MSBW LOAN APPLICATION FORM
(Separate Form to be obtained from Applicant / Co-applicant
PERSONAL DETAILS APPLICANT CO-APPLICANT
Name Gender M F T*
T* Transgender
Salutation Mr Mrs Ms Dr. Other Date of Birth
Marital Status Married Unmarried Other Name of Spouse Attach your
recent passport
No. of Dependents No. of Children Name of Father size photograph
Mother’s Name here
Nationality Residential Status Resident NRI/PIO If NRI, Country of Resi.
Religion Category Minority SC ST OBC Gen. If Minority :
Please sign here
Place of Birth Photo Identification (ID): Type
Photo Identification (ID): Number Photo ID valid upto
Driving License No. Driving License Valid Upto
Passport No Passport Valid Upto
PAN No. Aadhar No. Educational Qualification
Present Address: Staying at the present address for the past Years and Months. Type of Residence Owned Rented Alloted by Employer Other
House /Flat Apartment No. or Name
Street Name & No. and Area/Location
Landmark
City District Pin Code
State Country
Telephone (Landline) Mobile (Primary) Mobile (Secondary)
Email (Personal)
Permanent Address: Is permanent address same as present address? Yes No (To be filled if permanent address is different from present address)
House /Flat Apartment No. or Name
Street Name & No. and Area/Location
Landmark
City District Pin Code
State Country
Telephone (Landline 1) Telephone (Landline 2)
Office / Business Address:
Name of Org/Employer, Dept, & Floor
Street Name & No. and Area/Location
Landmark
City District Pin Code
State Country
Telephone (Landline) Mobile (Primary) Mobile (Secondary)
Email (Organizational)
Repayment Mode Cheque NACH Auto recovery from SB Account SI (Standing Instruction) Others
Reference (Names and address of two referees who are not related to you):
Name: Name:
NBFC Bank may Address: Address:
make enquiries
from the referees
if it deems
Email: Email:
necessary.
Tel: Mob: Tel: Mob:
MSBW LOAN APPLICATION FORM
EMPLOYMENT & INCOME DETAILS APPLICANT CO-APPLICANT
Nature of Occupation Salaried Agriculturist Businessman / Self Employed Professional / Proprietor or Partnership firm Pensioner
Salaried Individual
Employer Name Employment Status Regular Probationary Contractual
Employer’s Address Contact No.
Total Experience Yrs Months in Present Job Yrs Months in Previous Job
Previous Employer’s Name Contact Number
Organization Type Public Sector Unit Listed Private Company Unlisted Private Company MNC
Central/State Government Local Civic Body
Department Designation
Employee No. Remaining Service Yrs Months Date of Retirement
Website
Agriculturist
Total Lands Owned and in possession Acres out of which. Allied Activities
i) Presently irrigated Acres i) Poultry
ii) Seasonally irrigated Acres ii) Diary
iii) Rain Fed Acres iii) Others Specify
Businessman / Self Employed / Proprietor or Partnership Firms
Nature of Business Manufacturing Company Services Company Trading Company Trading Firm Others
Business Name Industry
Business Address
Trade Licence No. Trade Licence Expiry date Share holding (%)
In case of Professional, Registration No
Income / Financial Details
Income Details Income Head Gross Income Net Income Frequency Mode of Payment
Salary
Business
Rent
Agriculture
Other
For Salaried individual the above details should be based on latest salary slip and for the non-salaried applicants the
details should be as per latest ITR filed.
Deduction Details
Head Gross Deduction Net Deduction Frequency Remark
Income Tax
Other
Net Salary / Income
Loan and Cheque Details
Total loan amount File Charge @ 4.5% Interest rate (as per profile)
Emi (as per profile) No. of cycle No. of cheque
Cheque No. Cheque Date Cheque Amount Applicant Signature Co-applicant Signature EMI Date
MSBW LOAN APPLICATION FORM
Declaration
I/we declare that all the particulars and information given in the application form or true, correct and they shall form the basis of any loan MSBW may decide to grant me/us. I/we
confirm that I/we have no insolvency proceedings against me/us nor have I/we ever been adjudged insolvent and further confirm that I/we have read the brochure and understood the
contents. I am/we are aware that the equated monthly instalment comprising principal and interest is calculated on the basis of monthly rests.
I/we agree that Bank may take up such reference and may make such enquiries in respect of this application as it may deem necessary. I/we undertake to inform the Bank regarding
any change in my/our occupation/employment and to provide any further information that the Bank may require. MSBW may make available any information contained in this form,
other documents submitted to MSBW and information pertaining to the loan to any Institution or body. The Bank may seek or receive information from any source/p erson to consider
this application. I/we further agree that my/our loan shall be governed by rules of MSBW which may be in force from time to time.
I/We authorize MSBW to exchange, share or part with all the information relating to my/our loan details/repayment history/information to other MSBW Branches/ other NBFC
Banks/Financial Institutions/Reserve Bank of India/ Credit Bureau Agencies/Statutory Bodies as may be required and shall not hold MSBW and/or its agents liable for use of this
information.
I/we further declare and agree that the information furnished hereinabove is true to the best of our knowledge and belief and in case any information is found to be false at a later date,
the bank has right to recall the advance and initiate appropriate action as it may deem fit.
Name
Date Signature of Applicant / Co-Applicant
