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L•3r.:-
Application No :
O Jc
Date of Application

Product
SECUREr • - - • • • --· ·- ....,~"'

I✓ Bolll!s where appropriate and write N.A. If not applicable. "Mandatory Field, Use CAPITAL LmERS.)
Branch Name
Branch Code
Please Affix Recent Please Affix Recent
Sales Manager Name Self Attested Self Attested
Sales Manager Code Photograph Here Photograph Here

DSA/Connector Code
DST Code

JJI-- 1 ~ .,.. ~ lj[st Name

Name Mr/Mrs/Ms/M/s* ----:-----"4
~~ C ~BJ
;:~7-:-":-_;
~ ,:__ C.,
J?!:z.->-1
Miaclfe Name Last Name
___ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
0

Father's/Spouse's Name Mr/Mrs/Ms

Mother's Maiden Name Ms ----•7
3 1~ 7 - ; ; i ~ ~ i T ~ - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -

Date of Birth/lnc~ation • .Wlj [Link]?I f r,r)iyy I Marital Status• Married/ married/ Others Gender• '-/ F /~gender (T) Residential Status Resident/NRI/PIO

Religion: HindG/Muslim/Chr istian/Other (pis. specify) _.- - - - : ; : , - - - - - - - - - - Nationality O lmfian O Others _ _ _ _ _ _ _ _ _ _ __

Qualification• +f\..-
/Schedule rlbe/OB
!. ~ 2... 4 er£:
!, lo
No. of dependents• 2---'

Permanent Residence Address• grs;me as c-u-r-re-n+t_A_d_d_r-es_s_ _ _ _ _ __

Landmark•
City•
------- -------Pin*------- ---
--------------- ----------
Mobile*
Tel (std code)
----------- ----------
__ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
Email -;;,,'.....,e,,..;.."=:l~T---.....,QJl!~....=:J...:...J..!!:l.::...L.-11~~~;,,...~:.!..l?:!...!U_JL,01>}mail _ _ _ _ _ _ _
Current Re~ence : Owned/Rented/
PAN Card* ,.S. lrf'CIf .I)
8<8~c-,___ _ _ _ __
,., • I • • I I • I I Monthly Income _ _ _ _ _ __
-6)~..:::..---=---==-=___JW:-"f'""',rs (pis Specify with No.)_ _ _ _ _ _ _ __
A.1.2 PROFESSIONAL BUSINESS DETAILS
Occupation Type• D Salaried eJ'self-employed Non-Professional (SENP) D Retired
No. of yrs in Current job/Business• ,,O~l Ml M !
D Self-employed Professional (SEP) D Housewife D Student

Company/Business Name ( wt4¥~ bkffi>=i Retirement Age ~

Limited Company/ LLP/ Partnership firm/Proprietorship
Company/Business Type• Public Sector (PSU/Central) Governments/ State Governments/ Public Limited Company/Private

!;] Office Owned Ud am N o . ~ ""'oi-- r-O~ ~~lte!s~f Experience "1>'. IMIMI Designation fJ..-k ,

f -~..:---.-:-
Office Address• --t-----='---t ~-f-'-~=-=-- Ol !J ..R" b
,---,......-__.,_... :.....;;.....a,.._--- =--=-~'r-:::,'j~-L --____.:.=t--~..J Q..1,4-----=....-:
,,_----r----
'
Landmark* _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _~"'F::!.4-~"4 ,~~~--

Tel• (std code) ----------...., ..,,-c-----

Name Mr/Mrs/Ms/M/s*_ _ _ _ _ _ _ ___..:::;_" "7-ni.:-.. .::..:.----- --r--------

----------- ----------- --
Father's/Spouse's Name Mr/Mrs/Ms
Mother's Maiden Name Ms
Status• R s1dent/NRI/PIO
Date of Birth/ln~ration • 117Jt,T/!h6/ IJ1ifvl Marital Status• Mar~Unmarrie d / Others Gender• M_LeJ--Transgender (T) Residential
Religion: Hiniftj/Muslim/Chr istian/Other (pis. specify) _ _ _ _ _..,....._____ ____ Nationality Bfridian O Others _ _ _ _ _ _ _ _ _ _ __

Category of Customer• Schedule • C/Ge~ o. of dependents• Qualification•~fl\)

_ _......,,.....=-----,.;'- f---=2;;.___~_--':;..._,._,J;;;__;"'-'o- Permanent Residence Address• ~ m e as c_u_r..,re-n"'"t_A_d_d_r_e-ss_ _ _ _ _ __

Landmark•
------- ----
------- -------Pin*
City•------------ =="'--"'a.:a:.--" --';;;;.L.-
City•
------- ------- --
Te I (std code)___________ Mobile*
------- ---
Tel (std code) _ _ _ _ _ _ _ _ _ __ Mobile• _ _ _ _ _ _ _ _ __ ,
------- ---
Email _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ Email
-------
------- -------Monthly ------
Income _ _ _ _ _ __
• ented/Company Provided/Other(p ls specify)
s Is S ecif with

Occupation Type•
O Salaried D Self-employed Non-Professional (SENP) No. of yrs in Current job/Business•
0 Self-employed Professional (SEP) D Housewife

- - - - - - - - - Retirement Age
Company/Business Name• - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
Limited Company/ LLP/ Partnership firm/Proprietorship
Company/Business Type* Public Sector (PSU/Centraf) Governments/ State Governments/ Public Limited Company/Private

0 Office Owned O Office Rented Udyam No. _ _ _ _ _ _ _ __ Total Years of Experience I YI YIM INI j Designation _ _ _ _ _ _ _ _ _ _ _ _ __
______ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
Office Address• _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

------ ------- ------- ----- ------- -- City* Pin•

Landmark•
------- ------- -------
I Email
Tel• (std code)
0 =------ □ ---=---
-------=
Communication Address•: O ---- Residence
Mob i e *
Office Permanent Where Applicable - Employment ID

L65910MH1995PLC364635
Registered & Corporate Office: Unit No, 1101, 11th Floor, Cignus, Plot No. 71A, Powal, Paspoli, Mumbai - 400 087. Maharashtra CIN:
 Name Mr/Mrs/Ms/M /s• -_-_-_-_-_-_-_-_-_-_-_-_-_-_-_-_-_-_-_-_-_-_-_-_-_-_-_-_-_-_-_-_-_-_-_-_-_-_-_-_-_-_-_-_-_-_-_-_-_-_-_-_-_-_-_-_-_-~
Father's/Spouse's Name~M:;,:r/;M;r~s~/M;:s-_-_-_-_-_-_-_-_-_-_-_-_-_-_-_-_-_-_-_-_-_-_-_-_-_-_-_-_-_-_-_-_-_-_-_-_-_-_

Mother's Malden Name Ms

Date of Birth/Incorpor ation• ! !fl jMj'v1j j !Yi Y l Marital Status• Married/ Unmarried/ Others Gender• M / F / Transgender (Tl Residential Status• Resident/N RI/PIO

Religion : Hindu/Muslim /Christian/Oth er (pis. specify) - - - - - - - -

------- Nationality D Indian D Others
Qualification•
-------
of Customer• Schedule Caste/Schedul e Tribe/OBC/Ge neral No. of dependen ts•____
Category
Current Residence Address• _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
__ Permanent Residence Address• D
Same as c:::u-r:-re_n_t:--A-=--:d-:d-re_s_s_ _ _ _ _ __

__ Landmark"
Landmark" _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Pin• -_-_-_-_-.;
City•_ _ _-_-_-_-_-_ -_-_-_-_-_ -_-_-_-_-_ ::::-------
Pin" _ _ _ _ _ _ _ _ __
City" _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ Mobile•
Tel (std code) Mobile• _ _ _ _ _ _ _ _ __
Tel (std code)
-----------
Email
__
Email _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
Monthly Income
Current Residence is: Owned/Rente d/Company Provided/Oth er(pls specify) Others (pis Specify with No.) -----

. _ _ _ _ _ _ CKYC N o . _ _ _ _ _ _ _ _ _ UID No •

..••
CO-APPLICANT ■ GUARANTOR
A.3. 2 PROFESSIONAL DETAILS BUSINESS DETAILS ■·· .,
D Salaried D Self-employed Non-Professional (SENP) No. of yrs In Current job/Business•
■
• Occupation Type" D D
:• Self-employed Professional (SEP) Housewife
_ _ _ _ _ _ _ _ _ _ Retirement Age
Company/Business Name• _____________________________
Limited Company/Priva • •
te Limited Company/ LLP/ Partnership fir m/Propnetorsh1p
Public Sector (PSU/Central} Governments/ State Governments/ Public
Company/Business Type•

O Office owned O office Rented Udyam No. _ _ _ _ _ _ _ _ _ Total Years of Experience Y I l ~ lMl M! Designation _ _ _ _ _ _ _ _ _ _ _ _ __
-------
------:::::---:----------------------
Office A d d r e s s • - - - - - - - - - - - - - - - - - - - - -
_ _ _ City•_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
Landmark• _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
Email
Tel* (std c o d e ) - - - - - = - - - - - ----- -----
Loan amount required (Rs
,c D Residential Purpose of Loan _..i_::..__ _ _ _ __
\I LAP/LRD/NRP : Tenure (Months)_ _,c_:_-17~-----

Loan type: D BT D Top-Up D New

o 0 Flex1.
D Rate of Interest t·ing
Fixed D ~ i
~hase D Resale D BT D Extension Improvement
Home Loan: D Construction t,?tt,"
Monthly Expense --4t"--'"u 0
;,;¥~--
D Top-up D Plot D Pio ruction
Comfortable Serving EMI (Rs)
D Identified
------
Property Details: [=t EJlstin~
,(.,~~~~~~ ~::::!..-~~ ~J:....---'.- ---..t------
Property Address _ _ _.1./V0~~:_.!..•__,.,,,___, -.-1,_,...... [....J.~~~L
------ -
Landmark_ _ _ _ _ _ _ _ __ _ . ' - - ' ~ , . f A ~ l - ! - . L - , I , - - - - - -
D Vacant Built up Area (Sq. ft) _ _ _ _ _ _ _ _ _ __
Property usage : D Self Occupied D Let-out D Partly Let-out
Current Loan Outstanding (Rs) _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
If BT, Financier's Name ______ ______ ______ __
D Life Insurance D Health Insurance D General Insurance
I hereby provide my consent to avail Insurance D Yes D No if yes
Source to meet
Requirement of Fund 1. Loan Required ~---- -----
1. Land I Plot cost ~---- ------ --
2. Purchase/ Construction cost ~ - - - - - - - - - - - -
2. own construction
a. Amt already paid
~---- -----
~---- -----
3. Stamp Duty/Registra tion Fee ~ _ _ _ _ _ _ _ _ _ _ _ _
(I) -_:::::::: ::::::::::: :::::::::
Sources(II)
4. Renovation ~---- ------ -- b. Amt to be paid
(Ill)-------------
~----- -----
5. Other Amenities ~---- ------ -- Source (I) - - - - - - - - - - - - - - - (111)
6. Total ~---- ------ -- (11)

C. BANK DETAILS
Current/OD/C C

0. FINANCIAL INFORMATION

Immovable property with current value (Specify} Applicant (Rs.) Co-Applicant(s) (Rs.)
Particulars Applicant (Rs.) Co-Applicant(s) (Rs.)

1.
Savings In Bank --
2.
Life Insurance Policy(ies)

Sum Assured Other Assets (specify)

Maturity Dates 1.

2.
p
-
No
I am a Director {lnclud1ng Chairman/ MD) tn Fedfina
I am relatlve of ~dnna Director
In th!\ Firm, Fedfina Dl"'°or or their relative Is Interested as a partner, manager, emplo~e or guarantor _

In th,s company, Fedlina Director or their relative Is I n ~ as a major shareholder director, manager, employee or guarantor
I am a Senior Officer of Fedflna -

I am a relatM! of Senlo~of ~dflna

If any of the above 1s ~s. please prov,d, detaili

r - . " ' " " " " ' ' ' . ' : ' ' o::_

----- E _D_,_sfg_n_a_tlo_"_ _ _ _~ !
If the declaration Is found to be false, then Fedfina w,11 be entitled 10 recall the loan

1.I/We declare that all the particulars, information and details given/filled in this Application Form are true, correct, complete and up-to-date in all respects and
information whatsoever.2. I/We confirm that no Insolvency Proceeding or suits for recovery of outstanding dues of monies whatsoever or properties and/or
that I/We have not withheld any
any criminal proceedings have
I
any action and no other steps
been initiated and/or are impending against me/ us and that I/We have never been adjudicated Insolvent by any court or other authority. I/We have not taken
of a receiver, administrator, administrative receiver, trustee or similar
have been taken or legal proceedings started by or against me/ us in any court of law/ other authorities (or the appointment
related activ1t1es and shall
officer or for my/our _assets. 3.I/We confirm the I/We shall not use the Loan Facility (or any part thereof) for any improper/ illegal/ unlawful/ speculative/ capital market

I apply the Loan FaC1hty (or any part thereof) only for the llm1ted purposes specified herein. 4. I/We undertake to Inform Fedbank Financial Services Limited (Fedfina)
whatsoever in my/our addresses as specified herein above or my employment/ Profession and to promptly provide such further information that Fedfina (or its designated
agents or representatives) may require. I/We hereby give my/our consent for appropriate verification of the documents through your authorized representatives,
the credit bureaus, Internal and e>cternal databases, field verifications, tele-verlfications, reference and background check etc. I/We authorize Fedfina and tis group
as well
companies
regarding any changes

as
group companies or
conduct a check with
and their agents to
credit bureaus, agencies,
exchange, share or part with all the information relating to my/our loan detail and repayment history to other Fedfina group companies or banks, financial institution,
liable for use/sharing of this
statutory bodies, marketing/research etc. as may be required or as they may deem fit and shall not hold Fedfina (or any of its group companies or its/ their agents)
set out under this Application
information. 5.I/We acknowledge and agree that the sanction of the Faclllty by Fedlina to me/ us shall be subject to compliance by me/us or the terms and conditions
residence /office and collected the necessary documents. 7.I/We
Form as well as the other Transaction Documents. 6. Sales Officer/Channel Partner of Fedlina has personally met me /us at my
and not to sanction the
understand and acknowledge that Fedfina shall have the absolute discretion, without assigning any reasons (unless required by applicable law), to reject our application
any costs, losses, damages or
facility and that Fedfina shall not be responsible/Hable In any manner whatsoever to me/us for such rejection or any delay in notifying me/us of such rejection and
and fully authorised to issue
expenses, or other consequences, caused by reason of such rejection or any delay In notifying me/us of such rejection. 8. I/We declare that I/We am/are competent
/ availing of the requested Facility and to execute all other
such declarations, confirmations, agreements and undertaking and submit this Application Form for the purpose of borrowing
upon by Fedfina would
documents required by Fedfina for such purpose. 9. This Application Form has been duly and validly executed by me/us or in my/our behalf and when accepted /acted
the validity of such initial
constitute legal and valid obligations that are binding on and enforceable against me/us. I/We confirm that the initials on this Application Form are made by me/us and
form and the Terms
shall not be disputed by me/us.10.I/We here by confirm having received, read and understood the above terms and conditions applicable to this loan including the application
in force from time to time.
and Conditions/Agreement and accept the same. 11.I/We agree that my/our loan shall be governed by the terms and conditions/ agreement of Fedfina which may be
hereby give
12.I/We hereby unconditionally, agree that these terms may be changed by the Fedlina at any time and I/We will accept and/ or bound by the amended terms and conditions.13.1/We
SMS/e-mail and / or
our consent that Fedfina can share my/our KYC details and/or other details to CKYC. I/We do not have any objection if I/We get any communication from CKYC through
otherwise.14.I/We offer our permission to receive WhatsApp notifications on our registered mob lie number and have no objections.
be applicable from time to
I/We confirm that the executive who collected my/our application/ Documents has informed me/us and I/We am/are aware. 1. That GST and any other taxes as may
not be processed and the
time will be charged in connection with the loan, 2. That company will not by liable for loss or delay in receipt of documents. 3. That incomplete/defective application will
the resulting delay or otherwise. 4. That the application form, documents/ photographs will not be returned under any circumstances once
company shall not be responsible In any manner for
and the company has not
submitted to the company. 5. That approval of the application Is at sole discretion of the company. 6. That the quantum of the loan will be finally decided by the company
the balance outstanding of the loan. I/We
made any commitments to me/ us regarding the same. 7. That the loan prepayment charges which may be subject to revision are levied /calculated on
that in case or any
further confirm that the said executive had collected self-attested copies of the aforementioned documents from me/us and that I/We are /were specifically informed
for issuance of the pre-
prepayment request the applicant and the co applicant are required to personally visit the company's customer service branch after which the request will be accepted
said loan application. I/We
payment letter. I/We hereby confirm that I/We have read/been explained in detail and understood all the terms and conditions and charges applicable pertaining to the
interest rate model taking into account relevant factors such as cost of funds, margins and risk premium etc and
understand that Company has adopted Interest Rate policy broadly outlining the
and the approach for
determine the rate of interest to be charged for loans and advances and the company's approach of risk gradation in this regard for its lending business. The rate of interest
gradation of risk and rationale for charging different rate of interest to different categories of borrowers has been disclosed and uploaded on the company website [Link]

for additional documents

IMPORTANT NOT£: That the receipt of your application form for the loan does not imply automatic approval of your loan by the company. The company may request
other than those collected in connection with the application.

Note: WE DO NOT ACCEPT ANY PAYMENT IN CASH. ALL CHEQUE ISSUED SHOULD BE ACCOUNT PAYEE ONLY & FAVOURING "FEDBANK FINANCIAL SERVICES LIMITED"

Date 1tITTf1( P • j ' ~ Place_....;;(3c....~----t --

I
c2 ~
L__ _ _
Applicant Co-Applicant 1/ Guarantor 1 - Co-Applicant 2/ Guarantor 2

••••••••• ····· •·•···· . ················ •······ . . ... ···············. ······· ............................ ........................ .

______________________________________________________
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