Consumer Finance Application Form Case ID ____________________________

Please fill in all the required details in BLOCK LETTER. Tick ✓ boxes as applicable. Applied Loan Amount*
* Mandatory Fields
1 Personal Details

Name* F I R S T M I D D L E L A S T
Date of birth* D D M M Y Y Y Y Marital status* Married Unmarried Gender* Male Female Transgender
Education* Under graduate Graduate Post graduate Diploma holder Professional qualified
Net monthly income* < Rs. 15,000 Rs. 15,000 - 25,000 Rs. 25,000 - 50,000 Rs. 50,000 - 75,000 >Rs. 75,000
Turnover < Rs. 25 lakh Rs. 26 - 50 lakh Rs. 51 - 75 lakh Rs. 76 lakh - 1 Cr > Rs. 1 Cr
Vehicle owned* 2 Wheeler 4 Wheeler Both None Make_____________ Model______________
Identification document Credit card PAN card Voter ID Passport Ration card Driving license
Father’s name
Mother’s name
2 Contact Details
Residence is Owned Rented Co. Provided Parental Bachelor acco/sharing/PG
Residence address*

Area/locality* City*
Landmark* Pincode*
State* Mobile no.*
Phone Residing since* Y Y Y Y Years M M Months
Email ID
(Please provide your e-mail id in Block letters since the Loan Summary Letter would be mailed on the same)

Preferred mailing address* Residence address Office address Residence-cum office* Yes No
3 Employment/Business Details

Employment type* Self-employed Salaried Housewife Student Pensioner Farmer

Profession type* Self-employed Professional Architect Doctor CA CS Engineer
Dentist Consultant Freelancer Broker Other
Industry type* IT Banking and Finance Govt. service Consulting Telecom BPO-KPO
Manufacturing Trading Services Others
Work experience/no. of years in business___________________________________________________
Name of the company/business*
Designation
Office/business address

Area/locality* City*
Pincode State*
Office phone
4 Undertaking/Declaration
1. I/We hereby apply for a finance facility from Bajaj Finance Limited (’BFL’) as stated in this Application Form.
2. I/We declare that all the particulars, information and details provided in this Application Form and the documents submitted by me/us are true, correct, complete and up-to-date in all respects and that I/we have not
withheld any material information.
3. I/We have read and understood the fees and charges applicable to the finance facility (ies) that I/we may avail from time to time.
4. I/We confirm that no insolvency proceedings or suits for recovery of outstanding dues, monies or property (ies) and/or any criminal proceedings have been initiated and/or are pending against me.
5. I request BFL to procure my CIBIL report and provide it to me. Also, I hereby expressly consent for deducting applicable charges for the same.
6. I/We declare that I/we have not received any request for or made any payment in cash, bearers cheques or of any other kind in connection with this Application Form from/to any person.
7. I/We hereby authorise BFL to exchange or share information and details relating to my application to its group companies or any third party, as may be required or deemed fit, for the purpose of processing this loan
application and/or related offerings or other products/services that I/we may apply for from time to time.
8. I/We hereby consent to and authorise BFL to increase or decrease the credit limit assigned to me basis BFL’s internal credit policy and criteria at its sole discretion from time to time. I/We will not raise any objection
or dispute with regard to the same at any point of time.
9. I/We understand that my BFL account login credentials including login and transaction password issued by BFL from time to time, constitutes confidential information and I/we agree to keep the same secure and
confidential to prevent any unauthorized use.
10. I/We hereby confirm that I/we have no objection in authenticating myself/ourselves with Aadhaar based authentication system. I/We consent to provide and authenticate my/our Aadhaar number through the
available mode of Aadhaar based authentication, as permitted under the prevailing law/regulation, for the purposes of availing this product/service and for availing such other third-party products/ service from BFL
under this Application form.
11. I/We understand that the Aadhaar based authentication shall be used only for authenticating my identity with Central Identities Data Repository for the aforementioned specific purpose(s).
12. I/We hereby authorize BFL to store my/our KYC data/documents provided under this Application including my/our Aadhaar number, proof of identity and address obtained from UIDAI.
13. By submitting this application, I/we hereby expressly authorise BFL to send me communications regarding loans, insurance and other products from BFL, its group companies and/or third parties through telephone
calls/SMSs/emails/post, etc, including but not limited to promotional communications. I/We confirm that I shall not challenge receipt of such communications by me as unsolicited communication, defined under TRAI
Regulations on Unsolicited Commercial Communications. I/We understand that I/we can at any time opt not to receive any telecommunication by registering under the Do Not Call Registry.
14. I/We understand and acknowledge that BFL has the absolute discretion, without assigning any reasons to reject my application and that BFL is not answerable/liable to me, in any manner whatsoever, for rejecting
my application.
15. I/We hereby confirm having read and understood the Master Terms and Conditions Applicable to Loans for Consumer Durable, Digital, Lifestyle Products and EMI Cards and unequivocally accept the same.

Place _____________________________ DNC Yes No

Date Mobile no. ______________________________
Note: BFL shall be entitled at its sole and absolute discretion to reject/approve Application Form Submitted by the applicant/s. Signature of the applicant
55 Credit Card Undertaking/Declaration
I want to apply for the Bajaj Finance RBL Bank Co-branded Credit Card and I hereby consent for below:
i.) To share my application details and attached KYC with RBL Bank and use the same for my credit card application. The above is being done at my specific request in order to avoid resubmission of personal
details such as KYC documents and I shall not raise any objection/issue whatsoever with regard to the same against BFL or RBL bank. Furthur I undertake to read the credit card features and most important
terms and conditions (MITC) as mentioned on www.rblbank.com.
ii.) To authorise Bajaj Finance Limited and RBL Bank to contact me, as required, for the purposes of Bajaj Finance RBL Bank Co-branded Credit Card. I also provide my consent to RBL Bank to call me for
issuance, upgrade or downgrade of my credit card basis my telephonic, email, OTP based consent if I qualify for the same. I agree that the approval for credit card issuance and credit limit will be at sole
discretion and option of RBL Bank. I confirm that laws in relation to the unsolicited communication referred in ‘National Do Not Call Registry’ (the ‘NDNC Registry’) as laid down by TELECOM REGULATORY
AUTHORITY OF INDIA will not be applicable for such communication.
Place ___________________________________ Case ID_______________________________
______________________________
Mobile no. Signature of the applicant

65 Insurance Undertaking/Declaration
I hereby expressly authorise BFL, its group companies and their agents/representatives to send me communications regarding loans, insurance and other products of BFL, its group companies and/or third
parties through telephone calls/SMSs/emails/post etc. including but not limited to promotional communications, from time to time, irrespective of whether I am registered as a
Do Not Disturb customer or not either with TRAI, any telecom service provider or a bank or NBFC. I confirm that I shall not challenge the receipt of such communications as unsolicited communication at any
time under the Telecom Regulatory Authority of India Regulations on Unsolicited Commercial Communications.

Place ___________________________________ Mobile no. ______________________________

Signature of the applicant

7 ACKNOWLEDGMENT
We acknowledge the receipt of your application for a loan from Bajaj Finance Ltd. Please furnish documents mentioned overleaf for approval of your loan application.
Please write to us at the given email ID for your queries and suggestions: wecare@bajajfinserv.in
Applicant name
Loan amount applied: Sales representative mobile no.
Sales representative name
Processing fee: Rs. . Interest rate: % Annum. bounce charges: Rs. 350/EMI/Loan. Case ID
Late payment penalty will be charged 2% pm on an amount of EMI outstanding as on that date. Please note each product will be treated D D M M Y Y Y Y
Date
as different loan. No foreclosure or pre payment charges. Processing time of loan will be up to 15 days.
Bajaj Finance Limited
Note: Credit at the sole discretion of Bajaj Finance Ltd. Corporate Office: 4th Floor, Bajaj Finserv Corporate Office, Off Pune-Ahmednagar Road, Viman Nagar, Pune – 411 014, Maharashtra, INDIA
This is a preprinted acknowledgement and Registered Office: Mumbai - Pune Road, Akurdi, Pune - 411 035. Maharashtra, INDIA Tel +91 20 3040 5060 Fax +91 20 3040 5020 www.bajajfinserv.in
does not require any signature.
Please quote the Case ID no. in future reference
BAJAJ FINANCE LIMITED