APPLICATION 1.4 KOTAK MAHINDRA PRIME LTD.

FINANCE FACILITY APPLICATION FORM

ONLY FOR INDIVIDUAL

DETAILS OF: APPLICANT CO -APPLICANT GUARANTOR
IMPORTANT INSTRUCTIONS:
A) Fields marked with ‘*’ are mandatory fields. B) Please fill the form in English and in BLOCK letters.
C) KYC number of applicant is mandatory for D) For particular section update, please tick in the box available before the
update application. section number and strike off the sections not required to be updated.

For office use only (To be filled by financial institution)

Application Type* New Update
KYC Number CKYC Number (Mandatory for CKYC update request)

PERSONAL DETAILS
Name* (same as ID proof) MALA CHINNA MADDILETI

If any nick name

Maiden Name (if any)

Father Name/Spouse Name* MALA MADDILETI

Mother Name* M CHANDRAMMA

Date Of Birth 15/07/1997 Gender* Male Female Transgender

Marital status* Married Unmarried Other
Education Post Graduate Graduate High School Below HSC
Number Of Dependents Language Preference

Religion Hindu Muslim Christian Jain Sikh Buddhist Others

Caste SC ST OBC Others Citizenship* Indian Others (ISO 3166 country code)
Residential Status* Resident Individual Non-Resident Indian Foreign National Person of Indian Origin
Occupation Type* Service Private Public Government PSU Others
Business SEP SENP
Other Retired Housewife Student Agri Service (Unorganized) X -Not Categorised
Nature of Business / Industry*

PROOF OF IDENTITY(POI)*
(Self attested copy of any of the following Proof of Identity(POI) needs to be submitted)

Passport Number Expiry Date

Voter ID card
PAN Card*

Driving License Expiry Date

UID(Aadhaar)

NREGA Job Card

Others

Identification Number

Simplified Measures
Account
PROOF OF ADDRESS (POA)*
CURRENT RESIDENCE ADDRESS DETAILS(Self attested copy of any of the following Proof of Address(POA) needs to be submitted)

Same as borrower Relation with borrower

Address Type* Residential / Business Residential Business

Proof Of Address* Passport Driving License UID(Aadhar) Voter Identity card NREGA Job card

Utility Bill Others Simplified Measures Account-Document Type Code

Address Line 1* 114

Line 2 MACHAPURAM

Line 3 DEVANAKONDA City/Town/Village KURNOOL

 District* State / U.T Code* Years
Pin/Post Code* 518464 ISO 3166 Country Code* IN

Address Type*
Self Owned Rented Company Provided Family
Landmark:
Preferred Communication Address

OFFICE ADDRESS DETAILS

Office Name

Address Line 1* AGRICULTURE WORK

Line 2 MACHAPURAM

Line 3 DEVANAKONDA City/Town/Village KURNOOL

District* State / U.T Code* Years

Pin/Post Code* 518464 ISO 3166 Country Code* IN

Address Type*
Self Owned Rented Company Provided Family
Landmark:
Preferred Communication Address

ADDITIONAL ADDRESS DETAILS

Address Line 1*
Line 2

Line 3 City/Town/Village

District* State / U.T Code* Years

Pin/Post Code* ISO 3166 Country Code* IN

Address Type*
Self Owned Rented Company Provided Family
Landmark:
Preferred Communication Address
CONTACT DETAILS
Tel. (Res) Tel. (Off 1)

Tel. (Off 2) Office Ext

Mobile 1* (Preferred) 9666005392 Alternate Mobile Number

Fax

Email ID* CHINNACHINNA1332@GMAIL.COM

Preferred mode of Mobile Office Phone Residence Phone

Communication
*Mandatory for customer portal login

PRIOR FINANCE DETAILS (IF ANY)

From
Loan Account No.

Amount Financed

Contract Month Year Current Status

BANK DETAILS
Bank Name

Bank A/C No.

IFSC

Branch

Type of Account: Saving Current OD/CC Others___________

VEHICLE AND FINANCE DETAILS

1.Type of Loan* New Used Refinance Vehicle Enquity Loan Prime Vishwaas Two Wheeler
2.Used For: Personal Taxi Commercial
3.Vehicle Details
Brand / Make HONDA

Model
Color Varient

Fuel Type: Petrol Diesel Others___________ Registration No.

 YOM Smart Plug Device:
Yes No
4.Ex Showroom Price 72959.00 Discount Margin Money

5.On Road Price 88870.00 RTO Amount (To be filled only if Reg.funding) 8710.00

6.Finance Amount 75448.00 EMI Amount 3866.00 Tenure (In Months) 24

7.Supply Dealer Name SRI VASAVI

MOTORS-KURNOOL
8.Finance Dealer Name SRI VASAVI
MOTORS-KURNOOL
9.Salesman Name/Employee Code 1) 48579967 2)

3) 4)

REFERENCE
Relative Full Name
Address Line 1*
Line 2
Land Line No. Mobile No.

Relationship With Applicant

Friend Full Name

Address Line 1*
Line 2
Land Line No. Mobile No.

Please tick whichever is applicable. Whether applicant would like to opt for Term Cover for group of borrowers (Kotak Car loan cover) offered by Kotak Mahindra

Prime Ltd. (KMPL) under the terms and condition Policy No.F2 as contracted by KMPL with Kotak Mahindra Life Insurance Company Limited. Yes No

I/We hereby declare that I am/we are running business enterprises and original Investment in Cost of Plant and Machinery/Cost of Equipmentfor runningthe business
does not exceed as below.
ENTERPRISES MANUFACTURING SERVICE / TRADING

A) Micro Enterprises Up to 25 Lakhs Up to 10 Lakhs

B) Small Enterprises 25 Lakhs - 5 Crores 10 Lakhs - 2 Crores

C) Medium Enterprises 5 - 10 Crores 2 - 5 Crores

I/We hereby further declare/confirm that the vehicle purchased/to be purchased by me/us or the aforesaid loan shall be used by me/us solely for the purpose of business.
ACKNOWLEDGEMENT
Application No. TW40323677 For Kotak Mahindra Prime Ltd.
Received from MALA CHINNA MADDILETI

Application form for 75448.0

Loan/Facility of Rs.
Applicant would be advised of the Company's decision on the Application within 2 weeks from the receipt of complete
Authorised Signatory / Representative
information.
Received at KURNOOL
Date 28-Jun-2021
Visit us at www.carloan.kotak.com
SCHEDULE OF CHARGES (BANK COPY)

# To be deducted from disbursement Payment.* (Subject to Change)

Note:- Tax will be levied separately as may be applicable from time to time.
UNDERTAKING CLAUSE

Date:28-Jun-2021
Place: KURNOOL

(Please do not sign a blank application form. Please fill in all applicable information before signing) Signature/Thumb Impression of Applicant
FOR OFFICE USE - MANDATORY
Prospect No.:
KMPL RM: Mohammed Rafi m

KMPL SRM: VeeramRaju Samanuri

Bank RM:
Bank RM Employee Code:
RL Branch Name:
RL Branch Code:
ATTESTATION/FOR OFFICE USE ONLY
Documents Received Certified Copies
KYC VERIFICATION CARRIED OUT BY
Date
Emp. Name Mohammed Rafi m

Emp.Code 48579967

Emp. Designation ASSOCIATE

Emp. Branch KURNOOL

INSTITUTION DETAILS
Name
Code

EMPLOYEE SIGNATURE INSTITUTION STAMP

SCHEDULE OF CHARGES (CUSTOMER COPY)

# To be deducted from disbursement Payment.* (Subject to Change)

Note:- Tax will be levied separately as may be applicable from time to time.