Subsequent Disbursement Request Form

(For Home Loan/LAP)

Date:
Place Loan A/c No.
Customer Name
Property address

City State PIN Code

Mobile Number Reg. Email ID

Disbursement Details
Builder demand/requirement (if self-constructed) `
I have submitted original builder demand letter/requirement letter (if self-constructed).
I/We hereby authorize bank to disburse an amount of ` as per below:

Details for disbursement through Demand Draft: (Mark as NA if not applicable)

Sr No. DD Favoring Amount (in `)

1
2
3
4 Internal - TATA AIG GENERAL INSURANCE CO. LTD (Property Insurance)
Total Amount

Details For disbursement through RTGS/NEFT/Transfer: (Mark as NA if not applicable)

Particulars Favoring Details 1 Favoring Details 2

RTGS/NEFT/Transfer

Beneficiary Name

Bank Name

Bank A/C No.

IFSC CODE - In capital letters

RA/Disb./App. Form/Feb. 2020/Ver - I

Disbursement Amount (in `)

*Information to Borrower:
• In every demand raised by the builder, customer will have to make payment towards his own contribution (e.g.- If the Property value is 10 Lakh ,
3 lakh is your contribution and Loan amount is 7 Lakh For every demand that builder raised for part of 7 lakh, customer will also pay part of 3 lakh).
• Customers also need to submit his/her contribution payment receipts along with disbursement request form.(Please ignore this if your own
contribution is paid upfront and receipts are already submitted)

Customer Declaration
• I/We hereby declare that the above particulars and information given in the form are true and correct. I have submitted original receipts of my
payment to builder/developer/ towards self-construction along with this request.

Yours Faithfully,

Signature Applicant / POA holder Signature Co-Applicant 1/POA holder Signature Co-Applicant 2/POA holder

For more details on Part Disbursement, visit Axis bank website for FAQ’s or Call us on 1860-419-5555/1860-500-5555 (local charg es apply)