f0e:def1:d3d1 Language Name : English Application Number : PGOL00004550461 Date & Time : 2025-06-10 11:31:12 Mobile Number : 9253601517 Email ID :

8 of 13
6/10/25, 11:32 AM Loan Against Gold Jewellery - Application Form

4. BFL may, at any time during the Loan Tenure, in its sole and absolute discretion and/or in accordance with the BFL's internal policy, change the Loan variant from Gold Flexi
Loan to Gold loan or to such other variant of Loan as contemplated under these terms and may accordingly revise the EMI and repayment schedule of the Loan and I agree to
bound by revised repayment schedule.
8. That the gold jewellery deposited or to be deposited by me, for availing the Loan, is my bonafide property free of any claims, encumbrances and has not been obtained by
fraud or otherwise. Further, the said Gold placed as security is not fake, defective, stolen, spurious or of an inferior quality;
9. The end use of the Loan is for lawful and non-speculative purposes.
10. In the event of my failure to pay make payment or Outstanding Dues on or before the due date or in the event of failure to maintain the Required Margin (the percentage of
gold security at current gold prices to be maintained against the existing loan amount outstanding under the Loan) or upon occurrence of any event of default as mentioned in
the Standard Terms, BFL shall entitled to enforce the security created on gold jewellery and recover the outstanding dues by selling the same by public auction by giving me a
reasonable notice in the manner as stipulated in the Standard Terms and as may be intimated to me as per regulatory requirement;
11. I hereby authorize BFL to conduct verification/tests of purity of the gold jewellery through an assayer appointed by BFL for valuation;
12. I also authorize BFL:
a) To use, verify, exchange, share or part with all information and details as provided by me to BFL’s group companies/business partners/permitted assigns,
affiliate/subsidiaries/agents/ service provider/representatives/empanelled merchants (collectively referred to as “Assigns”) and any third party including but not limited to,
banks, financial institutions, credit bureaus, telecommunication companies, statutory bodies, empanelled merchants, Central KYC Registry, Protean eGov Technologies Reserve
Bank of India, GST Portal, CIBIL/CRISIL/any credit rating agency/credit information company(CIC), Information Utility, NSDL e-Governance Infrastructure Limited (NSDL)/UTI
Infrastructure Technology and Services Limited (UTIITSL), UIDAI for purposes such as, including but not limited to customer verification and due diligence, personalization of
products or services, credit rating, data enrichment, analysis, marketing or promotion of BFL services or related products or that of its Assigns or for enforcement of my
obligations and I shall not hold BFL/its Assigns liable for the use/storage/sharing of the data and informations as stated above. I am aware and I agree that my Aadhaar details
such Aadhaar Number, registered mobile Number, and registered email ID will be masked by BFL before sharing to its permitted Assigns and/or any third party as per
laws/regulations;
b) to seek/obtain any other information, generate periodic reports relating to me either by itself and/or from any third party;
c) To procure/avail my CIBIL report and provide it to me by deducting applicable charges for the same
13. I hereby expressly authorise BFL, its group companies, affiliates and/or business associates and their respective representatives to send me communications regarding loans,
insurance and their respective products and/or services (collectively “Other Products”) through telephone calls/SMSs/emails/post/bots/bitly etc. including but not limited to
promotional communications. I agree and understand that such Other Products if availed, are governed by their own set of terms and conditions, which shall be in addition to
and not in derogation to the terms and conditions prescribed by BFL herein. I understand that I can at any time opt not to receive any telecommunication;
14. I agree and understand that other products/services, belonging to BFL’s Assigns, availed if any, will be governed by their own set of terms and conditions, which shall be in
addition to and not in derogation to the terms and conditions prescribed by BFL herein;
15. I have given or shall give NACH mandate or any other electronic mandate in favor of BFL covering all the Outstanding(s). The NACH mandate or any other electronic mandate
given or to be given in favour of BFL is authorized for utilizing the same to recover all Outstanding amount including fees, penalties, cost and other applicable charges in
connection with my loan. Further, I confirm and understand that BFL shall, at its sole discretion, at multiple occasions on different dates, present in my bank account, the NACH
mandate or any other electronic or other clearing mandate which returns unpaid, for recovering my Outstanding Dues;
16. Interest Rate Methodology
Interest rate applicable for Loan against Gold Jewellery 9.5% p.a. to 24% p.a., may vary basis BFL's internal credit and risk policy and as per an algorithmic multivariate score
card which includes following variables (inclusive and not exhaustive):

Interest rate risk (fixed vs floating loan)

Credit and default risk in the related business segment
Historical performance of similar homogeneous clients
Profile of the borrower
Industry segment
Repayment track record of the borrower
Nature and value of collateral security
Secured Vs Unsecured loan
Subvention available
Ticket size of loan
Bureau Score
Tenure of Loan
Location delinquency and collection performance
Customer Indebtedness (other existing loans)

The aforesaid variables may be revised from time to time as per the BFL’s past performance in a given loan portfolio.

17. I understand that the timely repayment of loan as per the EMI due date/loan repayment due date has to be mandatorily adhered by me without exception, else, the loan
account shall be flagged as overdue as per Regulatory Instructions and the same is detailed below, for ease of your understanding

Consent Details : Accepted IP Address : 2402:8100:2b79:efac:fa0b:9f0e:def1:d3d1 Language Name : English Application Number : PGOL00004550461 Date & Time : 2025-06-10 11:31:12 Mobile Number : 9253601517 Email ID :

9 of 13
6/10/25, 11:32 AM Loan Against Gold Jewellery - Application Form

REGULATORY REQUIREMENT ILLUSTRATION

Classification as Special Criteria for classification of Loan account, is based on Non-receipt Date of payment of Loan Dues ( January 07, 2022) & its
Mention Account (SMA) / Non- of Principal or interest payment or any other amount wholly or classification upon non-payment
Performing Asset (NPA) partly overdue (shortly referred below as “Loan Dues”)

SMA-0 Non-receipt of Loan Dues till 30 days from the Due Date SMA-0: Upto February 05, 2022

SMA-1 Non-receipt of Loan Dues for more than 30 days and upto 60 days SMA-1: On February 06, 2022, it shall be classified as SMA-1 if
from the Due Date complete loan dues are not paid to BFL

SMA-2 Non-receipt of Loan Dues for more than 60 days and upto 90 days SMA-2: On March 08. 2022, it shall be classified as SMA-2 if
from the Due Date complete loan dues are not paid to BFL

NPA Non-receipt of Loan Dues as of 91st day from the Due Date NPA: On April 07, 2022, it shall be classified as NPA if complete
loan dues are not paid to BFL

18. The revision of Initial Fees and Charges and such other additional fees/charges as may be introduced by BFL ("Revised Charges"), may be notified by BFL on its website
[[Link] ([Link] and which shall constitute sufficient notice to me;

19. The fees and charges as communicated to me via the Loan acceptance journey and/or as specified above/intimated to me from time to time via telephone,
calls/SMS/WhasApp/bitly/bots/ emails/post etc shall be payable and may be deducted by BFL from the Loan amount disbursed or may be subsequently recovered as
outstanding dues payable under the Loan, in BFL sole discretion.
20. I hereby expressly consent for taking my photo/video along with the invoice and product evidencing the conduct of loan transaction by me and that such photo/video is
unconditionally agreed to be stored and preserved for a period of at least five (5) years or otherwise from the date of closure of my account and/or as the law/regulations may
so mandate, whichever is higher.
21. The Borrower agrees that repayment of loan shall have to be made from own account of borrower except in case of balance transfer, where the funds will be transferred by
Banks or Financial Institution directly in borrower loan account with BFL and accordingly borrower agrees that BFL shall be entitled to reject the payment received from any third
party individual towards repayment of loan.
22. The Borrower also agrees that in the event the Borrower decides to repay the Loan, he/she shall be required to repay the Loan only at the nearest BFL branch office.
23. Aadhaar based authentication (Aadhaar eKYC) facility provided by Unique Identification Authority of India “UIDAI”
a. CONSENT : At my own discretion, I voluntarily opt to perform and avail Aadhaar based authentication (eKYC) from UIDAI and hereby submit to the BFL, the physical copy of
Aadhaar card / physical e-Aadhaar / masked Aadhaar / Aadhaar Secure QR code / offline electronic Aadhaar xml as issued by UIDAI (Aadhaar), Aadhaar number, Virtual ID, e-
Aadhaar, Aadhaar Letter, XML file, date of birth, Aadhaar holder name, photo, demographic information, face authentication details and/or biometric information (collectively,
“Information”) for the purpose of establishing my identity / address proof or in the capacity of guardian of my minor child’s identity / address.
I am informed by the BFL that in connection with Aadhaar e-KYC services, BFL shall share Aadhaar number and/or biometrics with CIDR/UIDAI , and in response, the CIDR/UIDAI
shall share with BFL, the authentication data or verification data such as Aadhaar Holder Name, Date of Birth, Address, Photo, and Registered Mobile Number.
b. PURPOSE : I for myself/as guardian of minor child, authorise and give my consent to the BFL, for following informed purposes:
i. Above mentioned information shall be used for KYC and periodic KYC updation process as per the PML Act, 2002 and rules thereunder and RBI guidelines, or for
establishing my identity, carrying out my identification, e-KYC, or Yes/No Authentication, demographic or other authentication/verification/ identification as may be
permitted as per applicable law, for all accounts, facilities, services and relationships of/through the BFL, existing and future.
ii. Collecting, sharing, storing, preserving Information, maintaining records and using the Information and authentication/verification/ identification records: (a) for the
informed purposes above, (b) as well as for regulatory and legal reporting and filings and/or (c) where required under applicable law;
iii. producing records and logs of the consent, Information or of authentication, identification, verification etc. for evidentiary purposes including before a court of law, any
authority or in arbitration.
c. I further understand that Aadhaar number and core biometrics will not be stored/ shared except as per laws/regulations and for CIDR/UIDAI submission.
e. I am informed by the BFL, that the submission of Aadhaar is not mandatory, and there are alternative options for KYC and establishing identity including by way of physical
KYC with officially valid documents other than Aadhaar. All options were given to me.
24. CONSENT DATA AND INFORMATION SHARING FROM FOR DIGILOCKER PROVIDED BY MeIT (Ministry of Electronics and Information Technology)
I authorise and give my consent to the BFL to obtain, share and store Certified Copy of Officially Valid Documents (OVD) or equivalent e-documents of OVD including documents
issued through secured cloud based Digilocker platform of MeIT for the purpose of availing Financial Products from BFL.
25. CONSENT FOR ADDITIONAL DETAILS:
I hereby authorise and give my consent to the BFL to verify/check/obtain/download/upload/update/retrieve/receive my following details: (i) profession or (ii) income or (iii)
financial details or (iv) location or (v) IP address or (vi) photographs of residence/business premises or (vii) alternative mobile phone number or (viii) alternate residence
address or (ix) any other additional information as deemed fit by BFL through details shared by me for this Application Form and Loan Agreement
26. Loan Application will be processed within 12 days from the date of receipt of all the documents to the satisfaction of BFL.
27. I hereby declare that all the information voluntarily furnished by me is true, correct and complete. I will not hold BFL or any of its officials responsible in case of any incorrect
information provided by me.

FEES & CHARGES LEVIED BY BFL

Consent Details : Accepted IP Address : 2402:8100:2b79:efac:fa0b:9f0e:def1:d3d1 Language Name : English Application Number : PGOL00004550461 Date & Time : 2025-06-10 11:31:12 Mobile Number : 9253601517 Email ID :

10 of 13
6/10/25, 11:32 AM Loan Against Gold Jewellery - Application Form

Stamp duty (as per respective state)

Payable as per state laws and deducted upfront from loan amount

Processing Fees

0.15% (Inclusive of applicable taxes) of Loan Amount, Subject to a Minimum of ₹ 99/- (Inclusive of applicable taxes) and Maximum of ₹ 600/- (Inclusive of
applicable taxes)

Cash Handling Charges

₹ 50/- (Inclusive of applicable taxes) - Applicable for Cash mode of disbursement

Penal Charges:

3.00 % per annum on Outstanding Balance - Penal Interest will be over and above the interest rate which shall be applicable/chargeable in case of default in
repayment of the Outstanding Dues post-maturity.

Foreclosure Charges:

Nil, any time post disbursement of loan.

Part pre-payment Charges:

NIL

Convenience Fee

Convenience fee of ₹ 149/- (inclusive of applicable taxes) shall be levied for part release of ornament(s) pledged.

“Additional cess/ taxes, if any, will be applicable on all charges as per the respective State Laws as may be applicable from time to time.”
The aforementioned charges/fees may be modified by Bajaj Finance Limited from time to time upon prior intimation via Acceptable Modes of Communication from
Bajaj Finance Limited in this regard.

Consent Details : Accepted IP Address : 2402:8100:2b79:efac:fa0b:9f0e:def1:d3d1 Language Name : English Application Number : PGOL00004550461 Date & Time : 2025-06-10 11:31:12 Mobile Number : 9253601517 Email ID :

11 of 13
6/10/25, 11:32 AM Loan Against Gold Jewellery - Application Form

VERNACULAR DECLARATION FORM

Preferred Language : ENGLISH

English – The content of this Application/ Loan & Security Documentation/ Letter/ Terms and Conditions has been read out, explained and interpreted to the applicant(s)/
Borrower and to the Co-Borrower(s) in English and understood by the applicant(s)/ Borrower and Co-Borrower(s).

Assamese – এই আবেদন/ঋণ আৰু নিশ্চয়তাৰ নথিপত্ৰ/চিঠি/চৰ্ত আৰু নিয়মৰ বিষয়বস্তুখিনি আবেদনকাৰী/ঋণ গ্রহণকাৰী আৰু সহ-ঋণ গ্রহণকাৰী সকলক অসমীয়াত ব্যাখ্যা কৰা
হৈছে, আবেদনকাৰী(সকল)/ঋণ গ্রহণকাৰী আৰু সহ-ঋণগ্ৰহণকাৰী(সকল) বিষয়টো বুজি পাইছে।

Bangali – এই আবেদনের বিষয়বস্তু/ঋণ ও জামিন সংক্রান্ত দস্তাবেজ/পত্র/নিয়ম ও শর্তাবলী আবেদনকারী/ঋণগ্রহীতা এবং সহ-ঋণগ্রহীতাদের কাছে বাংলায় আবেদনকারী(দের)/
ঋণগ্রহীতা এবং সহ-ঋণগ্রহীতা(গণ) পড়ে শোনানো হয়েছে, ব্যাখ্যা করা হয়েছে এবং ঋণগ্রহীতা এবং সহ-ঋণগ্রহীতা(গণ) বুঝেছেন।

Gujarati – આ અરજી/લૉન અને જામીનગીરીના દસ્તાવેજ/પત્રના વિષયવસ્તુ / નિયમો અને શરતોને ગુજરાતીમાં અને અરજીકર્તા(ઓ)/ઋણકર્તા અને સહ-ઋણકર્તા(ઓ) દ્વારા સમજવામાં
આવતી ભાષામાં વાંચવામાં, સમજાવવામાં આવ્યાં છે અને તેનું અર્થઘટન કરવામાં આવ્યું છે.

Hindi – इस आवेदन की सामग्री/ऋण और सुरक्षा दस्तावेज/पत्र/नियम और शर्तों को आवेदक(कों)/उधारकर्ता और सह-उधारकर्ता(ओं) को हिंदी में पढ़कर सुनाया, बताया तथा समझाया गया हैं और
यह आवेदक(कों)/उधारकर्ता और सह-उधारकर्ता(ओं) को समझ में आ गया है।

Kannada – ಈ ಅರ್ಜಿ/ಸಾಲ ಮತ್ತು ಸುರಕ್ಷತಾ ದಾಖಲೆ/ಪತ್ರ /ನಿಯಮಗಳು ಮತ್ತು ಷರತ್ತು ಗಳ ವಿಷಯವನ್ನು ಅರ್ಜಿದಾರರು/ಸಾಲಗಾರರಿಗೆ ಮತ್ತು ಸಹ-ಸಾಲಗಾರರಿಗೆ ಕನ್ನ ಡದಲ್ಲಿ
ಓದಲಾಗಿದೆ, ವಿವರಿಸಲಾಗಿದೆ ಮತ್ತು ಅರ್ಥೈಸಲಾಗಿದೆ ಮತ್ತು ಅರ್ಜಿದಾರರು / ಸಾಲಗಾರ ಮತ್ತು ಸಹ-ಸಾಲಗಾರ(ರು) ಅರ್ಥಮಾಡಿಕೊಂಡಿದ್ದಾ ನೆ/ರೆ.

Kashmiri – ‫شرائیط آئے پرنہ واضح کرنہ تہ فکر تارنہ درخواست دہندگانن قرضہ حاصل کرن والین تہ تہندین ساتھین کاشری پاٹھی تہ درخواست دہند گانو قرضہ‬/ ‫ خط‬/ ‫قرضک مواد تہ سیکیورٹی دستاویز‬/ ‫ییمہ درخواستک‬
‫وصل کرن والیو تہ ساتھیو سمجھی‬

Khasi – Ka jingthmu jong kane ka aplikoshon/ Ka ram bad ki kot ki sla ban ba ia dei bad jingpan ram/ Shithi/ ia ki kyndon kiba la buh la pynpule, la batai shai sha ba pan ram
bad ia u ba kular ban ai ka jingbah khlieh ha ka jingshim ia ka ram, la pynsngewthuh ruh ha ka ktien Phareng ia u ba apply ia ka ram bad u ba ai ia ka jingbah khlieh ban
shimia ka ram.

Konkani – हो अर्ज / रीण आनी तारण सुरक्षा दस्तावेज / पत्र / नेम आनी अटी हातुंतलो मजकू र कोंकणी भाशेंत अर्जदार / रिणकार आनी सह-रिणकार हांका वाचून दाखयला, समजायला आनी
अर्थवणी करून सांगल्‍या आनी अर्जदार / रिणकार आनी सह-रिणकार हांका तो समजला.

Malayalam – ഈ അപേക്ഷ/ലോൺ & സെക്യൂരിറ്റി ഡോക്യുമെന്റേഷൻ/ലെറ്റർ/വ്യവസ്ഥകളും നിബന്ധനകളും അപേക്ഷകനും(കർ)/

കൂടാതെ വായ്പയെടുത്തയാൾ ഒപ്പം-വായ്പയെടുത്തയാൾ(വർ) എന്നിവർക്ക് മലയാളത്തിൽ വായിച്ചുകേൾപ്പിക്കുകയും,
വിശദീകരിക്കുകയും വ്യക്തമാക്കുകയും അത് അപേക്ഷകനും(കർ)/കൂടാതെ വായ്പയെടുത്തയാൾ ഒപ്പം-വായ്പയെടുത്തയാൾ(വർ)
എന്നിവർക്ക് മനസ്സിലാകുകയും ചെയ്തിട്ടുണ്ട്

Marathi – या निवेदनातील/ कर्ज व सिक्युरिटी दस्तऐवजीकरणातील/पत्रातील/अटी व शर्तींमधला मजकू र निवेदकाला/कर्जदाराला व सह कर्जदारांना मराठीत वाचून दाखवण्यात आला, समजावून
सांगण्यात आला व भाषांतरीत करण्यात आला असून निवेदक/कर्जदार आणि सह-कर्जदारांना तो समजला आहे.

Meiteilon – AeplikesN/ loN & sikyuritigi AoIba ce-caH/ciTi/cYngdbsiH AmsuH yangdbsiH Asida yaUribsiH Asi AeplikeNt(siH)/ seL puriba miAoI AmsuH seL pumiNnriba
miAoI(siH) da meitei loNda laUna pduna tahLle, sNdoQna taQle AmsuH AeplikeNt(siH)/ seL puriba miAoI AmsuH seL pumiNnriba miAoI(siH) Asina mmuY tana Kqle|

Mizo – He dilna / Loan leh tiamkamna lehkha pawimawh/Lehkhathawn/inremsiamna leh tiamkamna thupui hi loan puk tu te leh a puk pui te hnenah Mizo a chhiar chhuah
leh hrilh fiah a ni [Link] puk tu te leh a puk pui te pawn an hrethiam ani.

Nagamese – Idu Dorkhast/ Loan & Security Documentation/ Akhor/ Term-khan aru Condition-khan laga hontusto du jurkoi purise, bujaidise aru idu dorkhast diya manukhan/
dhar kora manu aru tai logote dhar kora manu(khan) te Nagamese te interpret kuriloise aru idu dorkhast diyakhan/ dhar kora manu aru tai logote dhar kora manu(khan) bara
buzise.

Nepali – यस आवेदन/ऋणको विषयवस्तु तथा सुरक्षण प्रलेख/पत्र/नियम तथा सर्तहरू आवेदक(हरू)/ऋणी र सह-ऋणी(हरू)का लागि नेपालीमा पढिएका छन्, अनुवाद गरिएका छन् र व्याख्या
गरिएका छन् तथा आवेदक(हरू)/ऋणी तथा सह ऋणी(हरू)ले बुझेका छन्।

Oriya – ଏହି ଆବେଦନ/ ଋଣ ଓ ଅମାନତ ଦସ୍ତାବିଜ/ ପତ୍ର/ ନିୟମ ଏବଂ ସର୍ତ୍ତାବଳୀର ବିଷୟବସ୍ତୁ କୁ ଆବେଦନକାରୀ(ଗଣ)/ ଋଣଗ୍ରହୀତା ଏବଂ ସହ-ଋଣଗ୍ରହୀତା(ଗଣ)ଙ୍କୁ ଓଡ଼ିଆ ଭାଷାରେ ପଢ଼ି ଶୁଣାଯାଇଛି,
ବୁଝାଇଦିଆଯାଇଛି ଏବଂ ବ୍ୟାଖ୍ୟା କରାଯାଇଛି ଏବଂ ତାହାକୁ ବିଷୟବସ୍ତୁ କୁ ଆବେଦନକାରୀ(ଗଣ)/ ଋଣଗ୍ରହୀତା ଏବଂ ସହ-ଋଣଗ୍ରହୀତା(ଗଣ) ବୁଝିଛନ୍ତି

Punjabi – ਇਸ ਬਿਨੈਪੱਤਰ/ ਲੋ ਨ ਅਤੇ ਸੁਰੱਖਿਆ ਦਸਤਾਵੇਜ਼/ ਪੱਤਰ/ ਨਿਯਮ ਅਤੇ ਸ਼ਰਤਾਂ ਦੀ ਸਮੱਗਰੀ ਨੂੰ ਬਿਨੈਕਾਰ(ਰਾਂ)/ ਕਰਜ਼ਦਾਰ ਅਤੇ ਸਹਿ-ਕਰਜ਼ਦਾਰ(ਰਾਂ) ਨੂੰ ਪੰਜਾਬੀ ਵਿੱਚ ਪੜ੍ਹਕੇ ਸੁਣਾਇਆ ਗਿਆ ਹੈ,
ਸਮਝਾਇਆ ਗਿਆ ਹੈ ਅਤੇ ਤਰਜੁਮਾ ਕੀਤਾ ਗਿਆ ਹੈ ਅਤੇ ਬਿਨੈਕਾਰ(ਰਾਂ)/ ਕਰਜ਼ਦਾਰ ਅਤੇ ਸਹਿ-ਕਰਜ਼ਦਾਰ(ਰਾਂ) ਵੱਲੋਂ ਸਮਝਿਆ ਗਿਆ ਹੈ

Tamil – இந்த விண் ணப்பம் / கடன் & பிணை ஆவணம் / கடிதம் / விதிமுறைகள் மற்றும் நிபந்தனைகள் விண் ணப்பதாரர்(கள் ) / கடன் தாரர்
மற்றும் இணை-கடன் தாரர்(கள் ) ஆகியோருக்கு தமிழ் மொழியில் படித்து காட்டப்பட்டது, விவரிக்கப்பட்டது மற்றும்
விண் ணப்பதாரர்(கள் ) / கடன் தாரர் மற்றும் இணை-கடன் தாரர்(கள் ) ஆகியோரால் புரிந்து கொள்ளப்பட்டது.

Consent Details : Accepted IP Address : 2402:8100:2b79:efac:fa0b:9f0e:def1:d3d1 Language Name : English Application Number : PGOL00004550461 Date & Time : 2025-06-10 11:31:12 Mobile Number : 9253601517 Email ID :

12 of 13
6/10/25, 11:32 AM Loan Against Gold Jewellery - Application Form

Telugu – ఈ దరఖాస్తు/ రుణ & సెక్యూ రిటీ డాక్యు మెంటేషన్/ లెటర్/ నియమ నిబంధనలలోని విషయాలను దరఖాస్తుదారు(లు)/ రుణగ్రహీత(లు) మరియు సహ-
రుణగ్రహీత(లు)కి తెలుగు లో చదివి, వివరించి మరియు అనువదించబడింది మరియు దీనిని దరఖాస్తుదారు(లు)/ రుణగ్రహీత(లు) మరియు సహ-రుణగ్రహీత(లు) అర్థం
చేసుకున్నా రు.

Urdu – ‫ قرض لینے والے(قرض دار) اور شریک قرض دار کے سامنے اردو میں پڑھ کر بیان کیا گیا اور اس کی‬/‫ شرائط و ضوابط کے مواد کو درخواست کنندہ‬/‫ خط‬/‫ قرض اور سیکوریٹی دستاویزات‬/‫اس درخواست‬
‫ قرض دار اور شریک قرض دار نے اس کو سمجھ لیا ہے۔‬/ ‫تشریح کی گئی ہے نیز درخواست کنندہ‬

By clicking on 'I Agree' or similar button at the end of this Application Form and/or by submitting the one-time password ("OTP") sent by BFL and/or by providing physical
signature, I hereby agree and acknowledge that

 I am above 21 years of age & have read & understood the Application Form and its Terms and conditions in relation to the Loan Against Gold Jewellery;

 I hereby confirm that I have read the entire text, features, disclosures, exclusions, etc and voluntarily applying for HDFC Life Group Jeevan Suraksha;

 I authorise BFL, its group companies and/or business associates and their respective representatives to send me promotional communications regarding various
products and services including but not limited to loans, fixed deposit and insurance. I understand that I can at any time opt not to receive any promotional
communication;
 I agree that my action of entering the OTP sent by BFL and/or clicking the 'I Agree' button and/or providing physical signature, constitutes a valid acceptance by me.

Date : 10-Jun-2025

Place : FATEHABAD - ANAJ MANDI

BFL/GL/Dig/AppF/English/2025/May/V1

Consent Details : Accepted IP Address : 2402:8100:2b79:efac:fa0b:9f0e:def1:d3d1 Language Name : English Application Number : PGOL00004550461 Date & Time : 2025-06-10 11:31:12 Mobile Number : 9253601517 Email ID :

13 of 13