Application Form DCB Home Loan DCB Business Loan DCB PayLess Loan Application. PLEASE FILL IN BLOCK LETTERS ONLY Personal Details (To be filled in case applicant / co-applicant / guarantor is an individual) *Account Type KYC. Title Gender Father / Spouse Full Mother s Full Mother s Maiden Current Residence Address Application Date Salaried Self Employed Self Employed Professional Applicant rmal Simplified (for low risk customers) Small OTP Based e-kyc Mr. Mrs. Ms. Dr. First Middle Last Male Female Third Gender Preferred Mailing Address: Res. Co-applicant Guarantor Off. rmal Simplified (for low risk customers) Small OTP Based e-kyc Mr. Mrs. Ms. Dr. First Middle Last Male Female Third Gender Landmark. of yrs at current residence Current residence is Rent per month, if rented Phone. with STD code Mobile. E-mail ID Permanent Address PIN Self owned Family Rented Company s. of dependants PIN Self owned Family Rented Company s. of dependants Phone. with STD code Date of Birth Marital Status Qualifications PAN Aadhaar Card Number Religion Category Residential Status GST Number U.S. Person: Country of Birth: *Place of Birth: *Citizenship: *Residence for Tax Purposes: Proof of Identity Proof of Address Simplified Measures Account Document Type Code 2278-Ver 1.1-Feb 2018 PIN D D / M M / Y Y Y Y Single Married Others Graduate Post-Graduate Other OBC SC ST DT / NT MBC Others Resident Individual Foreign National Resident NRI PIO n Resident Indian Passport. Expiry Date Driving Licence Expiry Date Passport Voter ID Driving Licence NREGA Job Card Person of Indian Origin UID (Aadhaar) Other PIN D D / M M / Y Y Y Y Single Married Others Graduate Post-Graduate Other OBC SC ST DT / NT MBC Others Resident Individual Foreign National Resident NRI PIO n Resident Indian Passport. Expiry Date Driving Licence Expiry Date Passport Voter ID Driving Licence NREGA Job Card Person of Indian Origin UID (Aadhaar) Other M007 / Mar 18 / 1.7
Business / Employment Details To be filled in case applicant / co-applicant / guarantor is non-individual. Details of employer to be filled in case of salaried employee. Occupation Salaried Nature of Business / Empl. of the Concern / Empl. Designation Business / Employment Add Public Ltd. MNC Applicant Co-applicant Pvt. Ltd. PSU Public Ltd. Others MNC Guarantor Salaried Self Employed Self Employed Salaried Self Employed Self Employed Professional Professional Pvt. Ltd. PSU Others Pin Pin. of yrs in current Phone. with STD code Fax. with STD code PAN business / employment Details of previous business / employment Date of Commencement Date of Commencement Directors / Partners (Applicant) DIN Address First Second Third Phone. with STD code PAN Date of Birth Mothers Full Father / Spouse Full Proof of Identity Proof of Address Simplified Measures Account Document Type Code Directors / Partners (Co-applicant / Guarantor) DIN Address PIN PIN PIN D D / M M / Y Y Y Y D D / M M / Y Y Y Y D D / M M / Y Y Y Y Fourth Fifth Sixth Phone. with STD code PAN Simplified Measures Account Document Type Code PIN PIN PIN Date of Birth D D / M M / Y Y Y Y D D / M M / Y Y Y Y D D / M M / Y Y Y Y Mothers Full Father / Spouse Full Proof of Identity Proof of Address
Reference 1 (From relative only) Reference 2 Relationship Relationship Address Address Phone Mobile Phone Mobile Bank Account Details of Account Holder of Bank Branch Account operated since Account. Account Type (SB / CA / OD) Credit Card Details of Bank Card. Year of issue Year of expiry Card Limit Existing Relationship with DCB Bank Limited Loan Account. Bank Account. Others Income / Assets / Liabilities Details Applicant Co-applicant VALUE VALUE ANNUAL TURNOVER INCOME Gross Monthly Income Net Monthly Take Home Other Income (specify sources) Average Monthly Expenses Monthly Instalments you pay ASSETS 1. Property and other Assets 2. Motor Vehicles 3. Fixed Deposit (if any) 4. Current in PPF 5. Current in PF (your share) 6. Other Investments (bonds / securities) 7. Sum assured of life insurance policies Applicant Co-applicant LIABILITIES & address of institution from whom loan has been availed with purpose of loan Outstanding () Term (Months) Repayment () Outstanding () Term (Months) Repayment () 1. 2. 3. Total Liabilities Property Details Property Address Area of land Area of flat / house / office Property Type Residential Commercial Ownership Type Sole Joint Pin Approximate Market Value Nearest Landmark Present Owner
Loan Details Loan Amount: Loan Tenure: years Interest Rate: Floating Rate Fixed and Floating Rate Purpose of loan Estimate of requirement of funds Estimate of sources to meet requirement of funds Business Expansion Purchase of Residential Property Home Construction Purchase of Commercial Property Home Repair Education Purpose 1. Total purchase price / construction cost 2. Incidental costs (if any) 3. Other costs Please specify 4. Loan requested 5. Savings from Bank 6. Disposal of investments (fixed deposits / shares etc.) 7. Amount already spent (source ) 8. Provident Fund (refundable/non-refundable) Personal Use 9. Other (specify ) Total requirement of funds A. (Sum of 1 to 3) Total Estimate of sources of funds B. (Sum of 4 to 9) Total te: A which is the total requirement of funds, should equal estimate of sources, B which indicates the sources from the cost will be met. It is important that you indicate in detail, the sources from where the cost will be met in order to help us process your application faster. Processing Fee Details Processing fee (non-refundable): Cheque / DD Number Dated Drawn on in favour of DCB Bank Limited. I / We agree to open a Savings / Current Account with DCB Bank Limited. 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. Applicant s photo signed across Co-applicant s / Guarantor s photo signed across Declaration 1. I / We declare that all the particulars and information and details given / filled in this application form are true, correct, and complete and up to date in all respects and that I / we have not withheld any information whatsoever. DCB Bank Limited (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 no insolvency 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 by any court or other authority. 3. 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 reorganisation or for the appointment of a receiver, administrator, administrative receiver, trustee or similar office or for my / our assets. 4. I / We authorise 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 history to other banks, financial institutions, agencies, statutory / regulatory bodies, court, forum, 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 and acknowledge that the Bank shall have the absolute discretion, without assigning any reasons (unless required by applicable law), to reject my / our application and 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, expenses, other consequences caused by reason of such rejection or any delay in notifying me / us of such rejection, of my / our application. 6. The Bank reserves the right to retain the photographs and documents submitted and will not return the same to the applicant, co-applicant or guarantor. 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 section 6 r / w schedule IA ofthe provisions of the Companies Act, 19562013. 8. 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 Home Loan / Business Loan / PayLess 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? o o I / We expressly authorise 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. 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- KYC 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. Signature of Applicant of Applicant: Date: Signature of Co-applicant / Guarantor of Co-applicant / Guarantor: Date: List of Documents Documents Application Form Photograph signed across Bank ment Last 6 months from Salary Account Last 6 months from Primary Business Account Proof of Income Last 2 Salary Slips / Salary Certificate Last 2 years; IT Returns with Computation of Income and Certified Financials Proof of Turnover t Applicable Latest Sales / Service Tax returns / VAT returns Proof of continuity / Current Form 16 / Company s appointment letter / Trade Licence, Statutory Licences, Employment / Business Stability Other supporting documents other supporting documents (any one) Proof of Identity (any one) Passport / Voter s ID / PAN Card / Photo Credit Card / Passport / Voter s ID / Pan Card / Photo Employee ID Card (Govt. & Public Ltd. Co.) Credit Card Proof of Address (any one) Passport / Ration Card / Utility Bill / LIC Policy / Passport / Ration Card / Utility Bill / LIC Policy / Lease Agreement / Leave & Licence Agreement Lease Agreement / Leave & Licence Agreement Proof of Age (any one) Passport / Driving Licence / Birth Certificate / LIC Policy / Passport / Driving Licence / Birth Certificate / LIC Policy / Government ID Card / School Leaving Certificate / PAN Card School Leaving Certificate / PAN Card Proof of Qualification t Applicable For Professionals: Copy of highest professional degree Copy of Partnership deed t Applicable For Partnership firm MOA, AOA, Board Resolution, Certificate of Incorporation, CA Certificate Loan Agreement and other documents enclosed in the kit Sourcing Channel t Applicable Salaried Pre-sanction Post-sanction Signature Verification For Companies Self Employed / Business Entity Proof of Identity: Document Code Description 03 Bank account or Post Office savings bank account statement. 01 Identity card with applicant's photograph issued by Central/ Government 04 Pension or family pension payment orders (PPOs) issued to retired employees by Departments, Statutory/ Regulatory Authorities, Public Sector Undertakings, Government Departments or Public Sector Undertakings, if they contain the address. Scheduled Commercial Banks, and Public Financial Institutions. 05 Letter of allotment of accommodation from employer issued by or Central 02 Letter issued by a gazetted officer, with a duly attested photograph of the person. Government departments, statutory or regulatory bodies, public sector undertakings, Proof of Address: Document Code Description scheduled commercial banks, financial institutions and listed companies. Similarly, 01 Utility bill which is not more than two months old of any service provider (electricity, leave and license agreements with such employers allotting official accommodation. telephone, post-paid mobile phone, piped gas, water bill). 06 Documents issued by Government departments of foreign jurisdictions and letter 02 Property or Municipal Tax receipt. issued by Foreign Embassy or Mission in India. ECS / SI / PDCs / Security Cheques of Executive Branch Branch Employee DSA BANK COPY ACKNOWLEDGMENT 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 completed application form with all supporting documents. KYC verification carried out by Employee & HRMS : Employee Designation: Branch : Date: Authorised Signatory Employee Signature
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, 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, proceed to point C C. Is the account holder an Indian Financial Institution If yes, please provide your GIIN, if any, If, 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, proceed to sign the declaration 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 s 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) 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. (iii) 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-todate. (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. 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 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 Entity Identification issuing Country Country of Residence for tax Purpose
Section 2: Classification of n-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) If, please provide your U.S. Taxpayer Identification Number (TIN) TIN b) An entity incorporated and taxable outside of India (other than US) If, 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 n-financial entities (NFFE) Active NFFE Passive NFFE without any controlling Person Passive NFFE with Controlling Person(s): US Others 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 If, (i) Please provide your Taxpayer Identification Number (TIN) TIN (ii) Please provide GIIN, if any If, 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 n-iga Jurisdiction n-reporting Financial Institution (FI) n-participating FI Owner-Documented FI with specified US owners DCB Bank Limited
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: 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 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 s 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) Date (DD/MM/YYYY) CUSTOMER COPY ACKNOWLEDGMENT Sr..: 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 completed application form with all supporting documents. Date Authorised Signatory