APPLICATION FORM -

HDFC BANK RETAIL AGRICULTURE LOAN

We understand your world
4377227

Branch Code
CRM No:H "Application Date:4062024
*RM Code: MIS code: 9lo
"so Code: 4 8 B
Group ldentiífer:HOU Proposal No.:93|92|o40 Sales Promo: Y4EEO
Lead Source by:RBG Branch VLE VOther LG Code:YI4&83O LC Code: 4BREIOO
JLGIFPO: Yes Not Other proposal No.
If yes, App form no. 4 3 22 (f any) Proposal 1: 939 2o403
Proposal 2: Proposal3 : H O Proposal 4: GO
To.
The Branch Manager,
HDFC Bank Ltd,.
Dear Sir.
uaiau Branch

/ We hereby apply for the following credit facilities under HDFC Bank Ltd. for total loan amount of Rs 1So,00o0o/ for KGCI
and furnish below information:
1. TYPE OF LOAN REQUIRED:

Facilities Cash Credit Overdraft FDL-DOD FDL-TL TL 2

Amount in Figures
lo ,00,0co|
Amount in Words TEN
(AkHS CAK HS

Purpose faun develabud fan deue lapvatfou Dedopwent

Frequency M M
Tenure in Months

Credit Promo

Information related to Term Loan: Whether IWe would avail subsidy from Government of India:YesNol If Yes, provide scheme name:
Beneficiary ID/Application ID: LOI No
2.SECURITY PROPOSED TOOFFER:
Type (Crops/Agri Land/ Urban Security Value (in Rupees)
Security Security Description
Property/Gold/Liquid security) Govt value Market Value

Primary
Hypothecation of asset created out of bank finance / Crops
Collateral 1

Collateral 2
Conhcaant LAN o 6E MoKTGAGE
Collateral 3
Commheial LandlLA) To BE MoKTGaGt
Collateral 4

3. DETAILS FOR ACCOUNT OPENING (Tick wherever applicable):

Account type Product Code Operating Instructions Insta Alert ATMDebit Card Required
Savings
169 Single Either or Survivor Jointly Former or Survivor Yes No YegNo
Cash Credit Single Elther or Survivor Jolntly Former or Survivor Yes No Yes No
Overdraft Single Either or Survivor Jointly Former or Survivor Yes, No Yes No
Either or Survivonl Jointly Former or Survivor
DOD
155 Single Ye_No Yes No

Reg1ster for Email statement Netbanking Yes NoO DBT Application Yes No

4.RELATIONSHIP WITH DIRECTORS OF OTHER BANKs:

9909/
MO19
Applicant is a director of any Bank or is a firm in which any director of other bank ls interested as partner/ guarantor or is a relative of director of other bank or is a firml
company in which a relative of director is interested as partner or director Yes [INaTYes, Nalure of relationship
5. RELATIONSHIP WITH DIRECTORS OF HDFC BANK:

Applicant is adirector/senior officer/relative of director or senior officer of the bank or is a firm/company in which bank's director is a partnerldirector or quarantor
Yes J/No ÍYes, Nature of relationship
Page 1/12
 6. DETAILS OF APPLICANT (Fill details in CAPITAL Letters only)

Pretix
Name: (Same as ID)
Maiden Name: (If any) AAAN3ARTIO
Father/Spouse Name:
Mother Name:
MAUAARN
*Mothers Maiden Name:
Date of Bith:
Customer ID (For existing customer)
Gender: MMale DF-Female OTTransgender Marital Status: Married Unmarried DOthers
Nationality: Education: iterate eraduate OuG PG
Residential Status: Resident Individual Non Resident Indian Foreign National uPerson of Indian Origin
Residence Type: Pakka OKutcha Temporary others Constitution: IndividualNon individual
*Religion:
*Category of Farmer: OMarginal DSmall DOther
"Weaker Section: Dsc DsT DOBC DPH Lofher
If Minority:
DBuddhists DMuslim Christians Osikhs OJains Zoroastrians
Occupation Type: s-Service Private Sector Public Sector UGovernment Sector) DB-Business
O-Others ( Professional Self Employed URetired D
Housewife Student )
MAILING ADDRESS
Address Line 1:
Address Line 2:
ARAMAN KAR PVlKLASHRALD40ALnbK
Village / Town / City:
Landmark:
ALRLLALDDKPOOAEARTehsil: AULDK L
District:
Pincode:E
Years at the mentioned Address: t
State:

Email Address:
NANHyAAASA Moble No.: A2 2324

PERMANENT ADDRESS!Please tick if permanent address is same as mailing address )

Address Line 1:

Address Line 2:

Village / Town / City:

Tehsil:
Landmark:
District:
Pincode:
Years at the mentioned Address:
State:
Mobile No.:
Email Address:

KYC Documents
KYC No. (As per Central KYC):

38345830 443o Proof of ldentity (Pol)

ariDAsdhaar BEEEBS5S D2PAN Card No.
3.Voter ID Card
4. NREGA Job Card
ABAU3a OR Fom 80
5. Driving License
LAJA DL Expiry Date
6. Passport No.
Passport Expiry Date
D7.Others (Issued by Gol) ID Proof: ID Proof No.
Expiry Date
Proof of Address (PoA)
Address Type Residential/Business Residential
Proof of Addres_
Business Registered Office
UID-Aadhaar Voter ldentity Card |Driving License Unspecified
Passport NREGA Job Card others (Pl. Specify)
7. ADDITIONAL FAMILY DETAILS:
No. of Family Members(H Name of Karta, in case of HUF:
8. PARTICULARS OF
LIABILITIES AS A GUARANTOR OF MAIN APPLICANT
Loan sanctioned to Shri/ Smt. Name of the Bank / Institution Amount of Loan (Rs.) Balance
Status of Account
New hwaiu Hpf Bauk Outstanding (Rs.) (Regular / Overdue)

Page 2/12
9. CO-APPLICANT DETAILS (Fill details in CAPITAL Letters ontv) (IN CASE OF MORE THAN Two co-APPLICANT SAME PHOTOCOPY TO BE USED)

Name: (Same as iD)

MKIAHEUKOAHE
Maiden Name: (If any)
Father/Spouse Name:

Mother Name:

"Mothers Maiden Name:

Date of Birth: Customer ID (For existing customer)

Gender: MMale DF- Female OTransgender Marital Status: Married DUnmarried others
Nationality: Education: Dliterate eraduate DuG DPG
Residential Status: Resident Individual Non Resident Indian Foreign National cPersoh of Indian Origin
Residence Type: Pakka OKutcha DTemporary DOthers Constitution: DIndividual Non individual
*Religion: *Category of Farmer: OMarginal Smal other
*Weaker Section:
Osc DsT DOBC OPH Cother
If Minority: DBuddhists OMaslim Christians Sikhs UJains DZorcastrians
Occupation Type: s-Service (UPrivate Sector Public Sector Government Sector ) DB-Business
O-Others Professional Dsef Employed Retired O
Housewife Student

MAILING ADDRESs
Address Line 1:
232
Address Line 2:
6KAMSHANKA KPKASRAK
Village / Town / City: Tehsil:

Landmark:
Pincode:4 L D
District:
Years at the mentioned Address:5o
State:
MADHyAAE Mobile No.81
Email Address:

PERMANENT ADDRESS Piease tick if permanent address is same as mailing address)

Address Line 1:

Address Line 2:

Village / Town / City: Tehsil:

Landmark:
Pincode:
District: Years at the mentioned Address:

State: Mobile No.

Email Address:

KYCDocuments
KYC No. (As per Central KYC):
Proof of ldentity (Pol)
UID-Aadhaar AN Card No. OR Form 60
3. Voter ID Card 4. NREGA Job Card
5. Driving License DL Expiry Date
6. Passport No. Passport Expiry Date
7. Others (Issued by Gol) ID Proof: ID Proof No. Expiry Date
Proof of Address (PoA)
Address Type Residential/Business Residential Business Registered Office Unspecified
Proof of Address UID-Aadhaar Voter ldentityCard Driving License Passport NREGA JOb Card Others (PL Specify)

Page 3/12
10. GUARANTOR DETAILS (Fill details in CAPITAI Lottere on) oASE OE MORE THAN ONE GUARANTOR SAME PHOTOCOPY TOBE USED)

Last Nane
Prefhx Frst Nae

Name: (Same as ID)

Maiden Narne: (If any)

Father/Spouse Name:

Mother Name:

"Mothers Maiden Name:

Date of Birth: Customer ID (For existing customer):

Gender: M- Male OF- Female DLTrahsgender Marital 8tatus: OMarried JUnmarried Dothers
Nationality: Eddcation: literate Graduate DuG PG
Residential Status: DResident Individu ONon Resident Indian Foreign National Person of Indian Origin
Residence Type: DPakka DKutcha OTemporary Constitution: Oindividual Non Individual
"Religion: *Category of Farmer: Marginal DSmall Dother
JL
"Weaker Section: OsT DOBC DPH Dother
If Minority: Buddhists Muslim Christians Osikhs O
Jains DZoroastrians
Occupation Type; s-Service ( Private Sector Public Sector Government Sector ) B-Business
o-others Professional Self Employed Retired DHousewife Student )

PERMANENT ADDRESS ( Please tick if permanent address is same as mailing address )

Address Line 1:

Address Line 2:

Village / Town /City: Tehsil:

Landmark: Pincode:

District: Years at the mentioned Address:

State: Mobile No.:

Email Address:

MAILING ADDRESS

Address Line 1:

Address Line 2:

Village / Town / City: Tgbsi

Landmark: Pincode:

District: Years at the mentioned Address:

State: Mobile No.:

Email Address.

KYC Documents
KYC No. (As per Central KYC):
Proof of ldentity (Pol)
D1. UD-Aadhaar 2. PAN Card No. OR Form 60

D3.Voter ID Card 4. NREGA Job Card

5. Driving License DL Expiry Date

D6. Passport No. Passport Expiry Date

O7 Others (Issued by Gol) ID Proof: ID Proof No. Expiry Date
Proof ofAddress (PoA)
Address Type Residential/Busjness Residential Business Registered Office Unspecified
Proof of Address UID-Aadhaa Voter ldentity Card Driving License PassportNREGA Job Card Others (PI. Specify)_

Networth of the Guarantor (in Rupees) Land Holding of the Guarantor (in Acre)
Page 4/12
11. DETAILSOF EXISTING LOANS, DEPOSITS AND ANNUAL INCOME:
Applicant / Co applicant
Applicant Appllcant /Co applicant Applicant /Co applicant
LOAN DETAILS

Bank & Branch Name

Loan A/cNumber
Facility type
Purpose of loan
Sanctioned Limit

Present Outstanding
Yearty Obligations
Installment payable H MO H

Security Offered
Consider for Takeover Y N N N N

DEPOSITS & INcOME DETAILS

Bank & Branch Name
Present Saving (incd FD)
Nc type (CASA/FD)
SB A/c IFDR no

Annual Agriculture
Income
Other
Total Income

12. PARTIcULARS OF LAND HOLDING

Land Details Owned Land
Applicant /Co-Applicant Applicant / Co-Applicant Applicant / Co-Applicant Applicant / Co-Applicant Applicant /Co-Applicant
Land Owner Nuwab
Apþicat T-8 Aee Apþicat
Name
Ahme d.
Abdul wcw
Survey No. 14 &( s) (46(s
To be Mortgaged? Yes /No Yes /No Yes /No Yes | No Yes JNo

Village Name Shencaupu dheakcwpu &haukciot

Census Village Code

Gram Panchayat O Patwari Halka Talathi Saja Patwar Circle Ward Zone

Revenue Block Revenue Circle Phirka / Firka Nyay Panchayat Sub Mandal - Tehsil

Mandal O Sub-district Block Sub-division

"Tehsil Gwdicue Gwali

"District

*State

PIN code 4740o ! 4440o l

*Area (acre) 2+82 Ace
"Irrigated Area
*Irrigation Source
*Crops cultivated
Govt rate/acre lo00O00( -
Market ratelacre So,00, 000(
Encumbrance if any
13. SIGNATURE MISMATCH DECLARATION
The signature on the ID proof/Address/Cheque provided is different
form as my updated signature in your bank records. from my signature on the account opening form. Please coerder the
signature on the Account openina

Old Signature as per document

New Signature as per account opening form
Page 5/12
14. NOMINATION DETAILS:
my/our account.
Yes, IWe wish to nominate (as details below) No, IWe declare that Ido not wish to make a nomination in
of the Banking Requlation Act 1949 and Rule 21) of the Banking companies (Nomination) Rules 1985 in the respect of Bank deOsits
Nomination under section 45ZA the amount/aold deposits of the above opened Account may be returned by
IWe nominate the following person to whom in the event of mylour/minor's death
HDFC Bank Ltd. By the account opening branch.
This Nomination will be applicable for Savings/Current account Fixed Deposit Recuring Deposit. |Gold Loan
Name of Address:
Nominee:
Landmark: City
Tel:
State: Pincode: Couetry:
Relationship with Applicant, if any:
Age: Years Date of Birth of Nominee:
(Leave out If Nominee is not minor)
Name of Nominee Address:

minority of the nominon

of Age to receive the amount/gold deposits of theeposit in the account on behalf of the nominee in the event of my/minor's death during the

Personal details of Witnesses (Thumb impressions shallbe attested by 2witnesses)r

Witness 1 Name Address:

Date
Signature Place

Witness 2 Name Address:

Date
Signature Place

Declaration for A/c opening by illiterate person.

Where the borrowerl guarantor signs in vernacular language / visually handicapped / illiterate person
, Mr/Ms. AE
Middie Name
and residing at
do hereby state, delcare and solemnly afirms as follows
Ihave read out and explained all of the contents of the Application form for Retail Agri loan from HDFC Bank and terms and conditions and allother documents incidental to
applying and availing credit facilities from HDFC Bank to,

Hin language (name of language in which applicant has signed) and he /she has confirmed to have understood all of such
terns and conditions as specifiedinthe documents being executed by him/ her by signatur e / af fixing thumb impression herein below as well on the application
form and such other documents for loan purposes.

Sahee8 Ahed

Witness Signature Name and Thumb impression / Signature

of Borrower / Guarantor
/We decare and state that we have understood content of the application form for Retail Agriculture loan from HDFC Bank with other incidental documents which has been
executed inour presence and has been executed by me/us bya fixing the signature/thumb impression on the given documents
15. DECLARATIONS

a. IWe hereby declare that the particulars given are true and correct to the best of mylour knowledge and belief.
b. We hereby declare that the Land/security documents for properties mentioned under own land in point 6 and collateral in point 5 are genuine and liwe confirm that
the ownership of these properties are in my/our name in the Government records.
C. IWe hereby authorize the Bank to disclose all or any particulars or details or information relating to mylour loan accounts with the bank to any other financial
institution, government or any other agency,as may be considered necessary or desirable by the Bank.
d.
/We hereby declare that no arrears/disputes are pending under Income Tax Act in respect of property offered as security to the Bank.
e. IWe am/are not defaulter with any other Bank, Co-operative Society or any other Financial Institution.
I/We delcare to undertake banking exclusively with HDFC Bank.
g.
t willbe in order for the Bank to dis-qualify me/us trom receiVing any credit facilities from the Bank in case it is provided that the declaration of my lour outside
borrowing made above contain mis-representation of facts.
h. IWe hereby declare that | /We have no borrowings/Liabilities excepting those mentioned above as on the date of application.
IWe hereby undertake to abide bytheterms and conditions that the Bank may stipulate in sanction of this loan and inform the Bank in the event of acquiring any
other assets during the tenure of advance.
/Weunderstand
and agree to avail thethe
that all benefit
otherunder
termsnatural calamity of
and conditions relief
the measures provided by
Loan Aareementand bank in event of any natural calamity defined as per prevailing RBI quidelines
k
other transaction documents shall remain unchangedand in full förce and effect.
/ We further declare that it is the sole responsibilty of tne Dorrower to intorm the bank about any changes in the cropping pattern from time to time as and when
such changes are made.
1/We take sole responsibility for any loss incurred due to non compliance of regulatoryauidelines
m We intend to avail total disbursement for Kharit and RaDI Season limits together and
hereby authorize bank to disburse total limit amount in my account.
n /we confirm that the terms and conditions of the below Insurance sGnemes have been
the bank to debit my/our SB account no/no's mentioned betow o e amountof initial explained to melus and /we hereby authorize
of the below mentioned Insurance Schemes for KGC holder. premium and renewal premium, if any in respect

|Insured Member 1 Name: Nominee Name:

|Insured Member 2 Name: Nominee Name Relationship: SB A/c no:
Insured Member3 Name Nominee Name Relationship: SB A/c no:
Reiationship: SB Alc no:
Page 6/12
 Personal Accident Insurance (As per Pradhan Mantri
Suraksha Bima Yojana -PMSBY)
Life Insurance (Pradhan Mantri Jeevan Jyoti Bima
ORs. 436
Yojana -PMJJBY)
Rs. 342 JRs 228 ORs. 114
Terme andconditions
The cover in PMJJBY policy starts from 45 days after enrolment The renewal premium for
PMJJBY to be debited in May of every year would be Rs. 330.
The cover will cease to exist if the auto debit of premium aite Subscriber should not hold more
than one policy of each kind as claim wOuld paid for only one
policy Please refer the detailed intormation, terms and conditions on banks website
UIDA-Andhaar Consent from Customer for authentication
| Ihereby submit my Aadhaar number issued by UIDAL. to HDFC Bank and voluntarily give my consent to use my Aadhaar number for authentication with
UIDAI as per Aadha.
ntained wh S Bank in mytor thepurpose
individual of Account
capacity opening/Aadhaar
and /oras linking / seeding
an authorized signalory to all my accounts/
in noñ-individúals accountsrelationships (existing,new and future)
Oholder
details to ot the Andhaarmenumber,
authenticate heretbyas voluntarily
with UIDAl per Aadhaar giveAct,my2016
consernt to HDFC Bank to oblain and use my Aadhaar number, Name and Fingerprintlris and my Aadhaar
and allother applicable laws
Jlalso authornze HDFC Bank to to use my Aadhaarnumber to open account /link and authenticate my Aadhaar number to all my accounts Irelationships with the Bank
as may be opened in future in individual and also in case of non-individual accounts in addition to the existing acCOunts and relationships.
IWe authorize and give consent to bank for credit bureau check pertaining to mel us / associated entities / group concern
IWe authorize and give consent to bank for obtaining FATCAdeclaration required for CASA account opening
IWe give my/our consent for Opt in /Opt Outof Prime Minister Fasal Bima Yojna (PMFBY)/Restructure Weather Based Crop Insurance Scheme (RWBCIS)
IWe choose to Opt in for PMFBY /RWBCIS, I/ We provide the consent to deduct the premium amount from my/our crop loan account as per the declared
cropping pattern (FOR PMFBY IRWBCIS)
IWe choOse to OptOut of PMFBY /RWBCIS, IWe would like to continue with KCC Loan, /We declare that Bank will not be held responsible for any losses due to
non under the PMFBY /RWBCIS scheme.
VWe take sole responsibility for non receipt of of government scheme benefits due to non adherence of scheme guidelines/ inability to submit required documents/
information (if any) by mel us.
In the event government withdraw scheme benefit extended in mylour account, IWe hereby authorize bank to refund the same to government by debiting my/our
account.

w
We authorize and give consent to bank to verify the details provided by mel us / associated entities / group concern, to any other financial institution, government
or any other agency, as may be considered necessary or desirable by the Bank."
wWe here by authorize the primary applicant to avail/accept the terms of additional loan/enhancement of credit facility and the authorisation will be continuing &
binding revoked and intimated to the Bank and Bank confirms such revocation. All acts done prior to the same will be binding on all the applicant(s).
Half Yearly Balance (HYB) Declaration
" /We have understood that | / We am l are required to maintain an Half Yearly Balance (HYB) of Rs. 10,000/- (for Metro / Urban branches) and Rs. 5,000/- (for Semi
Urban / Rural branches) for which the Bank would provide PhoneBanking, NetBanking, MobileBanking and ATM Services Free of charge except where otherwise
Iso understood that non maintenance of HYB will attract, a) Non maintenance charges / fees of Rs. 750/- per half
specified in the schedule of charges. I/ We have also
year which willbe levied without any further advice / notice and b)Other transaction charges will be detailed in the schedule of charges." IWe confirm that /we am/are
in possession of and have read the Terms & Conditions Booklet, which details the rules governing account operations and the Schedule of Service Charges, which
specifies the charges applicable for various services.
Declaration for Liability account opening
an account with HDFC bank and those relating to various services inciuding but not
IWe have read and understood the Terms & conditions governing the opening of banking (F) Bill pay facility (G) Insta Alert facility (H) Email Statement. lWe accept
limited to (A) ATMs (B) Phone banking (C.) Debit Cards (D) mobile Banking (E.) Net
those excluding/limiting the bank liability. IWe agree that the bank may Debit my account for the
and agree to be bound by the said Terms & conditions including that I/We am/are resident of India, IWe authorize the bank to disclose, from time to time
any information
applicable from time to time. IWe confirm
service charges
affiliate and associate of HDFC bank, and to third parties engaged by the bank for puposes as detailed in
relating to mylour saving account to any parent/subsidiaryamlare details the rules
in possession of and have read the terms & condition booklet which services and the tear away
of governing
the Terms & Conditions booklet. IWe confirm that IWe specifies the charges applicable from time to time for various
account operations, the service charges and the fees of brochure which of account
opening rules. Net Banking and SMS banking service the will be available to the customer upon openingprovided
CUstomers copy detailing the instruction and account formalities for activation of such services notwithstanding documentation and account opening form the
with the bank without requiring completion of any nthie of changes of address relocation or any other reason
application. Banks decision in regard would be the final. In case
bank reserves the right to acceptUreject your within tWo weeks of such changes with valid address
es oroof.
I/we would intimate the new address to the bank
to receive marketing information etc. through
telephone/mobile/SMS/Email by the bankits agents /We
DO NOT CALL REGISTRY I/Weconsentdo not consent board/general telephone numbers of offices / corporate employees)will be accepted for registration of "DO
agree and acknowledge that only direct telephone numbers (not the correctness of the request for registration
l/we may receive a call from the bank to verify
NOT CALL". IWe am/are aware that post registration

Acknowledgement
Date: Customer Name:
Application Form No:
Resident of
S/o, W/o, Dlo

for the purpose of

This is to confirm receipt of below mentioned
documents on behalf of HDFC BANK LTD
Documents received (Specify)
Documents received (Specify) Sr no.
Sr no.

connection with this loan application

any payment in cash, bearer Chegue or kind anyone in
IMPORTANT NOTICE: Kindly DO NOT make

Page 7/12
16. SIGNATURES ANDPHOTOGRAPHS OF APPLICANT

Coo Aupicart Photogragh

wth aossgrturet r o
Sebas irnpresson

CoApplicart 2
Co-Applicant 1
Applicant Narme
Name:bdul Waw Name:

Sigrature
Signature Signature

Guarantor Photograph with

Guarantor Photograph with
Co- Applicant Photograph cross-signature/ thumb
cross-signature humo
with cross-signature/ thumb impression
impression
impression

Co-Applicant 4 / Guarantor Co-Applicant 5 / Guarantor

Co-Applicant 3
Name: Name:
Name:

Signature Signature
Signature

Date: Place:
Gwaau,

KINDLY NOTE:
automatic approval of your loan by HDFC Bank Ltd. HDFC Bank Lto
That the receipt of your application form for the loan does not imply may request tor additional documents other than those colected in
Ltd
will decide the quantum of loan at its sole discretion. HDFC Bank the photograph and documents submitted along with the
connection with the application. HDFC Bank Ltd reserves the right to retain
Ltd shall not be liable for loss or delav in the receipt of
application form and shall not return the same to applicant. HDFC Bank Bank Ltd shall not be responsible in any manner for or
documents. Incomplete / Defective application will not be processed and HDFC
HDFC Bank Ltd only. Appiçation processing and loan
otherwise. That all Post Dated Cheques are to be issued favouringcompletion & submission of all relevant documents as per bank's
disbursement should take around 30 working days from the time of
criteria.

ADDITIONAL INFORMATION
working days from the time of completion &submission of all relevant
Application processing and loan disbursement should take around 30
documents as per bank's criteria.
Charges
Interest Rate:
% | Processing Fees: % + applicable taxes | Foreclosure

Onginal Seen &Venfied

ogandra Singh Bhedoune
Emp1D:-Y48834
HDFC BANK;TD ARSEF Gwalix
RM Name: cqndua S: KheLcusua RM Contact No.: &4o (72T2 stampSghature
Page &/12
 HDFC BANK FIELD VISIT REPORT

Visit Date o4o6 24 Br. Name Br. Code RM Code Y48 |3

RM Name Y l o a d D A k J a | | A
1. DISTANCE CRITERIA:

Applicants Distance From Nearest RM Location 20 Km Nearest Branch Km 20

Land Km

2. DETAILS OF FAMILY MEMBERS OF APPLICANT & THEIR RELATIONSHIP WITH MAIN APPLICANT:

# Name of the family member Gender Age Relationship If dependent Annual Income (ln Rupees)

1
AebuL WARI So Yes]/No 9 o, Doo
2
NAWA& AHHE fa£k Yos]/Na S, 60, to
3
M So MoTHÉK Yes NgD
4
KiHAN AHNES YesNoO
5 MIF YesNo

3. FAMILY TREE OF PRIMARY APPLICANT:

Wuwo Ahmd

Abd waws

4A. LAND HOLDINGDETAILS (OWNED LAND):

Village Name Survey No. Area Crop Name Irrigation Other
Name of Land Owner Source Observation
(Acres)

1 ALsUL WARS SHA NKARok 182(s) o-48

2 Nauwab Ahed SHAwaeo
3
t 146(s)
4

Total Land in Acres

4B. LAND HOLDING DETAILS (LEASED LAND):

Tehsil District Crop Area Total Lease Amt
Name of Lessee/ Village
Name of Lessorl Name (In Acres) (In Lakhs/Year)
Land Owner Cultivator

3
Page 9/12
 AND IMMOVABLE ASSETS I PROPERTY OWNED:
5. PARTICULARS OF MOVABLE Immovable Assets
|Asset seen
Nos. Apprx. Value (Rs.) during visit
Asset seen
Movable Assets Nos. Apprx. Value (Rs.) during visit
YNO
House Building
Live Stock, Cattle YONO
Farm Land in acres
Poultry: Birds YO N
Farm Shed
TWo /Four Wheeler
Tractor / Power Tiller
|o43oy,oro Y NO Fish Pond / Tank
Warehouse /Godown YN
Harvestor /Transport Vehicle YNO YO N
N.A. Plots
Others Y N
Others
Liquid Assets
YES/NO
IMPACTED DUE TO NATURAL CALAMITY IN LAST TWO YEARS:
6. HAS THE FARMER BEEN
If yes provide details
7.INCOME DETAILS(OF ALL APPLICANTS):
Proof of Income
Net Income / Annum Frequency
Source of Income (Mth /Qtr / HY /Yr)
(In Rupees)
Agricuiture S ecs &tu
Allied Activities:
Dairy Poultry
Fishery other ITR
Salary Slip / Form 16
Non Agri Income: Other
|Bank Statement
Salary Business0el Sww
Other

Total income (ay

REQUIREMENT:
8. ASSESSMENT OF TERM LOAN/ DOD
Farm Development Loan
End Use Specific
# Parameter
1 Cost of Assets
Lau dwelwt
2 Margin offered
Loan amount
Isoeeh.
3

4 Tenure months

5 Remarks

Calculation of Annual Cash Flow (Amount in Rupees)

Allied Activity/Produce Non Farm Activity Total
Frequency / Income Farm Activity/Produce
Monthly
Quarterly
Half Yearly
Yearly
Total Cash Flow

Less: Margin
(20% of cash flow)
Net Cash Flow

9A. ASSESSMENT OF CASH REQUIREMENT (Amount in Rupees)

Season
Khariff
Domestic MPBF for the Max LTV % to PBF
Acreage SOFIAcre Crop Expense Post Harvest per Crop
Crops (A) (B (C=A'B) household crops F(C+D+E) be extended (R)

Other

Total Farm Expenses

9B.VILLAGE REFERENCE

Reference 1 Reference 2

Name:
Puuyaut
Address:
Shankwepu
Mobile: Relation J b w Relation Nat

10A. RECOMMENDATION FOR NEW FACILITY

Amount ROI(%) Repay Freq. Tenure Sales Promo
Name of Facility
(Amt. in Rupees) Fixed Floating PF (70) (MIQJHYY)(In Months)
Cash Credit / Working Capital RO- keioSgreas 2S/ Bo4
b Overdraft l v o , Ooof RO- R{ Bofsacado 2s). 1o35
Dropline Overdraft ROI= {oafSprea 25/ ) 955
FDL - Term Loan ROI= Ret RatetSpread

Term Loan |I ROI- RENate+Spread

f Other ROI- KerRate+ Spread

Total RO= Ref Rate+Spread

10B. RECOMMENDATION FOR EXISTING RELATIONSHIP

Whether Enhancement Yes No If Yes, Customer iD| Proposal No:

Loan Account Number Sanctioned Amount Outstanding Amount
Name of Facility (Amt. in Bupees) (Amt. in Rupees)

Cash Credit / Working Capital

Overdraft

Dropline Overdraft

FDL- Term Loan

Remark:

11. DECLARATION BY RM
Guarantor were found correct during my visit to the borrower
"l certify that the information/s provided in the application form by Borrower /
basis the proof of records as produced by customer.
Remarks if any:

1)
Original Seen &Verified
2)
Yogepdra Singh Bhadqurta
Place
o o 6 2 24 RM Code HDFC BANKID RBG-E Gwalior
Date

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9. CO-APPLICANT DETAILS (Fill details in CAPITAL Letters onlv) ( IN CASE OF MORE THAN TWO co-APPLICANT SAME PHOTOCOPY TO BE USED)

First Naue Mdcito Nano Last Nane

Name: (Same as ID)

Maiden Name: (If any)

Father/Spouse Name:
Mother Name:

"Mothers Maiden Name:

Date of Birth: Customer ID (Eor existing customer):

Gender: M- Male DF- Female D-Transgelder Marital Status: O Married DUnmarried Others
Nationality: Education: Oiterate Graduate OuG PG
Residential Status: Resident Individual Non Resident IndiD Foreign National OPerson of Indian Origin
Residence Type: Pakka O
Kutcha Temporary others Constitution: Oindividual Non Individual
*Religion: *Category of Farmer: OMarginal OSmall DOther
Weaker Section: Osc DST DOBC OPH DOther
If Minority: DBrÑdhists Muslim DChristians Sikhs OJains D Zoroastrians
Occupation Type: s-Service (U Private Sector Public Sector Government Sector) B-Business
o-others ( Professional Self Employed DRetired OHousewife Student

PERMANENT ADDRESS ( Please tick if permanent address is same as mailing address )

Address Line 1:

Address Line 2:

Village /Town / City: Tehsil:

Landmark: Pincode:

District: Years at the mentioned Address:

State: Mobile No.:

EmailAddress:

MAILING ADDRESS

Address Line 1:

Address Line 2:

Village / Town / City: Tehsil:

Landmark: Pincode:

District: Years at the mentioned Address:

State: Mobile No.:

Email Address:

KYC Documents

KYC No. (As per Central KYC):

Proof of ldentity (Pol) A
D1. UID-Aadhaar PANdard No. OR Form 60

D3. Voter ID Card 4. NREGA Job Card

D5. Driving License DL Expiry Date

6. Passport No. Passpor Expiry Date 202

Aug
ID Proof No Expiry Date
D7.Others (Issued by Gol) ID Proof.
Proof of Address (PoA)
Address Type Resideal/BusinessResidential Business Registered Office Unspecified
Proof of Address yo-Aadhaar Voter ldentity Card Driving License PassportNREGA Job Card Others (P. Specify).

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