(To be stamped as an agreement and as an affidavit with additional stamp duty
for Notarial act, if sworn before Notary Public in accordance with stamp duty in
force in the State)
Before,
The Notary Public/Judicial/Executive/Special Magistrate,
_ _ _ _ _ _ _ __ _ _ _ _ _ _ _ _ _
(Place of Practice of the Notary Public/Place of Local Jurisdiction of the Magistrate to be
given here, as the case may be )
AFFIDAVIT
I, _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Son/Daughter/Wife of _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
_ aged _ _ _ _ _ _ _ _ (Date of Birth _ _ _ _ _ _ _ _ _ , Place of Birth _ _ _ _ _ _ _ _ _ _ _ _
_ ), by occupation _ _ _ _ _ _ _ _ _ resident of _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _, Telephone No._ _
_ _ _ _ _ _ _ (Office Address _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ , Tel. No._ _ _ _ _ _ _ _ _ _ _ _ )
do hereby solemnly affirm and declare on oath as follows:
1. That the State Bank of India, a Bank established under State Bank of India
Act, 1955 having its Branch at _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ (hereinafter referred to as Bank)
has at my request granted/and/or agreed to grant credit facility(ies) to the borrower _ _ _
_ _ _ _ _ _ _ _ _ _ _ (Name of the borrower), inter alia, against my guarantee and hence,
this affidavit is being sworn by me to satisfy the Bank about my worth/financial position.
2. That followings are my statement/details of assets & liabilities as on _ _ _ _
_ _ _ _ _ _ _ _ _ (give here date of swearing the affidavit) :-
a. DETAILS OF IMMOVABLE PROPERTY(IES)
Place(s) where Ancestral or If encum- Extent Market Whether Whether
land(s) or build- self ac- bered to what value in agricultural
ing(s) is/are situ- quired/ be- extent Of land Rupees. Any case/ or non-agri-
ated (Full ad- longing in in acres suit before cultural and
dress) individual any compe- whether
name / in tent comes in
joint names ceiling area
(if ances- Court au-
tral/ in joint thority in re-
names, spect of the
specify immovable
share property is
thereof) pending
1.
2.
b. LIQUID ASSETS
PARTICULARS Description Amount If encumbered to
what extent
Cash
Bank balance
c. GOVERNMENT SECURITIES :
(PLEASE GIVE FULL DETAILS)
d. SHARES :
(PLEASE GIVE FULL DETAILS OF SHARES)
e. LIFE INSURANCE POLICIES :
(PLEASE FURNISH THE SURRENDER VALUE)
POLICY NOS. :
f. JEWELLERY :
g. INVESTMENT IN BUSINESS IN ASSOCIATE FIRM, IF ANY :
h. INCOME PER MONTH :
i. LIABILITIES :
PARTICULARS :
i) BORROWINGS FROM BANKS :
ii) BORROWINGS FROM MARKET :
iii) BORROWINGS FROM OTHER SOURCES :
iv) ASSUMED INDIRECT LIABILITY :
3. That I undertake and declare further to notify to the State Bank of India, _ _
_ _ _ _ _ _ _ _ _ _ _ _ _ _ Branch, any change, whether by way of increase or diminution, in
the assets/liabilities as detailed above every year by _ _ _ _ _ _
4. That the Statements/declarations made in this affidavit in paragraphs 1 to 3
above are true to my knowledge.
Deponent:
Date:
Deponent is identified by _ _ _ _ _ _ _ _ _ _ _ _ _ _
