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B. INDIVIDUAL APPLICANT/CO-APPLICANT/PROPRIETOR/PARTNER/DIRECTOR/GUARANTOR Email ID: H. LIST OF DOCUMENTS

Permanent Address:
Title: Individual applicant Co-applicant- I Partner-I Proprietor Director-I Guarantor Latest Partnership Deed and Le er of
District: Applica on Form
authorisa on, wherever applicable
Name: Pin code: State: MOA/AOA ,Board Resolu on applying
Father/Spouse Name for loan and authorised person for
D. EXISTING LOAN DETAILS/FACILITY DETAILS Latest Bank Statement 6 months 12 months
Mother's Maiden Name signing all documents related to loan
CIF No KYC Iden fier applica on, wherever applicable
Loan Name of the Bank/FI Type of Loan Loan Amount EMI Loan Opening Date Tenure ROI Current Outstanding
DOB: D D M M Y Y Y Y Gender: Male Female Transgender ITR with Computa on of income last_____________years ECS /NACH Mandate (if applicable)
1.
Marital status: Single Married Widow Audited/CA Cer fied Financial Statements for last_______years Exis ng Loan account statement
Religion: Hindu Muslim Sikh Chris an Zoroastrian Buddhist Others 2.
Proof of Ownership of Residence
3. GST Return for last_____________months (Either by Applicant/Co-applicant):
Educa on: Under Graduate Graduate Post Graduate Professional Others
_______________________________
Category: General SC ST OBC MBC Others 4.
Proof of Address (Specify):______________________ Proof of Business (Specify):
Na onality DL / AADHAAR / VOTER ID / PASSPORT NO. _______________________________
(Please ck any one and men on the ID No in the box) E. BANKING DETAILS
PAN No. (Mandatory) *Exhaus ve list of documents
S.N. Bank Name Branch Account Number Type of Account Banking Since I. PRIORITY SECTOR CATEGORY/MSME
Occupa on: Service Re red Business Professional Others
1. Manufacturing Enterprise
Residence Address:
2. Investment in Plant & Machinery Value of Plant & Machinery Rs_______________
District:
Up to Rs 25 lakh (micro) Above Rs 25 lakh up to Rs 5 Crore (small)
Pin code: State:
F. LOAN REQUIREMENT DETAILS Above Rs.5 Crore up to Rs 10 Crore(Medium)
No of Months in the Residence address: Telephone No./Mobile No
Service Enterprise (Professional/Non Professional/SRTO/Trade/Retail Trade)
Residence ownership: Self-Owned Parental owned Rental Type of Facility Rs. In Lacs Tenure ( in Months) Purpose of loan
Investment in Equipment Value of Equipment Rs_______________
Email ID:
Up to Rs 10 lakh (micro) Above Rs 10 lakh up to Rs 2 Crore (small)
Permanent Address:
Above Rs.2 Crore up to Rs 5 Crore(Medium)
District:
J. REFERENCE DETAILS
Pin code: State: G. DETAILS OF PARTNERS /DIRECTORS
Reference 1 Reference 2
C. CO-APPLICANT-II/PARTNER – II/DIRECTOR - II /GUARANTOR Name of
Name: Mr/Mrs/Ms __________________________ Name: Mr/Mrs/Ms __________________________
Partners/Directors Exp. In the
of the Complete Residence Father/ Spouse AadharNo/ Contact Share Academic line of Address: ___________________________________ Address: ___________________________________
Title: Co-applicant- II Partner-II Director-II Guarantor Company/ Proprietors address name DOB DIN No. PAN No. number Holding % Qualifica on Ac vity
__________________________________________ __________________________________________
Name: __________________________________________ __________________________________________
Father/Spouse Name Pin Code: __________________________________ Pin Code: __________________________________
Rela onship with Applicant: Friend/Rela ve/ Rela onship with Applicant: Friend/Rela ve/
Mother's Maiden Name
Business Rela ons Business Rela ons
CIF No KYC Iden fier Email Id: __________________________________ Email Id: __________________________________
DOB: D D M M Y Y Y Y Gender: Male Female Transgender Phone No: ________________________________ Phone No: ________________________________
Marital status: Single Married Widow
Religion: Hindu Muslim Sikh Chris an Zoroastrian Buddhist Others K. INFORMATION ON OTHER PRODUCTS AND OFFERINGS
Educa on: Under Graduate Graduate Post Graduate Professional Others From me to me, Bandhan Bank communicates various new products/special features of exis ng
Category: General SC ST OBC MBC Others products/promo onal offers which are of significant benefits to its customers.
Na onality DL / AADHAAR / VOTER ID / PASSPORT NO.
(Please ck any one and men on the ID No in the box) I/We consent / do not consent to receive informa on /services for marke ng purposes through
PAN No. (Mandatory) Telephone/Mobile/SMS/Emails by the Bank/its Agent.
Occupa on: Service Re red Business Professional Others
Declara on
Residence Address: I/we hereby declare that all the par culars and informa on furnished in the applica on form are true, correct, complete and
District: up-to-date in all respects. I/we have not suppressed or furnished any wrong informa on. I/we confirm that I/we had no
Pin code: State: insolvency proceedings ini ated 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 am/are aware
No of Months in the Residence address: Telephone No./Mobile No
that the Equated Monthly Instalment comprising of principal and interest is calculated on the basis of monthly rest. I/we are
Residence ownership: Self-Owned Parental owned Rental aware about the rate of interest charged by Bandhan Bank. I/we understand that the document submi ed shall not be
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returned to me/us. The sourcing channel has not collected any cash or cheque other than processing fees to be deducted by DECLARATION FOR THE THUMB IMPRESSION/SIGNING IN VERNACULAR LANGUAGE (This declara on must be
Bandhan Bank. I/ we also confirm that the Loan proceedings will be u lised for the purpose as men oned in the applica on signed by a person other than the employee of Bandhan Bank Limited. The Witness should be related to the Bandhan
form and not for any other specula ve purpose. I/we also authorise Bandhan Bank or its agents to make references and
inquiries related to the informa on in this applica on which Bandhan Bank considers necessary. I/we also authorise Bandhan
Applicant). Bank Applica on Form – Small Enterprise Loan
Bank to exchange/ share all the informa on rela ng to my/our Loan details and repayment history to other Banks/Financial This is to cer fy that I have read out the contents of this applica on form to Mr./Mrs. _____________________
Date D D M M Y Y Y Y Applica on No
ins tu ons/ Credit Bureaus/Agencies as may be required; I/ we shall not hold Bandhan Bank liable for use of this informa on. ______________________________________ and he/she has understood the same.
I/we undertake to inform Bandhan Bank regarding any change in my residence/employment/occupa on/transfer and to
provide any other informa on that Bandhan Bank may require. I/we further agree that my Loan shall be governed by the rules Product Code
of Bandhan Bank which may be in force from me to me. I/we undertake to bear processing, service, documenta on Further; I would also like to cer fy that Mr. /Mrs. _______________________________________________ has Paste and sign
Paste and sign Paste and sign
charges etc. as s pulated by the Bank from me to me. I/we agree, note and understand that Bandhan Bank shall be en tled across the
affixed his/her thumb impression or has signed in vernacular language in my presence a er I have explained across the across the
at its sole discre on to call back, the en re Loan/advance whether due and payable or not at any me, without assigning any Photograph
Photograph Photograph
reason and enforce its rights, remedies and securi es. Bandhan Bank may at its sole discre on sanc on or decline the
the above contents to him/her. I declare that whatever I have stated herein above is true and correct to the
Branch Code Co-Applicant-I/
applica on of loan. best of my knowledge and belief. Applicant Co-Applicant –II
Guarantor
That I/ We shall furnish any addi onal documents as and when required by Bandhan Bank. RO Code Photograph Photograph
Photograph
That I/ We have not taken any loan from any other bank/ finance company unless specifically declared by me/ us and all are Date D D M M Y Y Y Y
standard as on date CM Code
I/We agree that Bandhan Bank Will Convey its decision within 3 weeks from the date of receipt of the applica on provided the Place _________________
applica on is complete in all respects and is submi ed along with all the documents as per ' check list' provided in the A. BUSINESS DETAILS:
applica on form for loan and/or any addi onal documents may be required by the Bank for proper appraisal of the
applica on. The computa on of melines shall start from the day on which all documents required for a proper appraisal of Name of Firm/Company
the applica on are provided by the Customer to the Bank. Signature of Witness Signature/Thumb impression of the
My own Personal / KYC details may be shared with Central KYC Registry. Applicant/Guarantor/Co-applicant
I/We hereby consent to receiving informa on from Central KYC Registry through SMS/ Email on the above registered Type of Cons tu on: Proprietorship Partnership Pvt. Limited Company Self Employed Professional
number/ email address.
CIF No. (for exis ng A/c):
In compliance to RBI Circular Ref DBR.No. Dir.BC.10/13.03.00/2015-16, clause 2.2.1 on gran ng loans and advances to
rela ves of directors and clause 2.2.2 on restric ons on grant of loans and advances to officers and rela ves of senior officers Date of Establishment/Incorpora on: D D M M Y Y Y Y
of banks.I/We agree that as per the regulatory guidelines classifica on of accounts as NPA is done Borrower wise and not GST No.
Facility wise and hence, in case of non-payment of dues by me/us in case of any facility availed from Bandhan Bank and
consequently the account is to be classified as NPA, all other loan accounts, with the Bank also shall be classified as NPA as per CIN No.
the guidelines issued by RBI and it shall en tle Bandhan Bank to recall all such loans/facili es availed by me/us from Bandhan Trade Licence No./ Registra on No.
Bank, irrespec ve of the regular repayment in such loan accounts.
PAN No.
Date of Commencement of Business D D M M Y Y Y Y
I/We hereby declare and confirm in respect of rela onship with director/Senior officer of the bank/Any Type of Business: Manufacturing Trading Services Others
other Bank Nature of Business:
1. I am a Director of Bandhan Bank Yes No
2. I am a Director of any other Bank Yes No Annual Turn Over (FY __________________) Net Profit ( FY_______________________)
3. I/We am/are a rela ve of director of Bandhan Bank/other Bank/Senior Officer of Bandhan Bank
If Yes men on the details below: I/We declare (s) that we I/We am/are related to the director(s) and or Senior
Officer(s) of Bandhan Bank or any other bank specified hereto
No of years in Business
Acknowledgement Receipt (Customer Copy)
Source of funds for Business: Owned Borrowed
Sr. No Name of the Director(s) Senior Officer(s) Designa on Rela onship Bandhan Bank will convey its decision (within 2 weeks for credit limit up to Rs. 5 lakh and
Applica on No
within 3 weeks for credit limit above Rs. 5 lakh and up to Rs. 25 lakh for Micro & Small Business Address
enterprises borrowers) and (within 30 working days for other borrowers) from the date of
Product Code
receipt of the application provided the application is complete in all respects and is
submitted along with all the documents as per 'check list' provided in the application for Date P.S. City
loan and/or any additional documents as may be required by the bank for proper
appraisal of the application. The computation of timelines shall start from the day on State Pin Code
which all documents required for a proper appraisal of the application are provided by
the Customer to bank. The Loan processing fee would be 2 % of the loan amount plus
Nearest Landmark
applicable tax approved by the Bank. Indicative rate of interest up to 18% p.a. SI bounce Office Tel No Mobile No
charges: Rs 100/- plus applicable tax per instance. Please note, the interest rate and
Date D D M M Y Y Y Y charges mentioned are indicative; these would be as per the rates mentioned in the Business Website
Sanction Letter, if the loan is sanctioned.
Place _________________ Email ID
Date D D M M Y Y Y Y Loca on: Metro Urban Semi urban Rural
On Behalf of Bandhan Bank
Place _________________ Authorised signatory Business Premises ownership: Self-Owned Parental owned Rent Leased
Signature of the Applicant Signature of Co-Applicant/Guarantor No of Employee working in the firm/company