Loan Application Form

Please fill information in capital letters and in black ballpoint pen only
(Note:- All field in "*" are mandatory)
Requested Loan Details
Product Name Home Loan Ready Purchase Home Top-up Loan
Home Self Construction Loan Home Equity Loan Date
Home Improvement Loan Composite Loan
Customer ID
Home Under Construction Purchase Staff Loan
Branch Name
Category Semi-Formal Informal
Branch Code
Loan Purpose
Loan Amount Applied for (In Rs.) Lead Type Open Market Existing Customer Staff

Tenure (In Months) Preferred EMI (In Rs.)

Applicant’s Details Applicant Co-Applicant

(in block letter)
Applicant Type Individuals Non Individuals Individuals Non Individuals
Salutation* Mr. Ms. Mrs. M/s. Mr. Ms. Mrs. M/s.
First Name*
Middle Name
Last Name*
Mother’s Maiden
Name (If any)
Father’s Name OR Spouse Name Father’s Name OR Spouse Name
First Name*
Last Name*
Nationality Indian NRI Other Indian NRI Other
Religion Hindu Muslim Sikh Christian Hindu Muslim Sikh Christian
Zoroastrian Buddhist Jain Other Zoroastrian Buddhist Jain Other
Category* General OBC SC* ST* NT General OBC SC* ST* NT
Others Minority* Others Minority*
Gender* Male Female Transgender Male Female Transgender
Date of Birth/
Incorporation*
Qualification* S.S.C H.S.C Graduate / Diploma S.S.C H.S.C Graduate / Diploma
Incorporation* Post Graduate Others Post Graduate Others
Marital Status* Married Single Widowed Divorced Married Single Widowed Divorced
No. of Dependents (Including Children)
(Including Children)
Nationality Indian Non Resident Indian Person of Indian Origin
Relationship with Applicant
Current Residential Address* Others
Address line 1*
Address line 2
Address line 3
Area Name
City/Town/Village*
District*
State*
Pincode*
Mobile No.*
Alternate Mobile No.(+91)
Phone No. (with STD Code) - -
E-mail ID* (Personal)

Current Residence Owned Family Rented Company Leased Owned Family Rented Company Leased
Period of Stay If Rented, Rent P.M. If Rented, Rent P.M.
Permanent Address Tick if same as Current Address
Address line 1*
Address line 2
Address line 3
Area Name
City/Town/Village*
District*
State*
Pincode*
Phone No. (with STD Code) - -
 KYC Document
Proof of Identity* Applicant Co - Applicant
PAN No.*
Aadhaar No.
Passport No.
Driving License No.
Voter ID
NREGA Job Card
Others (Any document notified
by the Central Government)
ID No.
Proof of Address* Passport Driving License Aadhaar Passport Driving License Aadhaar
Voter ID NREGA Job Card Voter ID NREGA Job Card
Others Others
Occupation Details
Occupation Category* Salaried Business Professional Retired Salaried Business Professional Retired
Farmer Others Farmer Others
Employer / Business
Name*
Address line 1*
Address line 2
Address line 3
Area Name
City/Town/Village*
District*
State*
Pincode*
Phone No. (with STD Code) - -
E-mail ID* (Official)

If Salaried* Central / State Govt. Pvt. Ltd. Public Ltd. Central / State Govt. Pvt. Ltd. Public Ltd.
Public Sector Undertaking Educational Inst. Public Sector Undertaking Educational Inst.
MNC Proprietor / Partnership Others MNC Proprietor / Partnership Others
Designation Designation
Current Work Experience Current Work Experience
Total Work Experience Total Work Experience
If Business* Trader Manufacturer Wholesaler Trader Manufacturer Wholesaler
Service Provider Others Service Provider Others
If Professional* Doctor CA/CWA/CS Architect Lawyer Doctor CA/CWA/CS Architect Lawyer
Others Others
Date of Commencement Date of Commencement
of Business / Profession of Business / Profession
Entity Type* Proprietary Partnership LLP Pvt. Ltd. Proprietary Partnership LLP Pvt. Ltd.
(Business / Professional)
Public Ltd. Trust Society HUF Individual Public Ltd. Trust Society HUF Individual

Correspondence
Current Permanent Office Current Permanent Office
Address*
Registered with GST Yes No Yes No
If yes, GSTIN

Loan and Property Details.

Land Area (Sq. Mtr.) Built up Area (Sq. Mtr.)
Ownership Sole Joint Land Type Freehold Leasehold Carpet Area . Sq.Mtr.
Property Address
City / Town
District
State
Pincode Landmark
Agreement Value (`) Cost of Plot & Construction (`)
 Bank Account Details
Applicant Co - Applicant
Bank Name
A/C Type Savings Current Over Draft Savings Current Over Draft
A/C No.

*Has/Have applicant(s) given Guarantee to any loan with USFB Yes No

Loan Repayment Mode NACH/SI Post Dated Cheque Cash
Family Information & Household Income Declaration
Relationship with ID ID Education Income/ Health
Name Age NGP* Occupation
Applicant Type Number Level Contribution (H/U/D)**

For office use only

Application Through Direct Sales Team Connector Customer Referral USFB Staff Others
Login Fees
Amount in Rs. Cash Cheque Online Cheque No. Date

Referrer Name Referrer ID:

Loan Officer Employ ID: UJJ Designation
Approver from Business Employ ID: UJJ Designation
Approver from Credit Employ ID: UJJ Designation
Loan Officer Employ ID: UJJ Designation
Connector Name Connector Code

Acknowledgement of Loan Application

Ujjivan Small Finance Bank Ltd. (USFB) acknowledge the receipt of loan application form (Applicant’s Name).
We shall convey our decision on this application within 30 days from here off.

Name of Loan Officer Signature Date

Declaration

“I/we authorize Ujjivan Small Finance Bank Ltd. to use my/our contact number mentioned in the form for transactional/promotional/service calls/massages.”

Applicant’s Name Co-Applicant’s Name

Applicant’s Signature Co-Applicant’s Signature

Co-Applicant’s Photo
Applicant’s Photo

Date Date
 Guarantor / Additional Co-Applicant Form
Please fill information in capital letters and in black ballpoint pen only

Guarantor Co-Applicant Name of Loan Applicant

Personal Details (Individual)
Relationship with Applicant
Name
Present Address Same as applicant

Gender Male Female Transgender House No.

Father’s Name Street/Area
City
Mother’s Name District
State
Mother’s Maiden
Name
Pin code
House Type Owned Leased Rented Years of saty
Spouse Name
Mobile No.

Date of Birth Permanent Address Same as applicant Preferred Address for Communication

Marital Status Single Married Widow Divorced Separated House No.

Nationality Indian NRI Other Street / Area
Religion Hindu Muslim Sikh Christian Landmark
Zoroastrian Buddhist Jain Other
City
Category SC ST OBC General Other Person with Disability
District
Highest Academic Qualification State
PAN Number
Pin code
UID No. Date of Issue
House Type Owned Leased Rented
VID No. Date of Issue Mobile No.
Passport No. Date of Expiry Nature of Employment Self Employed Salaried
Driving Licence Date of Expiry Wage Worker Contract Worker Farming

Occupation Details
Co-Applicant / Guarantor
Occupation Category* Salaried Business Professional Retired
Farmer Others
Employer / Business
Name*
Address line 1*
Address line 2
Address line 3
Area Name
City/Town/Village*
District*
State*
Pincode*
Phone No. (with STD Code) -
Extension No.
E-mail ID* (Official)

If Salaried* Central / State Govt. Pvt. Ltd. Public Ltd.

Public Sector Undertaking Educational Inst.
MNC Proprietor / Partnership Others
Designation
Current Work Experience
Total Work Experience
If Business* Trader Manufacturer Wholesaler
Service Provider Others
If Professional* Doctor CA/CWA/CS Architect Lawyer
Others
Date of Commencement
of Business / Profession
Entity Type* Proprietary Partnership LLP Pvt. Ltd.
(Business / Professional)
Public Ltd. Trust Society HUF Individual
 Correspondence
Current Permanent Office Current Permanent Office
Address*
Registered with GST Yes No Yes No
If yes, GSTIN

Bank Account Details.

Co-Applicant / Guarantor
Bank Name
Account Type Savings Current Over Draft
Account No.
IFSC Code
Declaration

“I/we authorize Ujjivan Small Finance Bank Ltd. to use my/our contact number mentioned in the form for transactional/promotional/service calls/massages.”

Name
Co-Applicant’s Photo

Date

Signature
Loan Officer Emp. ID UJJ
Cluster/Program Manager Emp. ID UJJ

Credit Officer Emp. ID UJJ

Note: This form is an addendum to the Home Loan Application form.
 Loan Applicant Form - Annexure
Please fill information in capital letters and in black ballpoint pen only

Loan Purpose
Home Loan Ready Purchase Home Top-up Loan
Home Self Construction Loan Home Equity Loan
Home Improvement Loan Composite Loan
Home Under Construction Purchase Staff Loan

Loan Amount Requirement:

Cost of Estimate (For Home Improvement, Under-Const., Self-Const.)
Cost of Home Purchase

Details of the Property offered as Security

Property Type Flat Individual House Vacant Site Plot

House No.
Complete Street / Area Name
Address of the
Property Landmark
City / District

State

PIN Code

Approximate value of the property (Rs.)

Is the Property Mortgaged / Held as Security at Present

No Yes (Pls Specify )

Property Type

Residential Mixed (Residential and Commercial)

Commercial Others (Pls Specify )

Any litigation and Disputes on the Property

No Yes (Pls Specify )

Name of the Property Owner

Relationship of the Property Owner with the major income earning member

Will the property be offered as security to Ujjivan Yes No

List of document submitted in support of ownership of the property

Applicant’s Signature

Name of the main applicant

Signature

Name of property owner (if different from main Applicant)

Signature
Date
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 DECLARATION FOR SIGNING IN VERNACULAR LANGUAGE

I, Son/Daughter of

residing at do hereby state and declare on solemn affirmation as under:

I have read out and explained the contents of the loan application and all other documents incidental to availing the loan

from Ujjivan Small Finance Bank L td. to M r./Mrs Mr./Mrs.

and Mr./Mrs. in the language known to him/her/there and

he/she/they have understood the same and agreed to abide by all the terms and conditions of the loan and the clause
of the same

He/she/they have affixed his/her/there signature/ thumb impression here in below pursuant to the same.

I declare that whatever I have stated herein above is true and correct to the best of my knowledge and belief the same.

Solemnly affirmed at on this day of

Witness

Name: Signature:

For Ujjivan Small Finance Bank Ltd.

Name: Date:

Emp. ID:

Borrower (Sig) Co-Borrower (Sig) Co-Borrower (Sig)

Borrower Name Co-Borrower Name Co-Borrower Name

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 PROPERTY VISIT REPORT
Visit Date

Applicant Name:

Co - Applicant Name:

Property Owner Name (as per property document):

Loan Type:

Loan Amt: Tenor: Months

Property Address (as per property document):

Property Address (as per visit):

Property Land Mark:

Proximities of Civic Amenities:

Development in the Area:

Property Description:

Remarks:

Opinion:

(Property Visited By)

Employee Name: Employee ID:UJJ

Signature with Date:

Property photographs along with the customer (one each - out side with street and in side)
MAP
 Login Cum Customer Screening Sheet
Basic Details
Branch Name: Date of Visit:
Applicant Name: Contact Number:
Product Name: Applied Loan Amount:

Login Checklist Guideline for filling the checklist: Y - Yes, N - No. NA - Not Applicable
Document Loan Officer Credit Officer
HL Application Form
Application Form Annexure
2nd Co-Borrower and Guarantor Sheet (If Applicable)
ID Proof for Applicant and Co-Applicants (2 Copies including 1 for Insurance)
Residence Proof for Applicant and Guarantor (2 Copies including 1 for Insurance)
Signature Proof Applicant, Co-Applicant and Guarantors
Passport Size Color Photos (1 each for Applicant, Co-Applicant and Guarantors)
Business Address Proof (If applicable)
Uptaded Passbook or Bank Statement Showing Transactions of the past 06 months. Borrower / Co-Borrowers
Proof of Income - Business / Salary for Applicant, Co-Applicant and Guarantors
Photograph of the Borrower with Business Unit in the background
Photograph of the Borrower with property (to be mortgaged) in the background
Photocopy of Property Document (Title/Chain/Revenue documents)
Cost Estimate (for Self-Construction / Home Improvement Loan)
Guarantor Details if applicable (KYC / Application / Income Documents)
Product Feature Slip
Customer Screening Details
Income Details
Name Relation with Applicant Income Source Monthly Net Income Experience (Years)

Total Household Income

Existing Loan Details
Lender Name Loan EMI Total Loan Amount Tenor Outstanding Loan Amount Tenor

Is there any closed loan? If yes, Loan Amount of closed loans

Is there any late payment in existing or closed loan? If yes mention
reason:

Loan Purpose Details

Loan Purpose: Loan Amount Required

Total Estimated / Purchase Cost: Margin Money

Work Start / Registration date - Planned: Source of Margin Money

Legal / Technical Aspects

Property Owner Name Boundry Matching? (Yes / No):
Relation with Applicant Title Chain Availability (Years):
Building Plan Approval (Yes/No) Road width to the House (Feet)
Other Details
Assets created in last 10 years
Amount invested in asset creation in last 10 years
How much EMI can this applicant pay comfortably after factoring all expenses
Is property owner ready to mortgage property with USFB?
Reference Checks (to be done by Loan Officer)
Response from Reference Check

Neighbour Reference Check

Employment/Business Reference Check

LO Name:

Credit Visit Report Date of visit

If the details provided by LO does not match with credit assessment/checks, mention the same as below
Mismatch Details Reason for mismatch

CO/CM Name CO/CM ID CO/CM Signature

OFFICE COPY
PRODUCT FEATURE - HOME LOANS
Ujjivan Small Finance Bank Limited
Home Loan Product Features:

Loan Amount Tenure Other Cost & Charges

Product Type (In Rs Lakhs) (In Months) (Non - Refundable)

Home Improvement Loan Log in Fees,

2,00,000- 25,00,000 36 - 120
(Secured) Rs 3000 + GST (Informal) &
Rs 2000 + GST (Semi - Formal)
Interest rate and Legal &
Home Purchase Loan 2,00,000- 75,00,000 36 - 240
Documentation Charges
as per sanction letter issued to
customer
Home Construction Loan 2,00,000- 75,00,000 36 - 240
Life insurance premium as
Applicable
Home Equity Loan Stamp duty as appliacble in
(Non - Housing Loan) 3,00,000- 25,00,000 36 - 180
State / UT

CERSAI Charges
Composite Loan 2,00,000- 30,00,000 36 - 240 Rs.50 5 Lakhs (Ex. GST)
Rs.100 5 Lakhs (Ex. GST)

Acknowledgement
I hereby acknowledge that
the entire features of the loans described above & the cost and charges associated with the
same have been explained to me by USFB official.

Customer’s Signature: Date & Place:

CUSTOMER COPY
Ujjivan Small Finance Bank Limited
Home Loan Product Features:

Loan Amount Tenure Other Cost & Charges

Product Type (In Rs Lakhs) (In Months) (Non - Refundable)

Home Improvement Loan Log in Fees,

2,00,000- 25,00,000 36 - 120
(Secured) Rs 3000 + GST (Informal) &
Rs 2000 + GST (Semi - Formal)
Interest rate and Legal &
Home Purchase Loan 2,00,000- 75,00,000 36 - 240
Documentation Charges
as per sanction letter issued to
customer
Home Construction Loan 2,00,000- 75,00,000 36 - 240
Life insurance premium as
Applicable
Home Equity Loan Stamp duty as appliacble in
(Non - Housing Loan) 3,00,000- 25,00,000 36 - 180
State / UT

CERSAI Charges
Composite Loan 2,00,000- 30,00,000 36 - 240 Rs.50 5 Lakhs (Ex. GST)
Rs.100 5 Lakhs (Ex. GST)
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 CLSS - Eligibility Form
Applicant Name:
Property Owner Name:
Relationship between the Applicant and the Property Owner:
Product:
Loan Amount:
Tenure: ROI:

Eligibility Criteria for CLSS

1. How many members are there in the family of the applicant ? (A family consists of Husband, Wife and unmarried children)
Ans.

2. Is there any adult female member in the family ?

Yes No

3. The property comes under which area ?

Municipal Limits
Grampanchayat Limits
Any other (Mention here)

4. Does the applicant or any member of his/her family (viz., spouse or unmarried children) own a pucca house in any part of India ?
Yes No

5. Family Income of the applicant (per annum) ?

Up to Rs. 3,00,000 Rs. 3,00,001 to Rs. 6,00,000

Rs. 6,00,001 to 12,00,000 Rs. 12,00,001 to Rs. 18,00,000

6. Whether the Beneficiary Family has availed central assistance under any Housing Scheme from Government of India ?
Yes No

7. Expected Carpet area of the property ?

Up to 30 Sq. Mtr (323 Sq. Ft.) Up to 60 Sq. Mtr (646 Sq. Ft.)

Up to 160 Sq. Mtr (1722.23 Sq. Ft.) Up to 200 Sq. Mtr (2152.78 Sq. Ft.)

8. Copy of Identity proof of all the adult family members have been collected: (Aadhar Card, PAN Card, Voter ID Card, Passport for
any other please mention type and number in blank space)

Proof Type UID No.

Member - 1
Member - 2
Member - 3
Member - 4

9. Is the customer eligible for CLSS ? (to be verified by CO)

Yes No
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To,
Ujjivan Small Finance Bank Ltd.,
Branch.
I/We,
1_________________, aged _________years, son / wife of______________________(“the Borrower” or “the Beneficiary”)
2_________________, aged _________years, son / wife of______________________
3_________________, aged _________years, son / wife of______________________ (“the family members”)
4_________________, aged _________years, son / wife of______________________ (“the Guarantor”) all residing at
________________________, ________________________, ________________________state, declare undertake and
agree as follows:
1)

2)
3)
Relationship
Name of family Aadhaar Source of Annual Income
SL. No. Age Sex with
members Number Income (In Rupees)
the beneficiary
Self

Total
4)

5)

6)

7)

8)
9)

10)
11)

12)

13)

This Letter/Undertaking shall be treated as part and parcel of the loan documents executed/to be executed by me/us in favour of
the Bank in connection with the loan sanctioned/to be sanctioned under the Scheme.
Place :
Names & Signatures of the Beneficiary,
Date : We state that the above statements are true and correct. his Family Members and the Guarantor
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