PERSONAL FINANCE

Aditya Birla Finance Ltd.

Business Loan Application Form

Please fill in all the required details in BLOCK LETTERS. Tick ✓ boxes as applicable. All Fields Mandatory

Personal Loan ✓ Business Loan Doctor's Loan Small Ticket Unsecured Loan
Applicant Co-Applicant
Application Form No. BL00000116284 Please paste Please paste
passport size passport size

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Requested Loan Tenure in photograph photograph
Amount 5 0 0 0 0 0 0 Months 3 6 here with here with
signature signature

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accross accross
Type of Loan ✓ New Top-Up

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For office use only

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Application Type* New Update

KYC Number

Account Type* Normal Simplified (for low risk customers)

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Entity Details(Non Individual)

Account Holder Type US Reportable Other Reportable

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Company/ Business Name C R E A T I V E I M P R E S S I O N

Industry Type T E X T I L E S
B

Business Type Trader ✓ Manufacturer Service

Date of Incorporation 0 1 0 7 2 0 1 7 Date of Commencnement of Business 0 1 0 7 2 0 1 7

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Place of Incorporation M A N E S A R

Country of Incorporation I N Country of Residence as per Tax laws Identification type TIN Issuing Country
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Tax Identification Number(TIN)

Company Registration No./CIN

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Company's PAN A A J P M 1 3 8 4 L Total Monthly Income

Other Income Total

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Number of controlling person(s) resident outside India for tax purposes GST ✓ Applicable Not Applicable Exempted
(Please provide details of each Controlling Person resident outside India for Tax purposes seperately in 'Annexure C2')
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GSTIN / UIN 0 6 A A J P M 1 3 8 4 L 1 Z E GST Exemption Notification No. (Pls Specify)

Address

Current Address P L O T N O 5 5 0 A , S E C - 3 7 , P A C E C I T Y I I , G U

R G A O N H A R Y A N A

City / Town / Village M A N E S A R District

Pin / Post Code 1 2 2 0 0 1 State / U.T Code S T ISO 3166 Country Code I N

No. of years at current address 0 6 0 6 No. of years in current city 0 6 0 6

Current Residence Self Owned ✓ Rented Other (Please specify) (Pls Specify)
 Correspodence/ Local Address Details

Same as Current / Permanent / Overseas Address Details (In case of multiple correspondence / Local Address, Please fill 'Annexure A1')

P L O T N O 5 5 0 A , S E C - 3 7 , P A C E C I T Y I I , G U

R G A O N H A R Y A N A

City / Town / Village M A N E S A R District

Pin / Post Code 1 2 2 0 0 1 State / U.T Code S T ISO 3166 Country Code I N

Preferred Mailing Address ✓ Current Office Permanent (Pls specify the reason for this selection)

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Contact Details

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Tel. (Off)

Tel. (Res)

6
FAX

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Mobile 9 9 9 9 8 9 9 4 4 1

Email ID D E E P A K @ C R E A T I V E I M P R E S S I O N . I N
Proof of Identity (Pol)*

PAN No. A A J P M 1 3 8 4 L Aadhar No.

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GST No. 0 6 A A J P M 1 3 8 4 L 1 Z E Voters ID
y:

Passport No. if passport, passport expiry date.

Driving License. if DL, DL expiry date

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Others (Please specify) (Pls Specify)

NREGA Job Card (any document notified by the central government)
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Simplified Measures Account - Document Type code Identification Number

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Proof of Address (PoA)*

Address Type* ✓ Residential/ Business Residential Business Registered Office Unspecified

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Proof of Address* Passport Driving Licence UID (Aadhaar)

Voter Identity Card NREGA Job Card Others (Pls Specify)

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Simplified Measures Account - Document Type code

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Detail of Related Person (In case of additional related persons, please fill 'Annexure B1')

Addition of Related Person Deletion of Related Person KYC Number of Related Person (if available)

Related Person Type Guardian of Minor Assignee Authorized Representative

Name

Individual Details

Name M r . D E E P A K M A H A J A N

Father's / Spouse's Name M R . K R I S H A N C H A N D R A G U P T A

Mother's Name N I R M A L A

Date of Birth 0 8 1 0 1 9 7 1 Gender ✓ Male Female Marrital Status Single ✓ Married

Citizenship ✓ Indian Other ISO 3166 Country Code

 Residential Status ✓ Resident Individual Non Resident Indian Foreign National Person of Indian Origin

Occupation Type* Service Private Sector Public Sector Government Sector Others Professional Self Employed

Retired House Wife Student Business Not Catagorised

PAN A A J P M 1 3 8 4 L Qualification G R A D U A T E
Address

Current Address H O U S E N O B L O C K H 3 5 5 B P A L A M V I H A R G U R

G A O N C A R T A R P U R I A L I A S D A U L A T P U R N A S I R A B A D 6 3

G U R G A O N H A R Y A N A

City / Town / Village G U R U G R A M District

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Pin / Post Code 1 2 2 0 1 7 State / U.T Code S T ISO 3166 Country Code I N

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No. of years at current address 0 6 0 6 No. of years in current city 0 6 0 6

Current Residence ✓ Self Owned Rented Other (Please specify) (Pls Specify)

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Correspodence/ Local Address Details

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Same as Current / Permanent / Overseas Address Details (In case of multiple correspondence / Local Address, Please fill 'Annexure A1')

H O U S E N O B L O C K H 3 5 5 B P A L A M V I H A R G U R

G
G A O N C A R T A R P U R I A L I A S D A U L A T P U R N A S I R A B A D 6 3

G U R G A O N H A R Y A N A
B
City / Town / Village G U R U G R A M District
y:

Pin / Post Code 1 2 2 0 1 7 State / U.T Code S T ISO 3166 Country Code I N

Preferred Mailing Address ✓ Current Office Permanent (Pls specify the reason for this selection)
B

Employment Detail

Occupation Salaried ✓ Self Employed Professional Designation P R O P R I E T O R

ed

Company / Business Name C R E A T I V E I M P R E S S I O N

Industry Type 9 5 0 0 3 : S T A F F L O A N S : P U R C H A S E O F C O N S U M E R
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Business Type Trader Manufacturer Services

Office Address P L O T N O 5 5 0 A , S E C - 3 7 , P A C E C I T Y I I , G U
er

R G A O N H A R Y A N A
en
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Pin 1 2 2 0 0 1

Business Constitution I N D I V I D U A L

Public Limited Private Limited Partnership Firm ✓ Proprietorship Firm Self business

Off. Ph. with STD Code Extn. No.

Official Email ID N A @ G M A I L . C O M

Total yrs in present occupation 0 6 0 0 Total Work Experience 0 6 0 6

No. of years at current address 0 6 0 6 No. of years in current city 0 6 0 6

Total Monthly Income Other Income Total

Contact Details

Tel. (Off)
Tel. (Res)

FAX

Mobile 9 9 9 9 8 9 9 4 4 1

Email ID D E E P A K @ C R E A T I V E I M P R E S S I O N . I N
Proof of Identity (Pol)*

PAN No. A A J P M 1 3 8 4 L Aadhar No.

GST No. Voters ID

Passport No. if passport, passport expiry date.

2
Driving License if DL, DL expiry date

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Others (Please specify) (Pls Specify)
NREGA Job Card (any document notified by the central government)

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Simplified Measures Account - Document Type code Identification Number

Proof of Address (PoA)*

Address Type*

Proof of Address*
✓ Residential/ Business

Passport
Residential Business

Driving Licence UID (Aadhaar)

Registered Office

G Unspecified
B
Voter Identity Card NREGA Job Card Others (Pls Specify)
y:

Simplified Measures Account - Document Type code

Individual Details
B

Name M r s . S H A L L A J A M A H A J A N

Father's / Spouse's Name M R . T A R A C H A N D

ed

Mother's Name S H A L I N I

Date of Birth 2 5 0 6 1 9 7 6 Gender Male ✓ Female Marrital Status Single ✓ Married

at

Citizenship ✓ Indian Other ISO 3166 Country Code

er

Residential Status ✓ Resident Individual Non Resident Indian Foreign National Person of Indian Origin

Occupation Type* Service Private Sector Public Sector Government Sector Others Professional Self Employed
en

Retired House Wife Student Business Not Catagorised

PAN A F F P M 1 6 8 7 R Qualification G R A D U A T E
Address
G

Current Address H O U S E N O B L O C K H 3 5 5 B P A L A M V I H A R G U R G

A O N C A R T A R P U R I A L I A S D A U L A T P U R N A S I R A B A D 6 3

G U R G A O N H A R Y A N A

City / Town / Village G U R U G R A M District

Pin / Post Code 1 2 2 0 1 7 State / U.T Code S T ISO 3166 Country Code I N

No. of years at current address 0 6 0 6 No. of years in current city 0 6 0 6

Current Residence ✓ Self Owned Rented Other (Please specify) (Pls Specify)

Correspodence/ Local Address Details

Same as Current / Permanent / Overseas Address Details (In case of multiple correspondence / Local Address, Please fill 'Annexure A1')
H O U S E N O B L O C K H 3 5 5 B P A L A M V I H A R G U R G

A O N C A R T A R P U R I A L I A S D A U L A T P U R N A S I R A B A D 6 3

G U R G A O N H A R Y A N A

City / Town / Village G U R U G R A M District

Pin / Post Code 1 2 2 0 1 7 State / U.T Code S T ISO 3166 Country Code I N

Preferred Mailing Address ✓ Current Office Permanent (Pls specify the reason for this selection)

Employment Detail

Occupation Salaried ✓ Self Employed Professional Designation P R O P R I E T O R

Company / Business Name C R E A T I V E I M P R E S S I O N

2
Industry Type 9 5 0 0 3 : S T A F F L O A N S : P U R C H A S E O F C O N S U M E R

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Business Type Trader Manufacturer Services

Office Address P L O T N O 5 5 0 A , S E C - 3 7 , P A C E C I T Y I I , G U

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R G A O N H A R Y A N A

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Pin 1 2 2 0 0 1

G
B
Business Constitution I N D I V I D U A L

Public Limited Private Limited Partnership Firm ✓ Proprietorship Firm Self business
y:

Off. Ph. with STD Code Extn. No.

Official Email ID N A A @ G M A I L . C O M
B

Total yrs in present occupation 0 6 0 0 Total Work Experience 0 6 0 6

No. of years at current address 0 6 0 6 No. of years in current city 0 6 0 6

ed

Total Monthly Income Other Income Total

at

Contact Details

Tel. (Off)
er

Tel. (Res)
en

FAX

Mobile 7 9 7 4 0 4 2 2 4 2

Email ID D E E P A K @ C R E A T I V E I M P R E S S I O N . I N
G

Proof of Identity (Pol)*

PAN No. A F F P M 1 6 8 7 R Aadhar No.

GST No. Voters ID

Passport No. if passport, passport expiry date.

Driving License if DL, DL expiry date

Others (Please specify) (Pls Specify)

NREGA Job Card (any document notified by the central government)

Simplified Measures Account - Document Type code Identification Number

Proof of Address (PoA)*

Address Type* ✓ Residential/ Business Residential Business Registered Office Unspecified

Proof of Address* Passport Driving Licence UID (Aadhaar)

Voter Identity Card NREGA Job Card Others (Pls Specify)

Simplified Measures Account - Document Type code

Detail of Related Person (In case of additional related persons, please fill 'Annexure B1')

Addition of Related Person Deletion of Related Person KYC Number of Related Person (if available)

Related Person Type Guardian of Minor Assignee Authorized Representative

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Name

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Remarks (If any)

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Existing Loans
Loan/Facility Financer'sName Account No. Loan Amount Tenure Months EMI/Interest Commencement Date Current Outstanding
PL Not Disclosed 0.0 0 32 0.0 0
PL
PL
Not Disclosed
Not Disclosed
0.0
0.0
0
981771
G 0
37
0.0
92566.0
0
981771
B
Bank Details
Current/Savings/OD (If
Sr. No. Name of Account Holder Name of Bank Branch OD Please Specify Account No. Banking Since
y:

Limit)
1
2
B

Reference 1

Name J A T I N
ed

Relationship F R I E N D

Entity Type
at

If Personal Guarantor Yes No

Current Address S E C 3 7 P A C E C I T Y I I G U R G A O N
er
en

Landmark
City M A N E S A R
G

State H A R Y A N A

Pin 1 2 2 0 0 1 Landline Mobile 9 8 1 0 0 8 6 6 8 0

Reference 2

Name P R A K A S H

Relationship R E L A T I V E

Entity Type
If Personal Guarantor Yes No

Current Address B B L O C K P A L A M V I H A R G U R G A O N

Landmark

City G U R U G R A M
State H A R Y A N A

Pin 1 2 2 0 1 7 Landline Mobile 9 8 1 0 0 1 3 3 3 8

2
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Acknowledgement Application Form No. _________________________

Dear Sir/Madam,

This is to acknowledge that ABFL has received your application form for Business Loan of Rs 5000000 ABFL shall communicate its decision on your application within
15 working days. This is subject to submission of all documents and conforming to internal guidelines of ABFL. Terms and Conditions are also available on our website
: www.adityabirlafinance.com

Business Development Manager: RAJANISH KUMAR Channel Name: DSA Contact No: _______________________
Date: Fri Aug 09 19:01:32 IST 2024 Email ID: ______________________________________________ Signature: _______________________
Declaration

1. I/We hereby declare that the details furnished above are true and correct to the best of my knowledge and belief and I under take to inform you of any changes therein, immediately. In case any of the above
information is found to be false or untrue or misleading or misrepresenting, I am aware that I may be held liable for it. 2. I /We confirm that no insolvency proceedings or suits for recovery of outstanding dues
or monies whatsoever and/ or any criminal proceedings have been initiated and /or are pending against me/ us and that I/We have never been adjudicated insolvent by any court or other authority. 3. No action
nor other steps have been taken or legal proceedings started by or against me/us in any court or law/other authorities for winding up, dissolutions, administration or reorganization or for the appointment of the
receiver, administrator, administrative receiver, trustee or similar officer for my /our assets. 4. I/We declare that I/We have not made any payments in cash, bearer cheque or kind along with or in connection
with this application to the executive collecting my/our application. I/we shall not hold Aditya Birla Finance Limited. (hereinafter referred to" ABFL") liable for any such payments made by us to the executive

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collecting this application. 5. I/We understand and acknowledge thatABFL shall have the absolute discretion, without assigning any reasons (unless required by applicable law) to reject our application and
ABFL shall not be responsible in any manner whatsoever to me/us for such rejection or any delay in notifying me /us of such rejection and any costs, losses, damages or expenses, or other consequences, caused
by reasons of such rejection, or any delay in notifying me/us of such rejection, of our application. 6.I/We understand and am/are aware that the processing fees collected from me/us by ABFL, is for the purpose

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of ABFL reviewing this loan application as per its own parameters and is not refundable to me/us under any circumstances whatsoever, irrespective of whether ABFL sanctions this loan application of mine or
not. 7. I/We confirm that I /we shall not use the products or the credit /loan facility(s) (or any part thereof) for any improper/illegal or unlawful purpose/ activities. 8. I/We shall inform to ABFL regarding any
changes in my /our address(s) or my employment or profession. 9.I/We hereby confirm that I/we am/are competent and fully authorized to give declarations, undertaking etc. execute and submit this application
form and all other documents for the purpose of availing the loan, creation of security and for all the purposes mentioned /required to be done for this. 10. I/We confirm that I/we shall cooperate with ABFL and
furnish additional documents and/or shall execute such other documents, if necessary to enable ABFL to abide by/comply with all other existing /further directives of the statutory /regulatory authorities/any

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other authority acting under any Law. 11. I/We hereby give consent to the ABFL or its Authorized Agents and third party service providers to use information/data provided by me to contact me through any
channel of communication including but not limited to email, telephone, sms, etc. and further authorize the disclosure of the information contained herein to its affiliates/group companies or their Authorized
Agents or Third Party Service Providers in order to provide information and updates to me on various financial and investment products and offering of other services. 12. I/We Agree that all personal or

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transactional related information collected/provided by me can be shared/transferred and disclosed with the abovementioned parties including with any regulatory, statutory or judicial authorities for compliance
with any law or regulation in accordance with privacy policy as available at the website of the ABFL.13.I/We hereby consent to receiving information from Central KYC Registry through $MS/Email on the
above registered number/email address. 14. I/We hereby provide our consent to ABFL to obtain the Applicant(s) information from Credit Information Company and/or information utility and/or such institution
set up under the provisions of law from time to time, as and when required. 15. I/We hereby undertake to ABFL that, I/we shall submit the OVD’s (any one of the a) Passport, b) Aadhaar, c) Voter ID, d)
Driving License e) NREGA Job Card) with the current address details within a period of 3 months from the date of submission of Deemed OVD’s (if it has been submitted at the time of applying loan). Non

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submission of the same shall be an event of default. 16. "I/We hereby authorize and give consent to ABFL to share, make disclosure(s) without notice to me/us of any information relating to me/us including
personal information, details in relation to loan, security, defaults etc with/to ABFL’s branches/subsidiaries/associates/affiliates, RBI/CIBIL/credit bureaus/ rating agencies/ other
governmental/regulatory/statutory or private agency/entity, service providers, any third parties, any assignees/potential assignees or transferees, who may need to process and publish the information in such
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manner and through such medium as it may be deemed necessary by ABFL/ above entities, for purposes including but not limited to, KYC information verification or other verification, credit risk analysis,
investigation, collections/recovery as also publishing the name as part of wilful defaulter’s list as and when required or for any other purpose incidental, related or ancillary thereto ."

IMPORTANT NOTE
y:

That the receipt of your application form for the loan does not imply automatic approval of your loan by ABFL. ABFL may request for additional documents other than those in connections with the
application. I/We confirm that executive who collected my /our applications/ documents has informed me/us and I/we am/are fully aware: 1. That Government Tax as may be applicable from time to time
will be charged in connection with the Loan. 2. That ABFL will not be liable for loss or delay in receipt of the documents. 3. That incomplete/defective applications will not be processed and ABFL shall not
be responsible for any manner for the resulting delay or otherwise. 4. That the applications forms, documents/ photographs will not be returned under any circumstances once submitted to ABFL. 5. That
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approval for the applications is the sole discretion of ABFL. 6. That the quantum of the loan will be finally decided by ABFL and ABFL has not made any commitment to me/us regarding the same. 7. That
equated installments (EMI) will be due on 1st/ 5th of every month (strike out which is not applicable)
The Most Important Terms and Conditions mentioned above are an indicative list of terms and conditions of our loan products. These Terms and Conditions are further described in our loan agreement
under relevant sections/ schedules and therefore should be read in conjunction with those mentioned in the loan agreement.
ed

____________________________ ____________________________
Applicant's Signature Co-Applicant's Signature
at

Place ____________________________ Date ____________________________

Common Document Checklist - All the submitted documents to be self-attested by the customer
er

Additional Documents - Salaried

■Last 3 months Salary Slip or Salary Certificate
en

■Latest Form 16
■Dully Filled and signed Application Form
(with cross signed photographs of App/Co- ■Latest 6 months Bank Statement where direct salary is being credited
■Non-Refundable Fee Cheque
App/Guarantor) Additional Documents - Self Employed/Professional/Partnership/Company
■Photocopy of Property Papers (where
■ KYC Documents of all parties to the loan Property is Identified) ■Financial Documents for 2 years
○ Identity Proof (Specify) ■Details of Limits and Loans availed
+ ○ ITR along with computation
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○ Signature Proof (Specify) ■Copy of PAN Card ○ Balance Sheet, P&L, Schedules
○ Proof of Residence (Specify) ■Repayment Track Record (if applicable)
○ Tax Audit Report
■Bank Verifiction Form
○ Proof of Office (Specify) ■Partnership Deed & MOA/AOA
■Latest Loan outstanding statement for
○ Proof of Qualification (Specify) Refinance cases ■List of Directors/Shareholders attested by CA/CS
■Latest 12 months Bank Statement (Both Business
and Savings)
■VAT/Sales Tax returns for current financial year
FOR OFFICIAL USE ONLY

Risk Category High Medium Low

Documents Received Self-Certified True Copies Notary

Institution Details
In Person Verification Carried Out By

Name C A T E Y E C O N S U L T A N C Y S E R
Emp. Name R A J A N I S H K U M A R

Code D A U N D _ 0 5 8 4 4
Emp. Code B G 4 2 6 6 8 2
[Institution Stamp]
Emp. Designation

Emp. Branch N O I D A

[Employee Signature]

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Aditya Birla Finance Limited
Registered Office: Indian Rayon Compound, Veraval, Gujarat - 362 266

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Corporate Office: One lndiabulls Centre, Tower 1, 18th Floor, 841, Senapati Bapat Marg,
Elphinstone Road, Mumbai 400 013 | www.adityabirlafinance.com

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(0) +91 22 4356 7000 | (F) +91 22 4356 7266 | CIN, U65990GJ1991PLC064603

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