Application Form DCB Micro Business Loan

Transcription

1 Application Form for DCB Micro Home / Business Loan DCB Micro Home Loan DCB Micro Business Loan Employment: Salaried Self Employed Application No.: Preferred Mailing Address: Residence Office Application Date: PLEASE FILL IN BLOCK LETTERS ONL (In case of more than 3 co-applicants, please fill up new application form) D D M M Personal Details Applicant Co-applicant 1 Co-applicant 2 Co-applicant 3 *Account Type: Normal Small Normal Small Normal Small Normal Small Simplified (for low risk customers) Simplified (for low risk customers) Simplified (for low risk customers) Simplified (for low risk customers) OTP based e-kc OTP based e-kc OTP based e-kc OTP based e-kc KC Number: Please affix a recent photograph Sign across the photo Name: Date of Birth: Nick Name: Relation with Applicant: Gender: Self Male Female Male Female Male Female Male Female Third Gender Third Gender Third Gender Third Gender Marital Status: Single Married Single Married Single Married Single Married No. of Children/s: Father / Spouse Full Name: Mother s Maiden Name: Mother Full Name: U.S. Person: Country of Birth: *Place of Birth: *Citizenship: *Residence for Tax Purposes: Residential Status Current Residential Address: (Address, Landmark, City, Pincode, State) Ownership of Residence: Permanent Residence Address: (Address, Landmark, City, Pincode, State) Resident Individual Foreign National Non Resident Indian Person of Indian Origin Self Owned Family Owned Rented Company Owned Details of Relatives in and around the Village / City Name: Relation: Address: Resident Individual Foreign National Non Resident Indian Person of Indian Origin Self Owned Rented Family Owned Company Owned Resident Individual Foreign National Non Resident Indian Person of Indian Origin Self Owned Rented Family Owned Company Owned Resident Individual Foreign National Non Resident Indian Person of Indian Origin No. of years at current residence: Mobile No.:

2 Applicant Co-applicant 1 Co-applicant 2 Co-applicant 3 Telephone (with STD Code): Mobile No.: ID: Educational Qualification: Religion: Category: General SC NT General SC NT General SC NT General SC NT OBC ST DT OBC ST DT OBC ST DT OBC ST DT MBC MBC MBC MBC Aadhaar Card Number: Proof of Identity: Passport No. Passport No. Passport No. Passport No. Driving Licence Driving Licence Driving Licence Driving Licence Voter Identity Card Voter Identity Card Voter Identity Card Voter Identity Card NREGA Job Card NREGA Job Card NREGA Job Card NREGA Job Card Expiry Date of Passport / Driving License: Proof of Address: Simplified Measures Account (Document Type Code) Available Asset: Other Document Passport UID (Aadhaar) NREGA Job Card Electricity Driving Licence Voter ID Other TV Other Document Passport UID (Aadhaar) NREGA Job Card Driving Licence Voter ID Other Other Document Passport UID (Aadhaar) NREGA Job Card Driving Licence Voter ID Other Other Document Passport UID (Aadhaar) NREGA Job Card LPG Kitchen RCC Construction Vehicle Toilet Driving Licence Voter ID Other Fan Refrigerator If LPG is available, Name of LPG company: HP Indane Bharat Gas Reliance Super Gas Other If LPG is available, Please provide the Gas Consumer Number and Bill copy Details of Business / Employment: Applicant Co-applicant 1 Co-applicant 2 Co-applicant 3 Source of Income: Salaried Self Employed Salaried Self Employed Salaried Self Employed Salaried Self Employed Daily Wages Daily Wages Daily Wages Daily Wages Salaried: Public Ltd. Pvt. Ltd. Public Ltd. Pvt. Ltd. Public Ltd. Pvt. Ltd. Public Ltd. Pvt. Ltd. PSU State Owned PSU State Owned PSU State Owned PSU State Owned MNC MNC MNC MNC Nature of Business: Name of the Concern / Employer: Designation: Business / Employment Address: Telephone (with STD Code): No. of years in current Business / Employment: No. of employees in Business: Details of previous business / Employment: GST Number: 2

3 Bank Account Details: Name of Account Holder Bank Branch Account Operated Since Account No. Account Type (SA / CA / OD) Existing Relationship with DCB Bank Limited: Loan Account No. Savings Bank / Current Account No. Details of Assets / Income / Expenses / Liabilities: Applicant Co-applicant 1 Co-applicant 2 Co-applicant 3 Annual Turnover Income / Expenses / Liabilities: Gross Monthly Income Net Monthly take home Other Sources Average Monthly Expense Monthly Installment you can Pay Assets: Property Agri Land Land Holding (acres) Motor Vehicle If yes, Please provide Vehicle registration No. LIC Fixed Deposits NSC Provident Fund Public Provident Fund Chit Funds / Pygmy Savings Other Securities / Bonds Existing Loans: If you avail any loan mentioned below: Home Loan Auto Loan Gold Loan Business Loan Education Loan Personal Loan Loan from Microfinance Institution Unsecured Loans from Friends / Relatives Loans from Moneylender / Societies / Trusts Please provide the details: Name & address of institution from whom loan has been availed: Applicant Co-applicant 1 Co-applicant 2 Co-applicant 3 Purpose of Loan: Balance Outstanding (): Balance Term (M): Balance Repayment (): Total Liabilities (): 3

4 Property / Security Offered: Property Address: City: Pin: Landmark: State: Area of Land: Country: Area of House / Flat / Office: Property Type: Residential Commercial Industrial Agri Land Open Land Ownership Type: Sole Joint Occupancy: Self Occupied Rented Leased Vacant Under Construction Approx Value : Free / Encumbered (If encumbered, Details to be given) Loan Details: Number of family members residing in the same house (Including children/s): Number of family members in your house sharing same kitchen: Total Monthly Family Income : Total Monthly Family Expenditure : Total Monthly Installment you can Pay : Purpose of Loan: Business Expansion Purchase of Residential Property for Self Occupancy Purchase of Commercial Property Home Construction Home Repair Education Purpose Personal Use Loan Amount Required : Loan Tenure: Months Interest Rate: Floating Fixed and Floating Reference Details: Name Reference 1 Reference 2 Relation: Address: (Address, Landmark, City, Pincode, State) Telephone (with STD Code): Mobile No.: 4

5 Processing Fee Details: Processing Fee (non refundable) : Cheque / DD Number: Dated: D D M M Drawn on in favour of DCB Bank Limited I / We agree to open a Savings / Current Account with DCB Bank Limited (DCB Bank) es No DCB Current and Savings Accounts come with a host of benefits such as Free RTGS / NEFT, Payable at Par Cheque Book, Free Phone / Internet / Mobile Banking, Free access to VISA ATMs, Any Branch Banking and much more. Name Signature Applicant Co-applicant 1 Co-applicant 2 Co-applicant 3 Services: SMS Banking & Alert Facility: Alerts facility enables you to receive alerts on your and / or Mobile regarding large debit, large credits, Standing Instruction failure, balance below Account Quarterly Balance and balance update. New alerts may be added from time to time. I / We don t wish to receive any Bank related promotional calls, SMS alerts or s. DCB On The Go (Mobile Banking) Phone Banking Preferred Language Options: English Hindi Marathi Gujarati Tamil Telugu I / We do not wish to register for DCB On The Go (Mobile Banking). DCB On The Go is an opt out service option, DCB On The Go facilitates the customer to place Requests, gather Account Information and Fund Transfer to DCB / Non DCB Accounts. By availing this customer is accepting the terms and conditions related to DCB On The Go Instant Mobile Banking updated on Terms and conditions: I / We have read, understood and hereby agree to the Terms and conditions as applicable to my / our account set forth on DCB Bank Limited ( DCB Bank, the Bank s ) website at I / We understand that access to any changes / updates in terms and conditions applicable to this relationship shall be available on the Bank s website only. I / We do hereby declare that information furnished in this Form is true and correct to the best of my / our knowledge and belief. I / We hereby authorise issuance of ATM / Debit Card and provision of Phone Banking, Mobile Banking Services, Internet Banking and Bill Payment Services. I / We are aware of charges applicable for various services offered and I / we affirm, confirm and undertake that I /we have read and understood the Terms and Conditions for usage of the Phone Banking, Mobile Banking Services, Internet Banking and Bill Payment Services of DCB Bank Limited as set forth in the Bank's website and I / we will adhere to all the terms / conditions as applicable from time to time. 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 and I / we understand and accept that they shall form the basis of any facility DCB Bank Limited (the Bank ) may decide to grant me/us. The Bank has the right to reject the application in case any of the information provided in this application form is found to be false / incorrect / misleading. 2. I / We confirm that there are no insolvency or bankruptcy proceedings or suits for recovery of outstanding dues or monies whatsoever or for attachment of my / our assets or properties and / or any criminal proceedings have been initiated and / or are pending against me / us and that I / we have never been adjudicated insolvent or bankrupt 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 of law / other authorities for winding up, dissolution, administration or re-organization or for the appointment of a receiver, administrator, administrative receiver, trustee or similar office or for my / our assets. 4. I / We unconditionally authorize the Bank to exchange, share or part with all the information / data or documents and details relating to my / our application and / or existing loans and / or repayment/credit history to other banks, financial institutions, credit bureaus, agencies, statutory/regulatory bodies, etc., as the Bank may deem necessary or appropriate as may be required for use of processing of the said information / data by such person(s). 5. I / We understand, agree and acknowledge that the Bank shall have the absolute discretion, without assigning any reasons, to reject my / our application and that I/we reserve no right to appeal against this decision of the Bank. I/we further agree that the Bank shall not be responsible / liable 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 reason of such rejection or any delay in notifying me / us of such rejection of our application. 6. The Bank reserves the right to retain the photographs and documents submitted and will not return the same to the applicant and/or co-applicant. 7. I am / We are neither related to any of the Directors of the Bank nor I am / we are his / her relatives as defined under the provisions of the Companies Act, I / We have been explained the product features of the loan I / we have applied for. I / We have understood the terms and conditions of Micro Home Loan/ Micro Business Loan product of the Bank and I / we agree to abide by them. 9. From time to time, the Bank communicates various features / products / promotional offers which offer significant benefits to its customers 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 the Bank to use information or data relating to me / us, for communicating marketing offers as outlined above. I / We do not wish to receive offers as outlined above. 10. I / We understand that Processing Fee and Administrative Fee are non refundable and my / our application being rejected by the Bank for any reason or same being withdrawn by me/us, I / we shall not be entitled to refund of same. 11. I / We undertake to guarantee the loan granted by the Bank to me/us. 12. I / We hereby unconditionally authorise the Bank to make any enquiries with any other finance company / bank / credit bureau / Reserve Bank of India (RBI) / agency/ies appointed by RBI regarding my / our credit history with them. 13. I / We confirm that the funds will not be used for speculative or anti-social purpose. 14. I / We undertake to inform the Bank regarding the change in my/our occupation/employment and to provide any further information and documents that the Bank may require from time to time.

6 15. I / We agree that my/our facility shall be governed by the terms and conditions of the Bank that are in force and may be amended by the Bank at its absolute discretion from time to time. 16. I / We have understood, acknowledge and agree that a request and demand for any information and documents by any authority under the law will be mandatorily complied with by the Bank. 17. I / We agree as a pre-condition of the facility given to me/us by the Bank and in that case, I/we commit default in the repayment of the facility or in the payment of interest thereon or any of the agreed instalment of the facility on the due date(s), the Bank and/or the Reserve Bank of India (RBI) will have an unqualified right to disclose or publish my/our name (including my/our photograph) as defaulter/s in such manner and through such medium as the Bank or RBI in their absolute discretion may think fit. 18. It will be in order for the Bank to disqualify / deny me/us from receiving any credit facility(ies) from the Bank in case it is proved that the declaration of my/our existing credit facility(ies) made above contains misrepresentation of facts. I/We understand that the Bank is relying on the information provided in this application form for the purpose of determining the status of the applicant named above in compliance with FATCA (Foreign Account Tax Compliance Act) / CRS (Common Reporting Standards). The Bank is not able to offer any tax advice on CRS or FATCA or its impact on the applicant. I/we shall seek advice from professional tax advisor for any tax questions. I/We agree to submit a new form within 30 (thirty) days if any information or certification in this application form becomes incorrect or incomplete or not up-to-date. I/We agree that as may be required by domestic regulators/tax authorities the Bank may also be required to report, reportable details to CBDT (Central Board of Direct Taxes) or close or suspend my / our account. I/We certify that I/we have provided the information in this application form and to the best of my/our knowledge and belief the information and certification is true, correct, up-to-date and complete including the taxpayer identification number of the applicant. Aadhaar consent: I/We have voluntarily submitted my/our Aadhaar/UID Number mentioned in this application form and consent to: Seed my/our Aadhaar/UID Number issued by UIDAI, Government of India in my/our name with my/our aforesaid account. Map it at NPCI (National Payments Corporation of India) to enable me/us to receive Direct Benefit Transfer (DBT) from Government of India in my/our above mentioned account. I/We understand that if more than one Benefit Transfer is due to me/us, I/we will receive all Benefit Transfers in this account. Use my/our Aadhaar details to authenticate me/us from UIDAI. Use my/our mobile number mentioned in my/our account for sending SMS alerts to me/us Consent for Authentication: I/We, the holder of the Aadhaar number stated in this application form, hereby give my/our consent to the Bank to obtain my/our Aadhaar number, name and fingerprint/iris for authentication with UIDAI. The Bank has informed me/us that my/our identity information would only be used for demographic authentication / validation / e- KC purpose and also informed that my/our biometrics will not be stored / shared and will be submitted to CIDR (Central Identities Data Repository) only for the purpose of authentication. I/We have been given to understand that my/our information submitted to the Bank herewith shall not be used for any purpose other than mentioned above, or as per requirements of law. Applicant Signature Co-applicant 1 Signature Co-applicant 2 Signature Co-applicant 3 Signature Sourcing Channel: Name and HRMS Code of Sourcing Employee: Branch: Branch Employee name and HRMS Code: For Bank Use Only Loan Application received on. Processing Fee (cheque / DD) received on. Request will be disposed of and acceptance / rejection notification will be mailed within 15 (fifteen) days from the date of the receipt of duly completed application form with all supporting documents, as required by DCB Bank Limited. KC verification carried out by Employee Name & Code: Employee Designation: Branch: Dated: D D M M Authorised Signatory

7 Self-Certification for Entities - FATCA / CRS Declaration Form Part I A. Is the account holder a Government body/international Organization/listed company on recognized stock exchange If No, then proceed to point B If yes please specify name of stock exchange, if you are listed company, and proceed to sign the declaration B. Is the account holder a (Entity/Financial Institution) tax resident of any country other than India If yes, then please fill in FATCA/ CRS Self certification Form If No, proceed to point C C. Is the account holder an Indian Financial Institution If yes, please provide your GIIN, if any, If No, proceed to point D D. Are the substantial owners or controlling persons in the entity or chain of ownership resident for tax purpose in any country outside India or not an Indian citizen If yes, (then please fill in FATCA/ CRS self-certification form). If No, proceed to sign the declaration es es es es No No No No Customer Declaration ( ) Under penalty of perjury, I/we certify that: 1. The applicant is: (i) An applicant taxable as a US person under the laws of the United States of America ( U.S. ) or any state or political subdivision thereof or therein, including the District to Columbia or any other states of the U.S., (ii) An estate the income of which is subject to U.S. federal income tax regardless of the source thereof. (This clause is applicable only if the account holder is identified as a US person) 2. The applicant is an applicant taxable as a tax resident under the laws of country outside India. (ii) (iii) I/We understand that the Bank is relying on this information for the purpose of determining the status of the applicant named above in compliance with FATCA/CRS. The Bank is not able to offer any tax advice on FATCA/CRS or its impact on the applicant. I/we shall seek advice from professional tax advisor for any tax questions. I/We agree to submit a new form within 30 days if any information or certification in this application form becomes incorrect, incomplete or not up-to-date. (iv) I/We agree that as may be required by domestic regulators/tax authorities the Bank may also be required to report, reportable details to CBDT or close or suspend my/our account. (v) I/We certify that I/we have provided the information in this application form and to the best of my/our knowledge and belief the information and certification is true, correct, up-to-date, and complete including the taxpayer identification number of the applicant. Name of the Entity Signature 1 Signature 2 Signature 3 (As per Mode of operation) Date: Part II Self-Certification Form (Entity) for Foreign Account Tax Compliance Act ( FATCA ) and Common Reporting Standards (CRS) Section 1: Entity information Name of the Entity Customer ID (if existing) Entity Constitution Type Entity Identification type Tax Identification Number (TIN) U.S. GIIN Company Identification Number Global Entity Identification Number (EIN) Other Entity Identification No. Entity Identification issuing Country Country of Residence for tax Purpose

8 Section 2: Classification of Non-Financial entities I/We (on behalf of the entity) certify that the entity is: a) An entity incorporated and taxable in US (Specified US person) es No If es, please provide your U.S. Taxpayer Identification Number (TIN) TIN b) An entity incorporated and taxable outside of India (other than US) es No If es, please provide your TIN or its functional equivalent Provide your TIN issuing country TIN c) Please provide the following additional details if you are not a Specified US Person: FATCA / CRS classification for Non-financial entities (NFFE) Active NFFE Passive NFFE without any controlling Person Passive NFFE with Controlling Person(s): US Direct Reporting NFFE (Choose this if any entity has registered itself for direct reporting for FATCA and thus the Bank is not required to do the reporting) Please provide GIIN number: Section 3: Classification of financial institutions (including Banks) I/We (on behalf of the entity) certify that the entity is : a. An entity is a U.S. financial institution es No If es, (i) Please provide your Taxpayer Identification Number (TIN) TIN (ii) Please provide GIIN, if any If No, please tick one of the following boxes below: FATCA Classification Please provide the Global Intermediary Identification number (GIIN) or other information Reporting Foreign Financial Institution (FFI) in a Model 1 Inter-Governmental Agreement ( IGA ) Jurisdiction Reporting Foreign Financial Institution in a Model 2 IGA Jurisdiction Participating FFI in a Non-IGA Jurisdiction Non-reporting Financial Institution (FI) Non-Participating FI Owner-Documented FI with specified US owners

9 Section 4: Controlling person declaration If you are classified as Passive NFFE with Controlling Person(s) or Owner documented FFI or Specified US person, please provide the following details: Name of controlling Correspondence Country of residence TIN TIN issuing country Controlling person person address for tax purpose type Details Controlling person 1 Controlling person 2 Controlling person 3 Controlling person 4 Controlling person 5 Identification Type Identification Number Occupation Type Occupation Birth Date Nationality Country of Birth

10 Section 5: Declaration (I) Under penalty of perjury, I/we certify that: 1. The number shown in this application form is the correct taxpayer identification number of the applicant, and 2. The applicant is (i) an applicant taxable as a U.S. person under the laws of the United States of America ( U.S. ) or any state or political subdivision thereof or therein, including the District of Columbia or any other states of the U.S., (ii) an estate the income of which is subject to U.S. federal income tax regardless of the source thereof, or 3. The applicant is an applicant taxable as a tax resident under the laws of country outside India. (ii) I/We understand that the Bank is relying on this information for the purpose of determining the status of the applicant named above in compliance with CRS/FATCA. The Bank is not able to offer any tax advice on CRS or FATCA or its impact on the applicant. I/we shall seek advice from professional tax advisor for any tax questions. (iii) I/We agree to submit a new form within 30 (thirty) days if any information or certification in this application form gets changed.. (iv) I/ We agree as may be required by the regulatory/statutory authorities, the Bank shall be required to comply to report, reportable details to CBDT or close or suspend my/our account. (v) I/We certify that I/we have provided the information in this application form and to the best of my/our knowledge and belief the information and certification is true, correct, complete and up-to-date including the tax payer identification number of the applicant. I/We hereby confirm that details provided are accurate, correct, complete and up-to-date. S.V Authorized Signatories and Company Seal (if applicable) Name Date (DD/MM/)

11 Proof of Identity: Document Code Description 01 Identity card with applicant's photograph issued by Central/ State Government Departments, Statutory/ Regulatory Authorities, Public Sector Undertakings, Scheduled Commercial Banks, and Public Financial Institutions. 02 Letter issued by a gazetted officer, with a duly attested photograph of the person. Proof of Address: Document Code Description 01 Utility bill which is not more than two months old of any service provider (electricity, telephone, post-paid mobile phone, piped gas, water bill). 02 Property or Municipal Tax receipt. 03 Bank account or Post Office savings bank account statement. 04 Pension or family pension payment orders (PPOs) issued to retired employees by Government Departments or Public Sector Undertakings, if they contain the address. 05 Letter of allotment of accommodation from employer issued by State or Central Government departments, statutory or regulatory bodies, public sector undertakings, scheduled commercial banks, financial institutions and listed companies. Similarly, leave and license agreements with such employers allotting official accommodation. 06 Documents issued by Government departments of foreign jurisdictions and letter issued by Foreign Embassy or Mission in India. Please call DCB 24-Hour Customer Care to enquire about your account application status DCB Bank Limited

12 2286-Ver 1.1-Feb 2018 DCB Bank Limited M019 / Mar 18 / 1.4 Acknowledgement Application No.: Loan Application received on. Processing Fee (cheque / DD) received on. Request will be disposed of and acceptance / rejection notification will be mailed within 15 (fifteen) days from the date of the receipt of duly completed application form with all supporting documents, as required by DCB Bank Limited. Dated: D D M M Authorised Signatory