BURMAN FINVEST PRIVATE LIMITED

Registered Address: 4th Floor, Punjabi Bhavan, 10 Rouse Avenue, New Delhi- 110002
CIN No. U65100DL1989PTC034593 RBI No.

LOAN APPLICATION FORM

Office use only

Applicant ID Application No.

Is this existing borrower Yes No Is this our group entity Yes No

Product
Term Loan Loan Against Property Others (Specify)
Demand Loan Loan Against Security

PART-1 GENERAL DETAILS

SECTION- I -APPLICANT DETAILS

Name
First Name Middle Name Last Name

Reg. Address:

City State Pin Code

Telephone Email ID:

Correspondence Address: Same as above

City State Pin Code

Telephone Email ID:

Constitution:
Proprietorship / Individual Private Limited Company Others (Specify)
Partnership / LLP Public Limited Company
HUF/AOP Trust

Legal Form: NBFC HFC Other Corporates Others (Specify)

Business Nature: Manufacturing Services Retail Trade Wholesale Trade

CIN No.

PAN No. GSTIN No.

MSME/ UID No. Yes No If Yes, MSME No.

Document Incorporation Certificate MOA/AOA MSME Certificate

Check List: PAN Card GST Certificate Others (Specify)

SECTION- II -AUTHORISED PERSON DETAILS

Name
First Name Middle Name Last Name

Permanent
Address:
City State Pin Code

Telephone Email ID:

Correspondence Address: Same as above

City State Pin Code

Telephone Email ID:

Page No. 1 out of 4

BURMAN FINVEST PRIVATE LIMITED
Registered Address: 4th Floor, Punjabi Bhavan, 10 Rouse Avenue, New Delhi- 110002
CIN No. U65100DL1989PTC034593 RBI No.

PART-2 LOAN DETAILS

SECTION - III - LOAN REQUEST DETAILS

Amount Requested: Rs. Tenure Months

Purpose of Loan:
Business Expansion Project Funding Working Capital
Acquision of Property Purchase of Equipment Others (Specify)

Nature of Loan: Secured Unsecured

If Secured, Details of Security:

SECTION - IV - EXISTING FACILITY DETAILS

Whether any credit facility availed with any bank and/or Financial Institution: Yes No
If yes, provide details:

Name and Address of

Bank and FI:

Category of Loan

Loan Amount Rs.

Current Outstandings

Purpose of Loan

Tenure of Loan

Annualised Rate of Interest

SECTION - V - OWNERSHIP AND MANAGEMENT DETAILS

Name of Person Share Holding PAN Address Gender Nationality

%

SECTION - VI - OTHER DOCUMENTS CHECKLIST

List of Shareholders Audited Financial Statements (3 Yrs) Other (Specify)

List of Directors Provisional Financial Statements

Copy of ITR Projected Financial Statements

SIGNATURE OF APPLICANT

Name of Applicant Date of Application Place of Signature Signature of Applicant

Page No. 2 out of 4

BURMAN FINVEST PRIVATE LIMITED
Registered Address: 4th Floor, Punjabi Bhavan, 10 Rouse Avenue, New Delhi- 110002
CIN No. U65100DL1989PTC034593 RBI No.

DECLARATION

[I/We], ("the Applicant(s)”), hereby unconditionally and irrevocably declare and confirm that:

1 Pursuant to [my/our] application for the Facility, [I/we] make this declaration for the benefit and reliance of the Lender [I/We] shall submit, sign and execute all such facility
agreements and other documents as may be prescribed and/or required by the Lender, in its discretion, in relation to availing such a Facility at any point of time.

2 [I/We] fully acknowledge that the grant of the Facility is at the sole discretion of Lender and is subject to [my/our] execution of documents deemed necessary by the Lender
and [my/our] fulfilment of other closing formalities as required by, and to the satisfaction of, the Lender in this regard. We also acknowledge that the Lender reserves the
right to reject [my/our] application for such a Facility without assigning any reasons whatsoever, and that [I/we] reserve no right to appeal against such a decision of the
Lender.
3 [I/We] declare that [I am/we are] [citizen(s) of/resident(s) in] India and [I/we] declare, warrant and represent that all the particulars and information and details provided in
the application form to avail the Facility and documents given by [me/us] to the Lender in connection therewith, are true, correct, accurate and up-to-date in all respects and
that [I/we] have not withheld or suppressed any material information from the Lender in this regard.
4 [I/We] further acknowledge that all the information given by [me/us] in the application for a Facility upon the Lender's request, shall form the basis of any loan or facility that
the Lender may decide to grant to [me/us]. We understand and acknowledge that the Lender reserve the right to retain all applicable information, photographs and other
documents submitted by [me/us] (forming part of such application and this declaration) and may not return the same to [me/us].

5 [I/We] hereby agree and give [my/our] consent for the disclosure by the Lender waiving specifically [my/our] right of notice, privacy, privity, defamation for such disclosure
by the Lender of all or any of the following:

(a) information and data relating to [me/us] as well our directors and group companies (as applicable) or obligations to be assumed by [me/us], our directors and/or our
group companies (as applicable) in connection with the Facility to be availed by [me/us] as well as any other information required to provided pursuant to such a Facility and
as required by the Lender and

(b) Any default committed by [me/us] and/or non-performance of our obligations prescribed in any facility document or other agreement executed pursuant to the Lender's
instruction (as determined by the Lender in its sole discretion) in relation to the Facility that will be granted to [me/us] upon the successful processing of [my/our] application
by the Lender, and as the Lender may deem appropriate and necessary to disclose and furnish to:

(c) The Reserve Bank of India ("RBI”) or and/or any other agency authorized in this behalf by RBI or any regulatory, supervisory or other authority, court of law, tribunal or
person, in India or any other jurisdiction, where such disclosure is required by law, regulation, judgment or order of court or order of any tribunal;

(d) any actual or potential assignee(s) or novatee(s) or transferee(s) of any rights and obligations of the Lender or other participants in any of its rights and/or obligations
6 under
[I/We]or relating
also to the Facility
acknowledge that theforLender
any purposes connected
shall have the rightwith the proposed
to seek assignment
information pertainingortotransfer.
[me/us] from regulatory authorities and other third parties including, inter-alia,
the RBI, Banks, the CIBIL, etc. in accordance with applicable law. [I/We] have no objection to furnish documents deemed necessary by the Lender and/or required as per
'Know Your Customer' guidelines issued by RBI. [I/We] acknowledge and appreciate that the Lender will have right to seek information related to the business transactions
from [my/our] business partners for the purpose of the sanction of Facility and ongoing monitoring in relation thereto.

7 [I/We] further acknowledge and declare that the funds availed by [me/us] pursuant to the Facility shall be used for the purpose for which such a Facility has been granted
and will not be used for any speculative, prohibited, forbidden, illegal, unlawful or anti-social purposes whatsoever. By signing/accepting this Letter of Declaration, [I/We]
[am/are] deemed to have accepted, read, understood and agreed to be bound by the terms (including amendments thereof) governing the Facility as determined by the
Lender in its sole discretion. Further, [I/we] have no objection to the Lender from sending [me/us] promotional offers of their products or services (including those of the
subsidiaries, affiliates or associate companies of the Lender and/or the Company).
8 [I/We] further acknowledge that the use of the above information shall not amount to violation of any of [my/our] rights or privileges pertaining to privacy or confidentiality.

9 [I/We] further confirm that the privacy rights available to us under, inter-alia, the Telecom Regulatory Authority of India Act, 1997 and the Telecom Commercial
Communication Customer Preference Regulations, 2010, and any statutory amendments thereto, will not be exercised by [me/us] in relation to any promotional offers or
information received from the Lender and their subsidiaries, affiliates or associate companies.

10 [I/We] accord the above consent, notwithstanding the grant of Facility, its rejection by the Lender, or the maturity of such Facilities and authorise Lender to use the said
information. In this regard, [I/we] represent and warrant that the declarations made above by [me/us] have been made in [my/our] true and lawful capacity and further
recognize that the Lender will rely on the correctness and accuracy of the declarations made by [me/us] in this declaration.

11 [I/We] acknowledge that any inaccuracies or falsehoods in the declarations made by [me/us] and/or information provided by [me/us] shall give an unconditional right to the
Lender, at any point in time, to cancel the Facility and exercise all rights available to such Lender against [me/us] under applicable law.

SIGNATURE OF APPLICANT

Name of Applicant Date of Application Place of Signature Signature of Applicant

Page No. 3 out of 4

BURMAN FINVEST PRIVATE LIMITED
Registered Address: 4th Floor, Punjabi Bhavan, 10 Rouse Avenue, New Delhi- 110002
CIN No. U65100DL1989PTC034593 RBI No.

ACKNOWLEDGEMENT

Name of Applicant:
First Name Middle Name Last Name

Applicant ID Application No.

Date of Receipt: D D M M Y Y Stamp & Signature

Note:
In case you do not hear from us within next 15 working days, the application is deemed to be rejected.

Page No. 4 out of 4