LOAN APPLICATION FORM (MICRO BUSINESS LOAN)

Please fill the form in CAPITAL LETTERS with BLACK ink only.
CREDIT/LOAN FACILITIES APPLIED FOR- TERM LOAN

Type of Facilities Amount Tenure

Requested (INR) (Months)
Form No.
Micro Business Loan - Secured by Collateral

Micro Business Loan- Secured by Credit Guarantee

Micro Business Loan - Unsecured

Date D D MM Y Y Y Y

Other

A. APPLICANT DETAILS (Leave space between two words)

Existing
Customer Yes No Account No./CIF No. CKYCR No.
Constitution Individual Proprietorship Partnership Firm Pvt. Ltd. Society Trust Others

*Name
Father's
OR Name
Spouse
*Mother's Name
Telephone Telephone
*Mobile NO. +91 No. (R) No. (O)

*Email ID
(In Capital Letters)

Religion Hindu Muslim Sikh Christian Jain Buddhist Zorastrian Others *Gender M F T
Category General SC ST OBC Others Date of Birth/
Marital Status Married Single Widow(er) Divorced * Nationality Indian Others Incorporation D D M M Y Y Y Y

Place of Birth/Incorporation
(Please provide
*PAN No. Form 60 Form 49A if PAN applied)

GST No. UDYAM No. U D Y A M - - -

Visually Impaired/Handicapped/Specially Abled YES NO
Education Illiterate Undergraduate Graduate Postgraduate Professional Degree Others
* Residential Status Resident Non-Resident PIO OCI Foreign National Do you want this account to be seeded with Aadhaar Yes No

*Address Line 1 Current Address

ADDRESS 1

Landmark *City

*District *State * PIN Code

Country India Others Number of years of stay at current city Number of years of stay at current Residence
Property Status Self-Owned Rented Company Provided Parental Others

*Address Line 1 Permanent Address

ADDRESS 2

Landmark *City

*District *State *PIN Code

Country India Others Property Self-Owned Rented Company Provided Parental Others
Status
KYC DETAILS
*Proof of Passport Driving Licence Aadhaar Voter ID Others *ID No.
Identity

* Proof of Passport Driving Licence Aadhaar Voter ID Others *ID No.

Address
OCCUPATION
Self-employed Self-employed Others
Professional Please paste your recent
Agri
Foreign Currency Exposure Yes No Annual Income (INR) passport size color
BUSINESS DETAILS photograph
here and sign across
*Total Exp. in Years Months the photograph
* Entity Name Business
Nature of
Business Manufacturer Service Provider Trader Agri & Allied Activities Others

Business Premises Self-Owned ( Mortgaged Free) Rented Parental Others Please do not use
pins, tape, staples
*Address Line 1 on the photograph
ADDRESS

Address Line 2

*City *District *Pin Code

Landmark *State Country India Others

Applicant's Signature

NAME & DETAILS OF BENEFICIAL OWNERS/ AUTHORISED SIGNATORIES

Name Age Gender Designation PAN Shares (in %) Contact No. ID Proof

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 B. CO-APPLICANT DETAILS (Leave space between two words)

Existing
Yes No Account No./CIF No. CKYCR No.
Customer

Constitution Individual Proprietorship Partnership Firm Society Trust Others

* Name
Father's
OR Name
Spouse
* Mother's Name
Telephone Telephone
* Mobile No. +91 No. (R) No. (O)

* Email ID
(In Capital Letters)

Religion Hindu Muslim Sikh Christian Jain Buddhist Zorastrian Others Gender M F T

Category General SC ST OBC Others

Marital Status Married Single Widow(er) Divorced * Nationality Indian Others *Date of Birth/ D D M M Y Y Y Y
Incorporation
(Please provide
* PAN No. Form 60 Form 49A if PAN applied)
* Residential Status Resident Non-Resident PIO OCI Foreign National

GST No. Visually Impaired/Handicapped/ Specially Abled YES NO

Education Illiterate Undergraduate Graduate Postgraduate Professional degree Others

Relationship with Applicant Place of Birth/ Incorporation

*Address Line 1 Current Address

Address Line 2
ADDRESS 1

Landmark *City

*District *State * PIN Code

Country India Others Number of years of stay at current city Number of years of stay at current Residence

Property Status Self-Owned Rented Company Provided Parental Others

*Address Line 1
Permanent Address
ADDRESS 2

Landmark * City

*District *State *PIN Code

Country Property
India Others Status Self-Owned Rented Company Provided Parental Others

KYC DETAILS

* Proof of Passport Driving Licence Aadhaar Voter ID Others * ID No.

Identity

* Proofof
Address * ID No.
Passport Driving Licence Aadhaar Voter ID Others
OCCUPATION
Govt. Self-employed Self-employed Agri Retired Others
Salaried
Private Professional
Public
Foreign Currency Exposure Yes No Annual Income (INR)
EMPLOYER/BUSINESS DETAILS
* TotalExp. in
* Entity/ Employer Name Years Months Please paste your recent
Job/Business
passport size color
Nature of Manufacturer Service Provider Trader Wholesaler Others photograph
Business here and sign across
the photograph
Constitution of Proprietorship Partnership Firm Pvt. Ltd. Others
Business Entity
Proof
Business Premises Self-Owned ( Mortgaged Free) Rented Parental Others Please do not use
pins, tape, staples
on the photograph
*Address Line 1
ADDRESS

Address Line 2

*City * District *Pin Code

Landmark * State Country India Others

Co-Applicant's Signature

NAME & DETAILS OF BENEFICIAL OWNERS/ AUTHORISED SIGNATORIES

Name Age Gender Designation PAN Contact No. ID Proof Shares (%)

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 C. CO-APPLICANT / GUARANTOR'S DETAILS (Leave space between two words)

Existing
Customer Yes No Account No./CIF No.
Please paste your recent
passport size color
CKYCR No. photograph
here and sign across
the photograph
Constitution Individual Proprietorship Partnership Firm Pvt. Ltd. Public Ltd. Society Trust Others

* Name Please do not use

pins, tape, staples
on the photograph

Father's
OR Name
Spouse Co-Applicant's/ Guarantor's
Signature

* Mother's Name

Telephone Telephone
* Mobile No. +91
No. (R) No. (O)

* Email ID
(In Capital Letters)

Religion Hindu Muslim Sikh Christian Jain Buddhist Zorastrian Others * Gender M F T
Category General SC ST OBC Others
* Date
of Birth/
Marital Status Married Single Widow(er) Divorced * Nationality Indian Others D D M M Y Y Y Y
Incorporation

* PAN No. (Please provide

Form 60 Form 49A if PAN applied) * Residential Status Resident Non-Resident PIO OCI Foreign National

GST NO.

Education Illiterate Undergraduate Graduate Postgraduate Professional degree Others

Relationship with Applicant Place of Birth/ Incorporation

*Address Line 1
Current Address
ADDRESS 1

Address Line 2

Landmark * City

*District * State * PIN Code

Country India Others Number of years of stay at current city Number of years of stay at current Residence

OCCUPATION
Govt. Self-employed Self-employed Agri Retired Student Housewife Others
Salaried Private Professional
Public

Foreign Currency Exposer Yes No Annual Income (INR)

Property Status Self-Owned Rented Company Provided Parental Others

*Address Line 1 Permanent Address

ADDRESS 2

Landmark *City

*District * State * PIN Code

Country India Others Property Self-Owned Rented Company Provided Parental Others
Status
KYC DETAILS

* Proofof Passport Driving Licence Aadhaar Voter ID Others * ID No.

Identity

* Proof
of
Address Passport Driving Licence Aadhaar Voter ID * ID No.
Others

NAME & DETAILS OF BENEFICIAL OWNERS/ AUTHORISED SIGNATORIES

Name Age Gender Designation PAN Contact No. ID Proof Shares (%)

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 D. EXISTING LOAN DETAILS
Account/ EMI Amount Facility Amount
S. No. Account No. Name of Institution Facility Type Tenure (INR) (INR)
1

E. REFERENCES

* Name
Reference 1

* Mobile No. 9 1 Relationship with Applicant Years of acquaintance

* Address

* email

*Name
Reference 2

*Mobile No. 9 1 Years of acquaintance

Relationship with Applicant

* Address

* email

F. PRIORITY SECTOR CATEGORY

Farm Credit Individual Farmers engaged in allied activities viz., dairy, fishery, animal husbandry, poultry, bee-keeping and sericulture.

Land Holding (acres) 0-2.47 2.48- 4.94 4.95 & above Specify (acres): Location : PIN :

Agri Infrastructure: Loans for construction of storage facilities (warehouses, market yards, godowns and silos) including cold storage designed to store agriculture produce/products
Ancillary activities: Food & Agro processing
Manufacturing or Service Enterprise :
Investment in P&M or Equipment upto INR 1 Cr. > INR 1 Cr. to INR 10 Cr. > INR 10 Cr. to INR 50 Cr. > 50 Cr.

Value of Investment (WDV) :

upto INR 5 Cr. > INR 5 Cr. to INR 50 Cr. > INR 50 Cr. to INR 250 Cr. > 250 Cr.
Annual Turnover

Annual Turnover
(Professional/Non-Professional/SRTO/Trade/Retail Trade)
:
Khadi & village industries (KVI sector): For the purpose of Agriculture and/or to assist the transport of own agriculture input, agriculture produce and farm product.
Declaration: I/we hereby declare/confirm that the vehicle purchased/ to be purchased/loan availed/to availed by me/us shall be used:
I/we are aware that it is on the faith of this representation, declaration and confirmation that you have agreed to consider my loan application for financial assistance
under the category of priority sector adcances. I/We shall indemnify the bank of make the loss of good in the event of any loss or damage that may arise on account of false/incorrect
declaration by me/us.

G. DECLARATION OF PURPOSE OF LOAN

The Facility applied will be utilized for below mentioned purpose

Purpose of Loan Business Amount Required Purpose of Loan Business Amount Required

Working Capital Agri & Allied

Activities

Cattle Purchase
Stock Purchase

Shop & Office Commercial

Purchase Contruction

Plant & Machinery Other Business

Purchase

Capital Expenditure Requirement

H. DETAILS OF PROPERTY OFFERED AS COLLATERAL

S. No. Type Name of Property Occupancy Status Area Address

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I. DOCUMENT CHECKLIST

Photograph Proof of Proof of Residence Loan 6 months SSI/MSME _______ Security Signature
(signed across) Identity Address Office Agreement Bank Statement Registration Post Dated Cheques Verification
Proof of turnover Last 2 yrs ITR with NACH/ Post Dated Income assessment working sheet Agri Land Docs
(Latest sales/service tax returns) computed income SI Mandate Cheques
Contract Copy/ Repayment Track Loan a/c statement for balance transfer/ Rent Agreement
Work Order Record balance transfer & top up. (if applicable for Residence & Business)
Projected balance sheets for the next two years in case of working capital limits and for the period of For partnership firm - Latest partnership deed, PAN of the firm and office address proof.
the loan in case of term loan
For company - Certificate of incorporation, MOA & AOA, PAN, Shareholding pattern and office
In case of takeover of advances, sanction letters of facilities being availed from existing bankers/ address proof.
financial
I.T returns for last 2-3 years (as applicable) with computation of income for both business and
Institutions along with detailed terms and conditions. individuals i.e partners/directors.
Copy of lease deed/title deeds of all the properties being offered as primary and collateral securities.
Industry/sector specific documents with respect to mandatory licenses/registrations/qualifications. etc. Any other documents as may be required.

J. DETAILS OF FEES & CHARGES

1) Stamp Duty : At actual as per applicable law. 3) Processing Charges (Non-Refundable) if INR. ______________________
2) Interest rate of _________% p.a. 4) Other Fees & charges applicable as per schedule of charges available on the website

NOTE: (1) Visit http://www.aubank.in for detailed fees and charges under the respective loan product. Changes in charges form time to time are updated on bank's website.
(2) All of the above charge are subject to change as per the Bank's discretion form time to time. (3) All of above charges are exclusive of all statutory and Govenment taxes.

K. FATCA- CRS DECLARATION

( Please tick the applicable tax resident declaration( Any One)

I am a tax resident of India and not resident of any other country OR I am a tax resident of the country/ies mentioned in the table below :
Please indicate the country/ies in which the entity is a resident for tax purposes and the associated Tax Number below
City of Birth* ____________________________________________ Country of Birth* _____________________
Address Type for Tax Purposes* Resident Business Registered office

Address for Tax purpose*

Country# Tax Identification Identification ( TIN or
Number^ Other please specify)^ Communication Address Permanant Address Please note the Address below

Landmark________________________________________________

PIN State _____________ Country_________________

# To also include USA, where the individual is citizen/green card holder of USA^ In case tax identification number is not available, kindly provide functional equivalent
FATCA-CRS Certification: I have understood the information requirements of this from (read along with the FATCA/CRS instuctions and Terms & Conditions) and hereby confirm
that the information provided by me/us on this Form is ture, correct, and complete and hereby accept the same.

L. LEGAL ENTITY IDENTIFIER (LEI) DECLARATION (APPLICABLE FOR NON- INDIVIDUALS ONLY)

I/We confirm that the total banking exposure of our firm/company after availing the proposed loan/ credit facility is above Rs.25 Crore. The Legal Entity Identifier( LEI)
is applicable to our firm/company and the details of the same are as under

1) LEI No.: 3) LEI Issuance Date:

2) LEI Issuer: 4) LEI Expiry Date :

I/We confirm that the total banking exposure of our firm/company after availing the proposed loan/ credit facility is Between Rs.5 Crore to 25 Crore. We Will endeavour
to obtain for the LEI at the earliest and agree to provide the LEI details to AU bank once we obtain the same.
I/We confirm that the total banking exposure of our firm/company after availing the proposed loan/ credit facility is below 5 crore. The Legal Entity Identifier (LEI) is
not applicable to us.
I/We confirm that if total banking exposure of out firm/company goes beyond Rs. 5 Crore during the tenure of the loan/credit facility ,we will endeavour to obtain
the LEI at the earliest and agree to provide the LEI details to AU bank once we obtain the same

I/We declare that the particulars and information given above are true , correct and up to date in all aspects.

DETAILS OF FEES & CHARGES (Custmer Copy)

1) Stamp Duty : At actual as per applicable law. 3) Processing Charges (Non-Refundable) if INR. ______________________
2) Interest rate of _________% p.a. 4) Other Fees & charges applicable as per schedule of charges available on the website

NOTE:
(1) Visit http://www.aubank.in for detailed fees and charges under the respective loan product. Changes in charges form time to time are updated on bank's website.
(2) All of the above charge are subject to change as per the Bank's discretion form time to time.
(3) All of above charges are exclusive of all statutory and Govenment taxes.

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M. DECLARATION

1. I/We declare that all the particulars and information and details given/filled in this application form are true, correct, complete and up-to-date in all respects and that I/we have not withheld
any information whatsoever.
2. I/We confirm that no insolvency proceeding or suit for recovery of outstanding dues or monies whatsoever or for attachment of my/our assets or properties and or proceeding have been
initiated and /or are pending against me/us and that I/We have never been adjudicated insolvent by any court or other authorities.
3. Neither action nor other steps have been taken or legal proceedings started by or against me/us in any court of law/other authorities for winding up, dissolution, administration or re-
organization or for the appointment of a receiver, trustee or similar officer or for my/our assets.
4. I/We understand and acknowledge that AU Small Finance Bank Ltd. shall have the absolute discretion without assigning any reason (unless required by applicable law) to reject my/our
application and that AU Small Finance Bank Ltd. shall not be responsible/lilable in any manner whatsoever to me/us for such rejection or any delay in notifying me/us of such rejection or
any costs, losses, damages or expenses, or other consequences, caused by reason of such rejection of our application.
5. AU Small Finance Bank Ltd. its group companies reserves the right to retain the photographs and documents submitted and will not return the same to the applicant
6. I/we am / are not the director(s) of AU Small Finance Bank Ltd and also not a director(s)/ partner(s), managing agent(s), employee(s) or guarantor(s) or holder(s) of substantial interest of
the borrower or its subsidiary or its holding company. if yes, Please specify____________________________________________________________________________________
7. I/we am/ are not the director(s) of any other bank or the subsidiary of any of the banks or trustees of mutual funds/venture capital funds set up by the banks and also not a director(s)/
partner(s), manager(s), managing agent(s), employee(s) or guarantor(s) or holder(s) of substantial interest of the borrower, If Yes, Please Specify
_____________________________
_______________________________________________________________________________
8. I/We am/ are neither related to any of the directors of AU Small Finance Bank Ltd. nor any other bank, as defined by extant guidelines of RBI from time to time and also not a
director(s)/partner(s) or major shareholder(s) or in control of the borrower or a major shareholder(s) or in control of the holding or subsidiary company of the borrower,
If yes, please specify _________________________________________________________________________________________
9. I/We hereby represent, warrant and confirm that the offers and purpose is a valid purpose and also agree and undertake to utilize the loan only for the above mentioned purpose and that
the loan shall not be used for any illegal and/or anti-social and/or speculative purpose including but not limited to participating in stock market/IPOS
10. I/We have been explained the product features for which I/We have applied for. I/We have read and understood the terms and conditions of the loan product of AU Small Finance Bank Ltd.
and I/We agree to abide by them. All the terms and conditions set out in the Facility Terms shall govern and apply to the facility and all my/our obligations (as well as AU Small Finance
Bank Ltd.'s rights and remedies) in relation thereto, if the facility applied for by me/us herein is sanctioned and granted by AU Small Finance Bank Ltd. based on my/our application.
11. I/We further authorize AU Small Finance Bank Ltd., and or its associates/subsidiaries/affiliates and have NO OBJECTIONS to verify any information by visiting at my office/residence and/or
contact me and/or my family members and/or my employer/Banker/Credit Bureau and to conduct internal checks for all my submitted documents and other information pertaining to the
policies of AU Small Finance Bank Ltd.. I/We also authorize AU Small Finance Bank Ltd. to conduct ROC search and charge creation against the facilities availed by me/us.
12. I/We hereby confirm that, I/We have no objection on AU Small Finance Bank Ltd. getting Guarantee Cover from CGFMU/CGTMSE (applicable in case of CGFMU/CGTMSE proposals only)
13. I/We undertake to inform AU Small Finance Bank Ltd, regarding any changes whatsoever in my/our address, email ID, contact number as specified herein above.
14. I/ We acknowledge and agree that the grant of the facility by AU Small Finance Bank Ltd, to me/shall be subject to compliance by me/us of the terms and conditions set out under this
Application Form, Sanction Letter and its schedules (collectively, the "Facility Terms")
15. I/We confirm that the Processing Fee paid by me/us is Non-refundable under any circumstances whatsoever including but not limited to decline/part disbursement/disbursement of the
facility.
16. From time to time, AU Small Finance Rank Ltd. communicates various features/products/promotional offers which offer significant benefits to its customer and may use the services of third
party agencies to do so. Do you wish to be informed about such benefits?
I/We expressly authorize AU Small Finance Bank Ltd. to use information or data relating to me/us, for communicating marketing offers as outlined above. (Please tick)
I/We do not wish to receive offers as outlined above. (Please tick)
17. I/We am/are relative/ known to an AU Bank Employee Yes No If Yes, then details are: __________________________________________________________________________
18. It is stated that the Customer/Account holder has provided consent that the Bank can extract his/her personal details, or any details as required by the Bank under law from CERSAI or any
other authority by way of submission of his/her CKYCR number, in accordance with RBI guidelines or any other relevant law.

Terms & Conditions: AADHAAR

1/We hereby give my consent to AU Small Finance Bank Ltd. to obtain my Aadhaar Number, Name and Fingerprint /iris for authentication with UIDAI. Bank has informed me that my identity
information would only be used for KYC and also informed that my biometrics will not be stored/shared and will be submitted to CIDR only for that purpose of authentication
I hereby grant my consent to subscribe and receive promotional campaigns, and important information and updates relating to my bank account, loan, insurance & other products and
communications from the bank on my WhatsApp mobile/alternative mobile no.................

Signature of Applicant Signature of Co-Applicant Signature of Co-Applicant/Guarantor

FOR BANK'S INTERNAL USE ONLY

Risk Level of the applicant based on KYC-AML guidelines: Low Medium High Lead Number

Loan Account No. Prome Code 1

LG Code LC Code TL Emp. ID Prome Code 2

Sourcing Channel Direct AU Value AU Connect Referral Other Channels

Channel Name Channel Code
Customer ID Document Submitted Customer ID Document Submitted
Applicant ID Proof Add Proof Photo Co-Applicant ID Proof Add Proof Photo

Document Submitted
Guarantor ID Proof Add Proof Photo Co- Applicant ID Proof Add Proof Photo
I confirm that I have visited the communication address(es) of the applicant(s) mentioned in the Application Form and the Applicant/Co-Applicant/Guarantor has signed in my presence

Signature of SO/BM/PBM RPC/CPC Stamp with Date RCU Signature & Date

Application ID:___________________
We acknowledge that we have received an application dated___________________ from Mr./Ms/M/s_______________________________________________________ resident of/situated at___________________________________

for a loan of INR__________________under_______________________________________________ and decision on sanction or rejection shall be communicated within 90 days from receipt of this application & all other relevant

particulars by the Bank.

For AU Small Finance Bank Ltd.
Please Note that:
1. This is only an acknowledgement for having received the application and this should not be construed as an
indication for our acceptance of the proposal. A decision on which will be taken only after due consideration of the
proposal on its merit and/or on fulfilment of conditions if any, that may be stipulated by the Bank.
2. The application will be taken for consideration only after all the particulars/date/documents as may be required are
received by the Bank.
3. In case the proposal is rejected/not considered, the reasons for the same will be intimated to the applicant. (Sign & Employee ID)
In case of query, you can drop us a mail at customercare@aunbank.in or call us at Toll Free No.: Authorised Signatory
1800 1200 1200

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