EMI Deferral Application form

To Date:
The Manager
………………………..….. Branch

Subject: Application for deferral of EMI against my/our loan/Investment with Prime Bank.
Reference: LD No. ….………………………………..

Dear Sir/Madam,

Please be inform that repayment of my/our ……………………………. loan/investment facility availed from your
bank has been impacted due to COVID-19 pandemic. Therefore, I/we would like to apply for EMI deferment
from ………………………………… to ………………………………… against said loan/investment. My/our personal details
& loan/investment particulars are stated below:
Personal Details:
Name of Customer
Address of Customer
Contact No Email

Existing Loan/Investment Particulars:

Disbursed Amount EMI Amount
Tenure Expiry Date
I/we the undersigned hereby declare that, I/we have read & understood below mentioned terms & conditions
applicable for EMI deferral and confirm my/our consent in this regard.
Terms & Conditions:
 Apart from revised EMI amount and expiry date, prevailing all other terms & conditions against the
loan/investment will be remain unchanged.
 EMI amount and loan/investment expiry date will be re-fixed upon execution of EMI deferment.
 Expiry date may be extended more than number of deferred months of EMI (where applicable) due to
amendment of the remaining repayment schedule.
 If my/our prevailing number of overdue EMIs are higher than number of deferred EMI, excess amount
might be adjusted from my/our own source prior to execution of EMI deferment facility.
 Bank preserve the right to approve or cancel the EMI deferment facility.

Signature of Applicant Signature of Co-applicants/Joint Applicants

Name: Name: