Bandhan Two-Wheeler Loan Application Form

Bank
Application Date: D D M M Y Y Y Y Branch: Branch Code:

Application Form No.: RM Code:

2.5 cm 2.5 cm

Please paste latest Please paste latest

photograph of photograph of the
the Applicant Guarantor
and sign across and sign across
3.5 cm

3.5 cm
Personal Details:

1. Details of the Applicant:

Mr./Ms./Mrs.

Date of Birth D D M M Y Y Y Y

2. Customer ID No(s). 3. AADHAAR Card No.

4. PAN: (In absence of PAN, Provide the form No. 60/61) 5. Voter ID Card No.

6. Gender: Male Female Others 7. Marital Status: Married Single

8. No. of Dependents: Adult Child

9. Category: SC ST OBC General Others _____________________

10. Religion: __________________________

11. Address: i) Present: ii) Permanent:

Landmark:

City:

State:

PIN Code:

12. Mobile No.: 13. Landline No.:

14. Email ID:_________________________________________________

15. Residence Ownership: Owned Co. provided Parental Rented 16. Rent per Month: ` _________________________________________________ ____________________

17. Years at Current: Residence Yrs. City Yrs.

18. Education: Matriculate HS/Dip. Graduate PG & Above Others (Specify) ___________________________

19. Employment Details:

Name of the Employer/Business:

Employer/Business’s Address:

Landmark: PIN Code: City:

State: Landline No.: Email ID:

Mobile: Fax: Designation: Email:

Years at Current Job/Business: Years Months

20. Occupation Details:

Salaried Self-employed Self-employed Professional

21. Nature of the Job/Business:

(i) Salaried: Pvt. Sector Govt. Central Govt. State PSU Defence MNC Others (Specify)___________

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(ii) Self-employed: Proprietorship Partnership Other (Specify) __________________________________________________

(iii) Self-employed Professional:

CA Doctor Engineer Architect Other (Specify) _____________________________

22. Type of Business:

Manufacturing Trading Export Import Service Agriculture Others

23. Others (Pick one) :

Retired Student Homemaker

24. Industry Type: _______________________________ Sub Industry _____________________________________________Industry Code______________________________________________

25. Bank Details:

i) Bank & Branch:

Account No.: Type of A/c. ___________________________Opened since________________________________

Total Balance as on: D D M M Y Y Y Y ` ______________________________________________________________________________

ii) Bank & Branch:

Account No.: Type of A/c. ___________________________Opened since______________________________

Total Balance as on: D D M M Y Y Y Y ` _____________________________________________________________________________

26. Reference Details:

Name: Mr. /Mrs. /Ms._____________________________________________________________ Name: Mr. /Mrs. /Ms._____________________________________________________________

Address: ________________________________________________________________________ Address: ________________________________________________________________________

PIN Code: _______________________________________________________________________ PIN Code: _______________________________________________________________________

Relationship with the Applicant: Friend Relative Relationship with the Applicant: Friend Relative

Email ID: ________________________________________________________________________ Email ID: ________________________________________________________________________

Mobile/Landline No.: ____________________________________________________________ Mobile/Landline No.: ____________________________________________________________

27. Particulars of the Guarantor:

Name:

Relationship with the Applicant: Date of Birth: D D M M Y Y Y Y

Address:

PIN Code: City: State:

Occupation:

PAN: AADHAAR Card No.: Voter ID No.:

Mobile No.: Landline No:

Email ID _________________________________________________________________ Amount of Guarantees already given (In `) _________________________________________________

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28. Credit Facility Availed with Other Bank/Financial Institution, if any:
Applicant Guarantor
Details of Loans from Other Banks Loan 1 Loan 2 Loan 1 Loan 2

Name of the Bank and Branch:

Type of the Loan Availed:

Amount of the Loan Availed: (In `)

Present Outstanding: (In `)

EMI: (In `)

Loan Tenure:

No. of EMI’s Paid:

29. If Credit Card Holders, Details of the Credit Card Applicant Guarantor

Name of the Issuing Bank/Agency:

Credit Limit: (In `)

Present O/S Amount: (In `)

30. Details of Assets (In `) Applicant Guarantor

Cash in Hand:

Deposits with the Bank:

Immovable Assets/Properties:

Movable Assets:

Investments (Specify each):

Others (Please specify):

Total Assets: (A)

31. Details of Other Liabilities (In `) Applicant Guarantor

Loans taken from the Employer:

Loans taken from Friends/Liabilities:

Other Liabilities:

Total Liabilities: (B)

32. Net-worth: (In `) (A-B)

33. Income Details (In `) Applicant Guarantor

Gross Salary/Income per Month:

(Attach Salary Sheet/I.T. Return/Form No.16)

Income Tax :

Other Deductions:

Other Income if any:

(Attach Proof)

Net Salary/Income:

Total Income:

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34. Vehicle(s) used
Car Two-wheeler NA No. of Vehicles: One Two More Vehicle: Owned Co. provided Financed
Currently:

35. Details of the Vehicle to be Purchased:

Cost of the Vehicle: (Ex-showroom Price) (In `) Maker and Model of the Vehicle:

Cost of the Registration: (In `) Name of the Dealer:

Road Tax (In `) + Insurance: (In `) Loan Request Amount: (In `)

Total Cost of the Vehicle/On Road Price: (In `) Margin: (In `)

Tenure Required: Months

Purpose: Personal Commercial

36. Processing Fee Details:

Amount (In `) ______________________________________________ Date: D D M M Y Y Y Y

Cheque No.: Drawn on Bank & Branch:

Declaration
DECLARATION FOR THUMB IMPRESSION/SIGNING IN VERNACULAR LANGUAGE
(This declaration must be signed by a person other than the employee of Bandhan Bank Limited. The Witness should be related to the Applicant)
This is to certify that I have read out the contents of this application form to Mr. /Mrs. _____________________________________________________________________________________
and he/she has understood the same.
Further, I would also like to certify that Mr. /Mrs. ________________________________________________________________________________________________ has affixed his/her thumb
impression or has signed in vernacular language in my presence after I have explained the above contents to him/her. I declare that whatever I have stated herein above is true and
correct to the best of my knowledge & belief.

Date: D D M M Y Y Y Y

Place : ________________________________ Signature of the Witness Signature/Thumb Impression

of Applicant/Guarantor
Name of the Witness: __________________________________________ Relationship with the Applicant: _______________________ Contact Number: ________________________________

Address:_______________________________________________________________________________________________City ________________________________________________________

State ______________________________________ PIN _____________________

Details of KYC document(s) of the Witness: 1. ________________________________________________________ 2. ________________________________________________________

Declaration
Relationship Declaration: Details of Relationship with the Director/Senior Officer of Bandhan Bank

Name of the Director/Senior Officer _____________________________________________ Relationship with the Director/Senior Officer __________________________________

I/we hereby declare that all the particulars and information furnished in the application form are true, correct, complete and up-to-date in all respects. I/we have not withheld any information. I/we
confirm that I/we had no insolvency proceedings initiated against me/us, nor have I/we ever been adjudicated insolvent and further confirm that I / we have read and understood the contents. I/we
are aware that the fees paid by me/ us are non-refundable. I/we are aware about the rate of interest charged by Bandhan Bank. I/we understand that the document submitted shall not be returned
to me/us. The sourcing channel has not collected any cash or cheque other than PF to be deducted by Bandhan Bank. I/ we also confirm that the Loan proceedings will be utilised for the purpose as
mentioned in the application form and not for any other speculative purpose. I/we also authorise Bandhan Bank or its agents to make references and inquiries related to the information in this
application which Bandhan Bank considers necessary. I/we also authorise Bandhan Bank to exchange/ share all the information relating to my/ our Loan details and repayment history to other
Banks/Financial institutions/ Credit Bureaus/Agencies as may be required, I/ we shall not hold Bandhan Bank liable for use of this information. I/we undertake to inform Bandhan Bank regarding any
change in my residence/employment/occupation/transfer and to provide any other information that Bandhan Bank may require. I/we further agree that my Loan shall be governed by the rules of
Bandhan Bank which may be in force from time to time. Bandhan Bank reserves the right to reject any application without providing any reason. I/we undertake to bear processing, service, documen-
tation charges etc. as stipulated by the Bank from time to time. I/we agree, note and understand that Bandhan Bank shall be entitled at its sole discretion to call back, the entire Loan/advance
whether due and payable or not at any time, without assigning any reason and enforce its rights, remedies and securities.

Date: D D M M Y Y Y Y

Place : ________________________________
Signature of the Applicant Signature of the Guarantor

Acknowledgement (To be returned to the Customer)

We have received Two - Wheeler Loan application from Mr./Ms./Mrs. ______________________________________________ ________________________________________________

for ` ___________________________________________________________________________ on ___________________________________________________________________________

Date: D D M M Y Y Y Y For Bandhan Bank

Place : ________________________________

Signature of the Bank Official

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