(925

RETAIL LOAN APPLICATION FORM

(Individual Customer ID Creation+ Loan Application)
FEDERAL BANK
YOUR PERFECT BANKING PARTNER

Channel: Branch Sales Team FedFina Date

t ll
□·· · · · · · · · · · · · · · · · · · · · · · · ·
Branch Branch Code SOL ID
Loan Applied For: Housing Loan Property Power Vehicle Loan Personal Loan
Employee ID Lead ID ABA ID

PERSONAL DETAILS OF APPLICANT

Customer ID CKYC No.
Title First Name Middle Name Last Name
Name
Father/
Spouse Name
Mother's
Name

Date of Birth ir Gender Male Female Third Gender Marital Status Single Married Others

Staff YES NO Related to Staff/Dir YES NO Nationality

Name of
Staff PF No. Staff/Dir

PAN Form 60 Yes No Aadhaar

(Not Mandatory)

Residential Status Resident NRI PIO Visa Type:

Passport No Passport Expiry Date r r Visa Validity:

Aadhar PAN Card Driving License NREGA Aadhar PAN Card Driving License NREGA
Voters ID Passport Others Voters ID Passport Others

r
Document No. Document No.
r r r
L
Issued On Valid Till T Issued On Valid Till I
Address Type Residential/Business Residential Business Registered Office Unspecified
Communication Please provide
Address
the full address
for faster courier
City/Town services

PIN State Country

Address Type Residential/Business Residential Business Registered Office Unspecified

Permanent Same as above ]
Address
City/Town
PIN State Country

Mobile Number l - - - - - -
Phone (Res)
- -- -- --
Email ID
Above details will be the Registered Mobile Number & E-mail 10
•., : I

Christian Hindu Muslim Sikh Others................... General 0BC SC ST Others........................ .

Qualification Family Details

Doctoral Professional PG No. of Dependents: None 2 3 □ ..............

Graduate Undergraduate No. of Working Members: None 2 3 □ ..............
Monthly Income Current Residence

<�10,0000 �10,001-25,000 �25,001-50,000 �50,001-1,00,000 Owned Inherited/ Family Owned

�1.00,001-5Lakhs �5,00,001-25Lakh �25,00,001-50Lakhs Rented Company Provided

>�50Lakhs
 Government
Public Sector
MNC
Public Co.
Pvt. Ltd. Co.
Others..................
Employee Number........................................
Work Period (present firm) ..........................
1
Job Title.............................................................
For Self-Employed
Firm Type
Proprietorship
Partnership
Private Ltd
Profession Type
CA
Doctor
Others..............................
Retirement Age..............................................
No. of years in present business..................................................
Office Address
Name affirm/
Employer
City/Town
PIN State Country

Office Tel. Email ID

FINANCIAL DETAILS
Loans/ Liabilities Amount(Rs.} Assets Amount(Rs.}
Housing Loan Cash in Hand

Vehicle Loan Bank Deposits

Other Mortgage Loan Investment in Shares/ Govt. Securities

Personal Loan Value of vehicles owned

Other Loans
Land & Buildings (Value)
Any Other Liability
Investment in other Business

Investment in Gold

Insurance

Others

TOTAL LIABILITIES TOTAL ASSETS

NET WORTH ( Total Assets - Total Liabilities )=

Details of Landed Properties/Buildin s Owned

SI No. Property Description Full Address Estimated Value of Property

(Plot/ Flat/ House etc.)

1.

2.

Income Details Income of Spouse/Others to be taken for Loan Repayment: Yes No

If Yes, then:
Gross Annual Salary/Income Gross Annual Salary/Income
Net Annual Salary/Income l 7 Net Annual Salary/Income
Other Approved Income L I Other Approved Income
Deductions
[ I Deductions

2
 Reference (Not related to you)
Name Name
Address ,- Address ,-

1 �

Tel No Tel No

Salary/Operative a/c details

Bank Name & Branch
Account Number
Account Type
Account Since

Loan Details
Type of Loan
Scheme Category
Purpose of Loan
Loan Amount (Proposed).......................................................................................
Period.......................................................................................................................... Mode of Repayment Auto Recovery NACH
Cushion Period......................................................................................................... Bank A/C Number...................................................................................................... .
Pre-EM I Option Requirement YES NO Bank Name............................................. Branch Name...........................................
Credit Linked Insurance Requirement YES NO IFSC

Existing Loan Details

Total EMI Paid .................................................................................................. . No. of Loans ...................................................................................................................
SI No. Type of Loan Name of Financial Institution Loan Amount Present Balance Loan Period Loan Start Date EMI Paid

Estimated Fund Requirements-HL Source to Meet Fund Req

Land Cost : Rs. Loan Applied For : Rs.
Total Purchase Price/Construction Cost : Rs. Savings/Personal Funds : Rs.
Incidental Costs : Rs. Others : Rs.
Other Costs : Rs Total : Rs
Registration Costs/ Service Tax : Rs Other sources of margin money (If any)
Total : Rs ..................................................................................................................................

3
 Personal Details Of Co- Applicant / Co-obligant/Guarantor/POA Holder

Customer ID CKYC No.

Title First Name Middle Name Last Name
Name
l
Father/
Spouse Name ][ ]
Mother's
Name ][ l
Date of Birth ir Gender Male Female Third Gender Marital Status Single Married Others

Staff YES NO Related to Staff/Dir YES NO Nationality

Name of
Staff PF No. Staff/Dir

PAN Form 60 Yes No Aadhaar

(Not Mandatory)

Residential Status Resident NRI PIO Visa Type:

Passport No Passport Expiry Date r T Visa Validity:

Aadhar PAN Card Driving License NREGA Aadhar PAN Card Driving License NREGA
Voters ID Passport Others Voters ID Passport Others
Document No. Document No.
Issued On r Valid Till r r Issued On -T Valid Till [ [
Address Type Residential/Business Residential Business Registered Office Unspecified
Communication ,­
Address L
·7 Please provide
the full address
for faster courier
City/Town services

PIN State Country

Address Type Residential/Business Residential Business Registered Office Unspecified

Permanent
Address
L Same as above ]
City/Town
PIN State Country

Mobile Number L_ _J Phone (Res)

Email ID
___J
Above details will be the Registered Mobile Number & E-mail 10
• • : I

Christian Hindu Muslim Sikh Others................... General OBC SC ST Others........................ .

Qualification Family Details

Doctoral Professional PG No. of Dependents: None 2 3 □ ..............

Graduate Undergraduate No. of Working Members: None 2 3 □ ..............
Monthly Income Current Residence

<�10,0000 �10,001-25,000 �25,001-50,000 �50,001-1,00,000 Owned Inherited/ Family Owned

Rented Company Provided
�1,00,001-5Lakhs �5,00,001-25Lakh �25,00,001-50Lakhs >�50Lakhs
No. of Houses Owned

Co-applicant's relation with Applicant :

Income Considered for Repayment: Yes No
Existing Loan Details

Total EMI Paid ................................................................................................... No. of Loans ...................................................................................................................

SI No. Type of Loan Name of Financial Institution Loan Amount Present Balance Loan Period Loan Start Date EMI Paid

5
 For Self-Employed
Government Public Co. Job Title............................................................. Firm Type Profession Type
Proprietorship CA
Public Sector Pvt. Ltd. Co. Employee Number.........................................
Partnership Doctor
MNC Others.................. Work Period (present firm) ..........................
Private Ltd Others..............................
Retirement Age..............................................
No. of years in present business..................................................

Office Address
Name of firm/
Employer
City/Town
PIN State Country

Office Tel. Email ID

FINANCIAL DETAILS

Loans/ Liabilities Amount(Rs.) Assets Amount(Rs.)

Housing Loan Cash in Hand

Vehicle Loan Bank Deposits

Other Mortgage Loan Investment in Shares/ Govt. Securities

Personal Loan Value of vehicles owned

Other Loans
Land & Buildings (Value)
Any Other Liability
Investment in other Business

Investment in Gold

Insurance

Others
TOTAL LIABILITIES TOTAL ASSETS

NET WORTH ( Total Assets - Total Liabilities )=

Details of Landed Properties/Buildings Owned

Property Description
SI No. Full Address Estimated Value of Property
(Plot/ Flat/ House etc.)

1.

2.

Income Details
Whether your income to be considered for loan repayment Yes No
Gross Annual Salary/Income Net Annual Salary/Income

Other Approved Income

L __________ Deductions
L ________

6
 Reference (Not related to you)
Name Name _]
_,

Address Address _]
_,

�
Tel No � Tel No J
Customer Search Made
STATUTORY DUES IF ANY .............................................................. D No Cust ID exists in the name of the applicant

................................................................................................................. D Cust ID exists in the name of the applicant

D KYC Norms Complied
Please paste
Customer Risk Rating D Low D Medium 0 High Passport Size
color
Photograph
here
Asst. Manager/ Rel. Manager Principal Officer
Signature of Co-Applicant/ Co-Obligant/Guarantor/POA Holder
SP No. """"'"" SP No . . .
'' '' '' ''

7
 Power of Attorney Details

Principal Name of Principal Name of POA Holder Relationship of Principal Customer ID*
with POA Holder
Applicant

Co-Applicant/ Co-Obligant/
Guarantor - 1
Co-Applicant/ Co-Obligant/
Guarantor - 2
Co-Applicant/ Co-Obligant/
Guarantor - 3

Declaration cum Undertaking

I/We declare that all the particulars and information given in the application form are true, correct and complete and updated in all respects and I/We have not withheld any
information. I/ We understand that the information furnished by me/us shall form the basis of any loan Federal Bank may decide to grant me/ us. I/We further undertake
to submit any other information as required by the Bank from time to time. I/we confirm that the loan shall be used only for the purpose mentioned in this application. I/We
confirm that there are no insolvency proceedings instituted or pending against me/us/Firm nor have I/We/Firm ever been adjudicated insolvent. I/We further confirm that
I/We have read the brochure, terms and conditions applicable to this loan and understood the contents therein. I/We also undertake to inform Federal bank regarding
change in my/our occupation/Business/ Employment /address/phone numbers/e-mail and to provide any further information that the Bank may require. I/We further
agree that my/our loan shall be governed by the instructions/ policies of the Bank in vogue and/or that may be amended by the Federal Bank from time to time. I/ We further
agree that the Bank in its sole discretion may reject my/our application without providing any reasons whatsoever, and the decision of the bank in this regard shall be final
and conclusive. I/We have read, understood, acknowledge and agree that Federal Bank may refer my/our name to any institution or credit referencing agency/ies/ Credit
Information Companies and/or make such references and enquiries as the Bank may consider necessary. I/We hereby authorize Federal Bank to disclose such information
relating to my/our credit rating or credit facility applied herein to such parties/agencies as deemed necessary at its sole discretion. Further, all fees and charges payable in
connection with the assessment I sanctioning of aforesaid credit facility including the Processing fee, Valuation Fee, Title Scrutiny Charges, Valuation Fee etc. are made
known to me/us by the bank and I/We undertake to pay the said charges as per the Bank's norms, as and when demanded. I/We hereby authorise the Bank to debit any
of my/ our account/s with the Bank, without any prior notice/ reference to me/ us, for the payment of such charges. I/we understand and agree that the fees / charges paid
by me are non-refundable and if my/our application is rejected by the Bank for any reason whatsoever, or the same is withdrawn by me, I/We shall not be entitled for refund
of the same either in part or in full. I/ We agree to have given my/our/firm's express consent to the bank to collect/disclose all information furnished by me/us to /from
Credit Information Bureau India Ltd. (CIBIL) or any other Credit Information Companies permitted to operate in India. Unless, there is a specific agreement to the contrary,
the Bank may disburse the loan amount, if sanctioned, to any of the account/s in my/our name. I/We agree and understand that the Loan Amount mentioned herein is the
amount proposed by me /us and that the Bank would sanction only the loan amount as per my/our eligibility as assessed by the Bank in its sole discretion. I/We hereby
understand that the loan applied may be granted to me/us. I/We agree to join as a Primary Borrower/Co-borrower/Co-obligant/Guarantor for the loan mentioned above.
I/We hereby give my/our consent to the Bank to disclose information provided in the application form for the purpose of cross selling to any third-party entities with whom
the Bank enters, or has entered into any arrangement, in connection with providing of services/products, including without limitation, cross selling of various financial
products

I/We hereby undertake: (A) To inform the bank immediately on any change occurring in my business/office/ residential addresses and /other contact details.(B) To pay any
overdraft created in my/our account by debit of charges aforementioned or inadvertently together with applicable interest and without demur.(C)To inform the bank of the
wrong credits in my/our account, pertaining to other customers and refund the same together with applicable interest and without demur.(D)We agree and affirm that the
instruction regarding operation of saving bank/current deposit Account is not revocable/or modified by one or more of us unless the request is signed by all of us jointly .(E).
I/ We undertake to submit all the required documents / details called for by the Bank for processing the loan and I/We understand that in case of my/our failure to submit
such details/ documents the Bank is entitled to reject the loan application.
I/We hereby declare that the details furnished above are true and correct to the best of my/our knowledge and belief and I/we 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/our personal/KY( details may be shared with Central KYC Registry. I/We hereby consent to receiving information from Central KYC Registry through SMS/Email
on the above registered number/email address.

FATCA- CRS Declaration

I am citizen/national/tax resident of any country outside India (If Yes, Please fill in the annexure separately)

Applicant Yes No Co-Applicant/ Co-Obligant/Guarantor/POA Holder 1 Yes No

Co-Applicant/ Co-Obligant/Guarantor/POA Holder 2 Yes No Co-Applicant/ Co-Obligant/Guarantor/POA Holder 3 Yes No
I/We hereby declare that the information provided by me/us is true. In case any changes, I/We will inform the bank within 30 days.
*In case of more than 3 Co-Applicants, please fill the declarations separately

Name of Applicant

Signature of Applicant

Signature of Co-Applicant/ Co-0bligant/Guarantor/P0A Holder 1 Signature of Co-Applicant/ Co-0bligant/Guarantor/P0A Holder, Signature of Co-Applicant/ Co-0bligant/Guarantor/P0A Holder 3

Name of Co-Applicant/ Co-Obligant/ Name of Co-Applicant/ Co-Obligant/ Name of Co-Applicant/ Co-Obligant/

Guarantor/POA Holder 1 Guarantor/POA Holder 2 Guarantor/POA Holder 3

Place
Asst. Manager/ Rel. Manager Principal Officer
Date
I I SP No............... SP No..............