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1 Date of Issue... Date of Receipt.. Initial Initial Serial No. INSURANCE EMPLOYEES CREDIT CO-OP SOCIETY LTD. APPLICATION FOR GENERAL LOAN ( Registration No. 60 CU/ ) (INCOMPLETE APPLICATION WILL BE SUMMARILY REJECTED) The Secretary, INSURANCE EMPLOYEES CREDIT CO-OPERATIVE SOCIETY LTD. L.I.C. BUILDINGS, CUTTACK Dear I beg to apply for a General Loan of Rs (Rupees. only) from the society to be expended for the purpose stated hereunder. I shall repay the loan with interest in Monthly installments as may be fixed by the Society. I furnish the following particulars which are true to the best of my knowledge and I solemnly declare that there is no court attachment against my pay. Date :. My S. B. A/c No. with Bank. PARTICULARS OF THE APPLICANT, ( in Full) Membership No. : 1. Purpose of Loan 2. Whether the P.F. & Gratuity dues of the member are free from incumbrance?.. 3. Has the member availed IEH or House Building Loan? If so, the amount of outstanding Loan : 4. Particulars of other borrowings, if any. 5. Whether indebted to any other Credit Society or Benefit Society (a) Full Name.. (In Block letters) (b) Designation.. (c) S.R. No. (d) Name of the Office.. Full Address.. (e) Under.. Divisional Office (f) Year of Appointment... (g) Date of Joining P.F. (h) Date of Birth... (i) Date of Retirement... We agree to stand sureties for the loan of Rs.. (Rupees only) applied by Shri/Smt... Member Present Length of Outstanding Full Name of the Sureties Office Address Designation No. Salary Service Loan

2 Date of Joining in Service. Recurring Year of Service. ( FOR OFFICE USE ONLY ) M. No... Date of Admission. Name. Address.. Monthly Salary : Rs... General Loan applied for : Rs... Outstanding SPL. Loan : Rs. Rate of interest agreed upon.. Shares held. Addl. Shares Required Thrift Deposit Rs.... P.G. Fund held Rs... Addl. P.G. Fund required Rs.. Maximum Eligibility : Rs.. Processed By Verified By Submitted to Board Meeting Passed for Payment Dated Secretary President SPACE FOR CALCULATION REMARKS (if any) Loan Processed After Salary GENERAL LOAN GRANTED : LESS : O/s General Loan O/s Interest on General Loan Share Money PAYMENT PARTICULARS : Rs. : Rs. : Rs. P. G. Fund : Rs. BALANCE PAYABLE Rs. TOTAL : Rs. Rs. Paid Rs... Vide Cheque No...Dated... Cheque Prepared By: Cheque Signed By:

3 INSURANCE EMPLOYEES CREDIT CO-OPERATIVE SOCIETY LTD., CUTTACK Salary particulars of the Applicant for the month of Basic Pay -- Rs. Special Pay -- Rs. D. A. -- Rs. House Rent -- Rs. Others, if any -- Rs. P. F. -- Rs. P.F. Loan & Int. -- Rs. Festival Adv. -- Rs. Flood, Cyclone -- Rs. Total Co-op. Dues -- Rs. Ins. Premium -- Rs. Others / I.E.H. etc. -- Rs. of the applicant ( attested ) Office-in-Charge B.M. / A.B.M.(A) Rs. Total Deduction -- Rs. Net pay Rs. of Office-in-Charge B.M. / A.B.M.(A) Certified that Sri. Joined LIC/GIC on.. Whether Salary is attached to Bank Loan? If so, monthly recoverably Amount Officer-in-Charge P. DIVISIONAL MANAGER / BRANCH MANAGER Advance Receipt Received from Insurance Employees Credit Co-operative Society Ltd.., Cuttack a sum of Rs..... (Rupees... only) being the net Spl./Gen. Loan payable to me out of sanctioned loan of Rs Membership No. Name (in full). Address.... of the Loanee (in full) Please send the amount by Crossed Demand Draft on / SB A/c No. Bank..(Core Bank only)

4 BOND I,.a member of the Insurance Employees Credit Co-operative Society Ltd. (Registered under the Co-operative Societies Act. [(Act. XI of 1952) of 1951], son of residing at (Permanent Address) and working in the Life Insurance Corporation of India/General Insurance Corporation of India as (Designation), hereby acknowledge that subject to the Bye- Laws of the Society I have received from the said Society a loan of Rs.(Rupees only). I undertake to pay interest on this loan or such porting of it as may remain actually unpaid at different relevant point of time at percent per annum convertible monthly or at such rate as may, from time to time, be fixed in accordance with the Bye-laws of the society. I agree to repay this loan with interest in such number of monthly installments or in accordance with the rules of the Society whenever I shall be called upon to do so. If I fail to pay interest or any installment of Principal on the due date the whole loan with interest shall become immediately due and repayable. I further undertake to pay additional interest of one more percent over the prevailing rate of interest, or at such rates as may be laid down in the rules of the society, on any overdue payment from the date of default. I do, hereby, further agree that in the event of default in repayment of installments of Principal and/or interest thereon, on account of whatever reason may be, the proceeds of my provident fund and gratuity dues shall stand attached to the said Society to the extent or my liabilities i.e. the balance loan and interest thereon. I declare that I have authorised irrevocably to the Trustees of concerned P.F. through my employer in this regard to deduct from my dues and to satisfy my liabilities to the said Society whenever such occasion arises. Notwithstanding to anything contained as above, the said Society shall have the right to recover from me the outstanding loan along with its interest through legal proceedings. Further, I undertake that the loan shall be expended on..within one month from this date. If the loan is not so applied, I undertake to repay the money with interest as may be levied in accordance with the Bye-laws. It is also hereby agreed that I shall take all steps to ensure timely repayment of loans by way of deduction from the Salary or otherwise. In case of any lapse in my part in this regard it will be treated as willful default. The Society is free to take any action as will be decided by the Board of Management and / or General Body. of Borrower (in full) Date : M.No.. We, the undersigned, hereby agree to stand as sureties for the above mentioned loan and to be jointly and severally liable unconditionally for (1) its repayment with interest and costs incurred in collection : (2) its employment in accordance with the purpose mentioned in the bond. Date : Date : Date : 1. : Office Address : Father s Name : 2. : Office Address : Father s Name : 3. : Office Address : Father s Name : M.No. M.No. M.No.

5 LETTER OF AUTHORITY OF THE SURETY I hereby, authorise and request you to deduct from the amount of my pay bills or any other moneys which may be due to me by the Corporation all or any sum or sums of money for which the Insurance Employees Credit Co-operative Society Ltd., may apply to you for payment as due by Sri.... In respect of whom I stand as a surety to the said Society for principal, interest or otherwise in respect of loan of Rs (Rupees...only) granted to him by the said Society in the event of his failure to repay the dues in respect of the said loan in terms and conditions of repayment of loan as laid down from time to time by the said Society and as will be decided by the said Society by means of refusal of payment, death, dismissal or suspension from Service or any other reason whatsoever of the aforesaid loanee for whom I stand as surety. I have verified the Salary Certificate of the Applicant and found Correct as per our office record. LETTER OF AUTHORITY OF THE SURETY I hereby, authorise and request you to deduct from the amount of my pay bills or any other moneys which may be due to me by the Corporation all or any sum or sums of money for which the Insurance Employees Credit Co-operative Society Ltd., may apply to you for payment as due by Sri.... In respect of whom I stand as a surety to the said Society for principal, interest or otherwise in respect of loan of Rs (Rupees...only) granted to him by the said Society in the event of his failure to repay the dues in respect of the said loan in terms and conditions of repayment of loan as laid down from time to time by the said Society and as will be decided by the said Society by means of refusal of payment, death, dismissal or suspension from Service or any other reason whatsoever of the aforesaid loanee for whom I stand as surety. I have verified the Salary Certificate of the Applicant and found Correct as per our office record. LETTER OF AUTHORITY OF THE SURETY I hereby, authorise and request you to deduct from the amount of my pay bills or any other moneys which may be due to me by the Corporation all or any sum or sums of money for which the Insurance Employees Credit Co-operative Society Ltd., may apply to you for payment as due by Sri.... In respect of whom I stand as a surety to the said Society for principal, interest or otherwise in respect of loan of Rs (Rupees...only) granted to him by the said Society in the event of his failure to repay the dues in respect of the said loan in terms and conditions of repayment of loan as laid down from time to time by the said Society and as will be decided by the said Society by means of refusal of payment, death, dismissal or suspension from Service or any other reason whatsoever of the aforesaid loanee for whom I stand as surety. I have verified the Salary Certificate of the Applicant and found Correct as per our office record.

6 LETTER OF AUTHORITY I hereby, authorise and request you to deduct from my salary or any other moneys which may be due to me by the Corporation as per the demand invoice of the Insurance Employees Credit Co-operative Society Ltd., as may be due by me to the Society towards Loan principal, interest or otherwise in respect of loan of Rs..(Rupees. only) granted to him by the said Society. I would request you to remit my dues so deducted from my salary to the said Society from time to time. I further authorise you irrevocably to deduct the loan in full along with its interest or any part thereof as may be charged by the said Society on account of this loan, from my gratuity or any other dues in order to satisfy my liabilities to the Society in the event of my default in repayment of the loan along with interest due to the reason whatsoever. This authorization shall cease to be operative when I repay in full the loan and interests thereon. LETTER OF AUTHORITY I hereby, authorise and request you to deduct from my salary or any other moneys which may be due to me by the Corporation as per the demand invoice of the Insurance Employees Credit Co-operative Society Ltd., as may be due by me to the Society towards Loan principal, interest or otherwise in respect of loan of Rs..(Rupees. only) granted to him by the said Society. I would request you to remit my dues so deducted from my salary to the said Society from time to time. I further authorise you irrevocably to deduct the loan in full along with its interest or any part thereof as may be charged by the said Society on account of this loan, from my gratuity or any other dues in order to satisfy my liabilities to the Society in the event of my default in repayment of the loan along with interest due to the reason whatsoever. This authorization shall cease to be operative when I repay in full the loan and interests thereon. The Trustees, LETTER OF AUTHORITY (Provident Fund) With reference to the sum of Rs.. (Rupees only) granted to me as loan by the Insurance Employees Credit Co-operative Society Ltd., Cuttack, I hereby agree and authorise you to deduct the said amount from my own contributions and interest thereon at the time of settling my Provident Fund Account and pay such amount as may be due from me on account of principal and interest thereon, to the said Society through the Corporation in settlement of their claims against the loan granted to me. This authorization shall not be revoked by me until the loan sanctioned to me is completely wiped off by repayments. Place Name : SR. No. : Office :