TWO WHEELER LOAN APPLICATION FORM 9234TA00116

Fields marked in "RED" are mandatory

Sourcing Channel Branch DST DSA PBK Web Referral Sales Other Channel (Specify)
Source 1 Source 2 Source 3 Source 4
Branch Code 909 LTS/CRMN No. Sales Promo Code LNL700P2 LG Code
SM Emp Code A49114 SE Code HT10780 DSA/DDSA Name H0135-15260-HBL-BRANCH
ASM Emp Code S3370 TSE Code DSA/DDSA Vendor Code Dealer SE Code

RSM Emp Code TL Code

Application Type New Update A/C Type Normal Simplified ( for low risk customers) Small Application Date 2 2 0 5 2 0 2 5

CUSTOMER SECTION (to be filled by Customer in CAPITAL LETTERS GSTN No.

Cust ID Loan No. Credit Card No. KYC No. FWLPP0811G (Mandatory For Existing Customers And KYC Update Request)

I Confirm that I do not have any existing customer ID/ Customer IDs apart from the one mentioned above. In case found otherwise, Bank reserves the right to consolidate the customer IDs as it
may decide without any prior notice to me.
Note: Information available in your existing relationship or revised information provided in this form will be used for processing this application and will be updated in all relationship maintained with HDFC
Bank.

A. PERSONAL DETAILS (Leave space between two words)

Title Mr. Ms. M/S. Others Borrower Co-Borrower PAN No FWLPP0811G
Borrower Name
(Same as ID Proof) SHRUTI PANDEY
Maiden Name (If
any) SHRUTI PANDEY
Citizenship IN - Indian Others ( ISO 3166 Country Code ) Residential Status Resident Individual NRI PIO/OCI Foreign National
Proof of Identity Passport Driving Licence Voter ID NREGA Job Card Others______________ Aadhaar No.
Tick if PAN
Reference No. Expiry Date. Aadhaar No. given above will be linked with Primary account no. held with HDFC Bank.
/Aadhaar not
given) D D M M Y Y Y Y

Father's/ Spouse's
Name
Mother's Name
Date of 0 9 0 7 2 0 0 1
Gender: F Third Gender Status Single Married Divorced No. of Dependents 0
Birth/Incorporation

SC ST
Educational Details Undergraduate Graduate Post Graduate & above Others_____ Religion HINDU Physically Disabled Yes No
OBC Other: GENERAL
City of Birth ISO 3166 Country Code of Birth
Country of Tax Residency Tax ID No. (TIN)

Address for Tax purpose (please tick) Same as Mailing Address Same as Permanent Address

Proof of Address Passport Driving Licence Voter ID NREGA Job Card Others______________
Present
Address SUDHAKAR PANDEY Ward no 11 Chhotu ram nagar,Line par Bahadurgarh
(Residence)

Landmark shiv mandir Years at current city 23

City JHAJJAR PIN Code 124507 Years at current residence 23
State HARYANA Tel (R) -
Mobile No. 91 9310676620 e-mail ID ganeshpandey2542@[Link]
Present Address is Owned Parental Company provided Rented (Monthly Rent in ________________) Tick if permanent address is same as above
Address Type Residence Business Residential and Business Registered Office Unspecified
Permanent Address same as Present / Mailing Address Address Type Residence Business Residential and Business Registered Office Unspecified
Permanent Address (If
SUDHAKAR PANDEY WARD NO 11 CHHOTU RAM NAGAR,LINE PAR BAHADURGARH JHAJJAR HARYANA 124507
any)
Personal Reference "Name and Address" GANESH PANDEY CHHOTU RAM NAGAR LINE PAR,WARD NO 11, JHAJJAR HARYANA
Contact :_________________________
B. OCCUPATIONAL DETAILS
Self employed
Occupation Salaried Self employed Retired Housewife Student Other_____
professional
If self employed professional Doctor CA/CS Consultant Architect Lawyer Other______
Type of company Pvt ltd. Partnership Proprietor Public Ltd. Retailers PSU Govt. MNC Other____

If Salaried / self employed Automobiles Agriculture based Banking BPO Capital goods Telecom IT Retail
Type of industry Consumer
Real estate FMCG NBFC Marketing / Adv. Pharma Media Other______
Durables
Employer / Business Details Designaton: OTHER Exp in Current Job/Business 1 Yrs Total Exp in Job/Business 3 Yrs
Company /
color coating and chemical Preferred Mailing Address
Employers Name
Company / Residence
Employers MI part B plot no 2140 bahadurgarh ,Bahadurgarh Office
Address
Landmark diamond private limited PIN Code 124507
City JHAJJAR Tel (O) 9226987570
State HARYANA Official e-mail ID
 [Link] AND BANKING DETAILS
Monthly salary 25000 Annual turnover Net Profit Other Income
Other income source Rental Agricultural Other ________________ Interested in opening HDFC Bank Account Yes No
STATE BANK OF RAILWAY ROAD
A/c No. 39679484128 Bank Name Branch
INDIA BAHADURGARH
Applicant's
Opened
Primary Cust ID Account Type SAVINGS
In
A/c Details
Credit Card
Issuing Bank
No.

D. LOAN DETAILS
Ex-Showroom Price() 111750 RTO Amount() 12600 Insurance Amount() 7150 Accessories Amount() 3500
Discount Offered by dealer _______ Discount Offered by DSA _________ Discount Offered by manufacturer _________ Other Charges(if any) _________
Loan Amount () 113889 Loan Tenure 24 Months EMI 5768 No. of Advance EMI 0
Scheme LPO AGRI Repayment Income F4 NIP Others STP ELIG_TWL
BAJAJ FREEDOM 125 NG04 DISC
Asset Make FREEDOM. Model Usage: Personal Commercial Top Up
LED
Dealer ANSH BAJAJ Valuation / Invoice Price () Margin Money () 23742
E. MOST IMPORTANT TERMS AND CONDITIONS AND DECLARATION BY THE CUSTOMER

I/We agree and confirm:(1)To the applicable schedule of charges , informed to me by HDFC Bank Ltd.(Bank) and as more particularly mentioned in the "Schedule of Charges" of this Application. (2)
That the bank's representative /staff will not receive any payment in cash/bearer cheque or kind along with or in connection with this loan application from me/us. (3) That no discount or free gift or
any other commitment whatsoever is give to me/us by the Bank or any of it authorized representative(s) other than what is not documented in this Form to the loan agreement. (4) The Bank shall not
process incomplete/defective application form, for which if any loss od delay is caused to me/us, I /We will not hold the Bank liable for such loss or delay. (5) That loan processing and disbursement
will take at least 7 working days post submission of all requisite documents and information as may be required by the Bank as per Bank's criteria. (6) That submission of loan application to your bank
does not imply automatic approval by the Bank and the Bank will decide the quantum of the loan at it's sole and absolute discretion. (7) The Bank reserves its right to reject the loan application and
retain the loan application form along with the photograph and documents. (8) That I/We shall furnish any additional documents as and when required by the Bank (9) That I/We have not taken any
loan from any other bank/finance company unless specifically declared by me/us.. (10) that there is no pending litigation against me/us filed by any other financier / bank (11) that the funds shall be
used for the purpose which loan has been applied and will not be used for speculative or antisocial purpose. (12) I/We do not have any existing customer ID or customer ID apart from the one
mentioned above, and in case found otherwise,Bank reserves the right to consolidate the customer Ids under a single customer ID as its may decide , without any prior notice to ,e/us. (13) the the
information furnished by me/us above it true and accurate and I understand the inform you of any changes therein, immediately. In case any of the above information is found to be false or untrue or
misrepresenting, I am aware that I may be held liable for it.I/We authorize HDFC Bank Ltd. to make any enquires regarding my application.I/We have read and understood the contents of all the four
(4) pages of the loan application form and accept the same. (14) That the Bank shall have the right to make disclosure of any information relating to me/us including personal information, details in
relation to Loan, detaults , security etc to the Credit Information Bureau of India (CIBIL) and/or any other government /regulatory/statutory or private agency/entity, credit bureau, RBI , the Bank's
other branches/subsidiaries / affiliates /rating agencies , service providers, other banks/financial institutions,any third parties, any assignes /potential assignees or transferees , who may need,
process and publish the information in such manner and through such medium as it may be deemed necessary by the publisher/Bank/RBI, including publishing the name as part of wilful defaulter's
list from time to time,as also use for KYC information verification,credit risk analysis, or for other related purposes. (15) That I/We hereby authorize and give consent to the Bank to link Adhar No. with
account/s maintained by the HDFC Bank. (16) That the information furnished by me/us above it true and accurate. (17) That I am interested in buying insurance policy/ies and would like to make
enquiries for the same. I hereby consent to receive information/services through Telephone/Mobile/SMS/E-mail / any other mode of communication from the Bank.

F. DOCUMENT SUBMITTED/SCHEDULE OF CHARGES / IMPORTANT TERMS & CONDITIONS

I/ we confirm having submitted the following self attested documents (ticked below) along with this loan application form to the Bank representative
Photograph Proof of Identity Proof of residence Latest 2 salary slips 3/6 months bank statement ______Post Dated Cheque
Proof of continuity of
current job Proof of office Proof of qualification Loan Agreement Signature Verification ECS/SI mandate

______Security Post- Proof of turnover (latest sales/services tax Lst 2 yr ITR with computed income Loan a/c statement for balance transfer / balance transfer & top up /
dated cheques returns) repayment / retention cases

G. Other declarations : I / We : (1) shall advise the HDFC Bank Ltd. (Bank) in writing of any change in my / our residential or employment address. (2) hereby authorize and give consent to the Bank (i) to disclose,
without notice to me/us, information /data furnished by me/us in the application form(s)/related documents executed/to be executed or collected by the Bank now or hereafter in relation to the facilities availed by
me/us from the Bank from time to time, to the Bank's other Branches/subsidiaries/affiliates/credit bureaus/Rating Agencies, Service Providers, banks/financial institutions, governmental/regulatory authorities or
third parties for information verification, credit risk analysis or for other related purpose that the Bank may deem fit. I /We acknowledge the exercise of authority by the bank is for my/our benefit and service,
accordingly I/We waive the privilege of privacy and privity of contract." (3) shall credit all sums received by you in either or all the names of this account. (4) hereby confirm having received, read and understood
the terms and conditions applicable to this loan and accept the same. (5) hereby unconditionally, agree that these terms and conditions may be changed by the Bank at any time and I/We will be bound by the
amended terms and conditions. (6) Confirm that I/We are citizen of India. (7) hereby consent to receiving information from Central KYC Registry through SMS/Email on the register number / email address
I / We also confirm that the executive collecting my loan Application / Document has informed me / us : (1) that GST is applicable and will be charged in connection with the loan. (2) all the commission/s
(in the form of up front and trail commissions) payable to HDFC Bank for the insurance policy recommended to me/us. (3) In case of loan cancellation, the applicable pro-rata interest charges on any outstanding
loan amount will have to be borne by me / us. I understand that Processing Fee, Stamp Duty and RTO charges (UCL / Re-finance/Rewards) are non-refundable charges and would not be waived/re-funded in case
of loan cancellation. (4) that all post dated cheques are to be issued favouring HDFC Bank Limited A/c < Mention Product Name> only. (5) that the Bank is only a finance provider and subsequent to vehicle/asset
finance disbursement to the dealer, Bank has no liability towards condition / colour / make / performance /quality of vehicle/asset at the time of delivery/delay in delivery of vehicle/accessories/spare-part from the
dealer or availability of specific colour/model/quality/version at the dealership. (6) that any discount in pricing of the asset is purely an offer by the manufacturer / dealer. (7) that loan related information like
“welcome letter”, “repayment schedule” , “loan agreement”, “disbursal advice”, will be sent on the e-mail id mentioned by me/us in this loan application form. (8) that I / We can log on to HDFC Bank Net
Banking ([Link]) to view the welcome letter and repayment schedule. I/We may also request for a physical copy of Welcome Letter and Repayment Schedule separately if need be. (9) I/We agree
that the rate of interest offered is valid for a period of 30 days from the date of application. HDFC Bank Ltd reserves the right to revise the interest rates, if the loan is disbursed post this period OR in case of any
changes in Base Rate or Risk Based Price. In such case, the revised interest rate as communicated under revised Schedule cum Key Fact sheet will be applicable. (10) I/We hereby undertake that any discount /
subvention offered by the dealer / manufacturer / DSA would be upfront deducted from the Asset Cost and funding would be net of such discount. (11) I/We explicitly understand that the Bank is not involved in any
kind of discount / subvention negotiations with the dealer / manufacturer / DSA and the loan scheme does not fany such discounts in the interest rate computation. (12) I/We declare that the Invoice Price of
Vehicle mentioned above is post deducting such discounts availed by me/ us from the dealer / manufacturer / DSA.

H. POLITICALLY EXPOSED PERSON (PEP) DECLARATION

Politically Exposed Persons (PEPs) are individuals who are or have been entrusted with prominent public functions by a foreign country, including the Heads of States/Governments, senior
politicians, senior government or judicial or military officers, senior executives of state-owned corporations and important political party officials. I hereby confirm and declare that I am not a Politically
Exposed Person(s) (as per the definition of the Reserve Bank of India Master Direction - Know Your Customer (KYC) Direction, 2016) or a relative of a Politically Exposed Person.

Please tick Yes / No

1st Applicant PEP / Relative or Close Associate of PEP: Yes No 2nd Applicant PEP / Relative or Close Associate of PEP: Yes No

I hereby agree that the Bank reserves the right to recall the loan in case, the aforesaid declaration is found to be untrue. In the event of any change in this declaration and/or if I subsequently become
a Politically Exposed Person(s) or a relative of a Politically Exposed Person, after the opening of account, I hereby agree to promptly inform the Bank regarding the same and forthwith submit the
relevant Politically Exposed Person (PEP) declaration form at an HDFC Bank branch.

I.

DO NOT CALL REGISTRY : I understand that in case I do not wish to receive promotional information through telephone calls / email / sms on products and services not currently availed by me, I
can register for "Do Not Call" service through the Bank's website [Link] or through PhoneBanking or other channels that the Bank may offer. I agree that this service will not apply to
receipt of advice and information regarding products and services currently availed by me, to help me in fully realising the benefits of the range of financial solutions designed to make my banking
relationship value added and more convenient.
J.

I/We shall be registered for services prevailing to all digital platforms & channels, including but not restricted to Mobile Banking, NetBanking, SMS & Tollfree Banking & WhatsApp. I/we also
understand that the Mobile Number specified for account opening will be linked with NetBanking, Mobile Banking, SMS & Tollfree Banking & WhatsApp.
I/We have read and verified the entire contents of the aforesaid Loan Application Form including the information, the Most Important Terms and Conditions , the
Declarations being Part A to Part H. I hereby declare that the details furnished above are true and correct to the best of our knowledge and belief and I undertake to
inform you of any changes therein, immediately. In case any of the above information is found to be false or untrue or misleading or misrepresenting , I/we am/are
aware that I/we may be held liable for it. My personal/KYC details may be shared with central KYC Registry, I hereby consent to receive information from central KYC
registry through SMS/email on the above Registered number/email address.
Do not sign this form if it is BLANK. Please ensure all relevant sections and columns are completely filled to your satisfaction and then only sign the
form.

Borrower's / Coborrower's Signature S1 Dealer /DSA Stamp /Signature

Name: SHRUTI PANDEY Date: 30/05/2025 Place: JHAJJAR

Signed On 2025-05-31 17:19:16

 K. DOCUMENT SUBMITTED /SCHEDULE OF CHARGES / IMPORTANT TERMS & CONDITIONS
Purpose of Loan Home renovation Marriage Travel Education Business expansion Agriculture / Farming Transportation of Agri Produce Other______________
I/we confirm having submitted the following self attested documents (ticked below) along with this loan application form to the Bank representative
Proof of Proof of Latest 2 3/6 months bank _______Post Dated Proof of continuity of Proof of Proof of Loan Signature ECS/SI
Photograph Identity residence salary slips statement Cheques current job office qualification Agreement Verification mandate

___Security Post-dated cheques Proof of turnover(latest sales/services tax returns) Last 2yr ITR with computed income Loan a/c statement for balance transfer / balance transfer & top up / repayment / retention cases
[Link] of Charges communicated to me/us by the Bank representative
1) Stamp Duty:As per State laws 2) Customer rate of interest (Fixed) of 19.50 % p.a. (monthly) reducing. 3) Non Refundable processing Fees of 2225.00 4) Documentation charges: (Derived values) 2% of loan
amount 5) Payment Return Charges - 450/- per instance 6) Delayed instalment payment charge :- 18% per annum on overdue instalment amount 7) CIBIL Report Copy Charges: 50/- per Copy 8) POD collection
charges: ______ per case 9) Legal, repossession and Incidental charges: At actual 10) Loan re-booking / re-schedulement charges: 400/- 11) Duplicate NOC Rs. 250/- per instance 12) Duplicate
Amortization/Repayment Schedule Charges 50 per schedule for physical copy. Customer can also download from website free of cost. 13) Repayment Mode change charges - 500/- (including applicable government
taxes and other levies) 14) Date on which annual Outstanding balance statement will be issued: 31st May 15) Loan Cancellation Charges: Nil interest would be charges for the interim period between date of
disbursement and date of loan cancellation. 16) Special NOC : Rs. 200/- per instance
Note:Visit httlp://[Link] for detailed fees and charges under the respective laon product. Changes in charges from time to time are updated on bank's website.
Registration Certificate (RC) Collection Fee/ Collateral charges refundable incase of loan cancellation."Applicable Government taxes and other levies will be charged additionally on Cheques/SI/ACH Return, Collateral,
Documentation and Valuation charges"

Due date of Prepayment not allowed up to payment

2nd / 6th 03 EMI
EMI of

Up to 24 Months - 5% of the Principal Outstanding.

Post 24 Months - 3% of the Principal Outstanding. Name of the Applicant: SHRUTI PANDEY
Type of Loan Applied _____________
NIL Premature Closure charges for Fixed rate loan facility up to Rs. 50 Lakh Branch Code: ____________ Date & Time of Receipts ______
availed by Micro & Small Enterprises and Closure from Own Source. Branch Contact Person Name ____________ Contact No
____________
*Govt Taxes & Levies and other government levies, as DSA Contact Person Name AARTI MOHAN Contact No 9728347312 For more information please visit
[Link]
applicable would be charged additionally. Follow us on

*Loan Processing fees, Documentation charges & Stamp Duty is [Link]/hdfcbank

[Link]/hdfcbank_offers
non-refundable. Watch us on
Signature of Executive /
*Collateral Charges / Registration Certificate (RC) Collection [Link]/hdfcbank Bank Staff
Fee are refundable in case of loan cancellation.
*Zero Processing Fees for loan facility up to Rs. 5 Lakh availed
by Micro & Small Enterprises
CONTACT US

To get the status of your loan application you can reach us at below Contact Numbers

Delhi & NCR 011 61606161

Chandigarh 0172 6160616
Ahmedabad 079 61606161
Jaipur 0141 6160616 Andhra Pradesh , Assam, Gujrat, Haryana, Karnataka, Kerala, MP/ Chhatisgarh,
Bengalaru 080 61606161 Maharashtra, (except Mumbai & Pune) / Goa, Orissa, Punjab, Rajasthan, Tamil Nadu /
Chennai 044 61606161
Cochin 0484 6160616 Pondicherry, UP / Uttarakand, Bihar / Jharkhand, West Bengal / Sikkim, J & K / HP,
Hyderabad 040 61606161 Meghalaya/Tripura, Arunachal Pradesh, Nagaland/Mizoram/Dadra & Nagar Haveli/Daman
Indore 0731 6160616
Lucknow 0522 6160616 &Diu/Lakshadeep: 1860 267 6161
Mumbai 022 61606161
Kolkata 033 61606161
Pune 020 61606161

Please visit [Link] or below link for checking application status "[Link]
 MOST IMPORTANT TERMS AND CONDITIONS AND DECLARATION BY THE CUSTOMER

I/We agree and cofirm: (1) To the applicable schedule of charges, informed to me by HDFC Bank Ltd.(Bank) and as more particularly mentioned in the "Schedule of Charges" of this applcation. (2)
That the Bank's representative/staff will not receive any payment in cash/bearer cheque or kind along with or in connection with or in connection with this loan application from me/us. (3) That no
discount or free gift or any other commitment whatsoever is given to me/us by the Bank or any ot its authorized representative(s) other than what is not documented in this Form to the loan
agreement. (4) The Bank shall not process incomplete/defective application form, for which if any loss or delay is caused to me/us.I/We will not hold the Bank liable for such loss or delay. (5) That
loan processing and disbursement will take at least 7 working days post submission of all requisite documents and information as may be required by the Bank as per Bank's criteria. (6) That
submission of loan application to your bank does not imply automatic approval by the Bank and the Bank will decide the quantum of the loan at its sole and absolute discretion . The Bank in its sole
and absolute discretion may either sanction or reject the application for granting the loan. Incase of rejection, the Bank shall not be required to give any reason. (7) The Bank reserves its right to reject
the loan application and retain the loan application form along with the photograph and documents. (8) That I/We shall furnish any additional documents as and when required by the Bank (9) That
I/We have not taken any loan from any other bank/finance company unless specifically declared by me/us.. (10) that there is no pending litigation against me/us filed by any other financier / bank (11)
that the funds shall be used for the purpose which loan has been applied and will not be used for speculative or antisocial purpose. (12) I/We do not have any existing customer ID or customer ID
apart from the one mentioned above, and in case found otherwise,Bank reserves the right to consolidate the customer Ids under a single customer ID as its may decide , without any prior notice to ,
e/us. (13) the the information furnished by me/us above it true and accurate and I understand the inform you of any changes therein, immediately. In case any of the above information is found to be
false or untrue or misrepresenting, I am aware that I may be held liable for it.I/We authorize HDFC Bank Ltd. to make any enquires regarding my application.I/We have read and understood the
contents of all the four (4) pages of the loan application form and accept the same. (14) That the Bank shall have the right to make disclosure of any information relating to me/us including personal
information, details in relation to Loan, detaults , security etc to the Credit Information Bureau of India (CIBIL) and/or any other government /regulatory/statutory or private agency/entity, credit bureau,
RBI , the Bank's other branches/subsidiaries / affiliates /rating agencies , service providers, other banks/financial institutions,any third parties, any assignes /potential assignees or transferees , who
may need, process and publish the information in such manner and through such medium as it may be deemed necessary by the publisher/Bank/RBI, including publishing the name as part of wilful
defaulter's list from time to time,as also use for KYC information verification,credit risk analysis, or for other related purposes. (15) That I/We hereby authorize and give consent to the Bank to link
Adhar No. with account/s maintained by the HDFC Bank. (16) That the information furnished by me/us above it true and accurate. (17) That I am interested in buying insurance policy/ies and would
like to make enquiries for the same. I hereby consent to receive information/services through Telephone/Mobile/SMS/E-mail / any other mode of communication from the Bank.

IMPORTANT INFORMATION FOR CUSTOMER - FROM No. IL

Period of coverage: ____________________months. Premium Amount:_____________

1). Anti-Rebating Warning: As per Section 41 of the Insurance Act 1938, as amended, the practise of rabating is prohibited , as follows : No person shall allow , either directly or indirectly, as an
inducement to any person to take out or renew or continue an insurance policy in resepct of any kind of risk relating to lives or property in India, any rebate of the whole or part of the commission
payble or any rebate of the premium show on the policy, not shall any person taking out or renewing or continuing a policy accept any rebate, except such rebate as may be allowed in accordance
with he published prospectus or tables of the insurer. Violation of Secion 41 of the insurance Act 1938, as amended, shall be punishable with a fine which may extend to five hundred (500) Rupees.
2) Insurance is the subject matter of the solicitation. 3) For any loss reported under the Section of Credit Shield Cover of Sarv Suraksha Plus/Star, the loss will be paid by HDFC ERGO General
Insurance Co. Ltd to HDFC Bank Limited, Under "Assignee Clause" 4) On receipt of request from HDFC Bank Limited, for cancellation of insurance, due to for example, cancellation of loan, forfeiture
of loan, payement default etc., and alos policy cancellation by the insurer, HDFC ERGO General Insurance [Link]., to cancel the policy and pro-rata premium for the remaining tenure of the loan
would be refunded to HDFC Bank Limited and the insurance would cease to exit.