APPLICATION FORM FORM NUMBER

PLKD2306081252907020
FOR PERSONAL LOANS

Channel Details
Source DSA Sub Source DSA

Campaign Name Campaign Code Additional Information

Other Information Sourcing City Bengaluru DSA Name FAST CREDIT

DST RM Name Other Sales User

Bank Branch Name Tele Calling Executive (OCC) DMA Coordinator

Sales Tele Caller Document Executive(Login) Document Executive(Disbursal)

CPA Maker (Login Backend Executive Scheme Normal Program

Co-ordinator)
Sub Scheme

Application Details
Application Date 06/08/2023 Type of Loan 01 Loan amount required 1000000

Tenure 6 Year Application Form No. Customer Type NTB

ETB Type CRN Purpose of Loan 001

Applicant Details
CKYC reference CKYC No. CKYC Update Type

ID Proof Type Aadhaar Card ID Proof No R91531316854 ID Proof Expiry Date

Address Proof Type Aadhaar Card Address Proof No R91531316854 Address Proof Type Aadhaar Card

Address Proof Expiry Date First Name KOUSHIK Middle Name

Last Name DUTTA Date of Birth 12/28/1980 Gender Male

Nationality Marital Status 02 Mother's Maiden Name SIPRADUTTA

Father's First Name CHANDAN Father's Last Name DUTTA Spouse's First Name RAJESHWARI

Spouse's Last Name DUTTA No of Dependents Education Qualification 02

Mobile no *****80811 PAN Number ALFPD9617C

Personal Mail ID koushik.mca@gmail.com

Employment Details
Employer Name TECH MAHINDRA LIMITED Applicant Office Department Total Work Experience More than 10 Years

Designation Security Consultant Industry Type Information Technology Applicant Employee ID L64200MH1986PLC041370

No. of years in the Type of Company Public Limited Office No

Organisation
Official Email ID koushik.dutta2@techmahindra.com

Address Details
Residence Address Details
Residence Address Line 1 FLAT NO-201 SVK HOMES Residence Address Line 2 6TH CROSS BANK AVENUE Residence Address Line 3 BABUSAPALYA HORAMAVU

Residence Address Line 4 Pincode 560043 Residence Sub City

City Bengaluru State Residence type Rented With Family

Residence Since 04/13/2022 Rental With No Permanent false Prefered Mailing Address Residence address
Address
Office Address Details
Office Address Line 1 PLOT NO 45 47 KIADB Office Address Line 2 PHASE 2ELECTRONIC CITY Office Address Line 3
INDUSTRIALAREA
Office Address Line 4 Pincode 560100 City Bengaluru

State
Permanent Address Details
Same as Residence Address false

Permanent Address Line 1 PLOT NO-1 Permanent Address Line 2 GULAB BHAWAN BOHENAGAR Permanent Address Line 3 GATE NO-1 MADHYAMGRAM

Permanent Address Line 4 Pincode 700129 City Kolkata

State Permanent Address Contact

Number
Other Address Details
Address Line 1 Address Line 2 Address Line 3

Address Line 4 Pincode City

State

Reference Details
Reference 1_Details
Reference 1_Name Karan Malhotra Reference 1_Relationship Friend Reference 1 Address House No 25 Vande Marga
Church Koramangla Bangalore
State City Pincode 560034

Reference 2_Details
Reference 2_Name Atanu Roy Choudhury Reference 2_Relationship Colleague Reference 2 Address Embassy Village Vartur Whitefield
Bangalore 560087
State City Pincode

Coapplicant / Guarantor Details

Existing Obligation Details

Applicant Type Primary Applicant

Applicant Obligations(Loans/Cards)
Obligation Account Sanction Obligation EMI Current Account Opening Account Closure
Source Bank Name Total Tenure
Type Number Amount Consideration Amount Outstanding Date Date
Consumer Not to
CIBIL 24555.00 0.00 05/24/2023 0.00 CIBIL
Loan consider

Obligation Account Sanction Obligation EMI Current Account Opening Account Closure
Source Bank Name Total Tenure
Type Number Amount Consideration Amount Outstanding Date Date
Consumer Not to
CIBIL 24705.00 0.00 05/24/2023 0.00 CIBIL
Loan consider

Obligation Account Sanction Obligation EMI Current Account Opening Account Closure
Source Bank Name Total Tenure
Type Number Amount Consideration Amount Outstanding Date Date
Consumer Not to
CIBIL 7011.00 0.00 05/18/2023 0.00 CIBIL
Loan consider

Obligation Account Sanction Obligation EMI Current Account Opening Account Closure
Source Bank Name Total Tenure
Type Number Amount Consideration Amount Outstanding Date Date
Personal Not to
CIBIL 30000.00 0.00 12/22/2022 0.00 CIBIL
Loan consider

Obligation Account Sanction Obligation EMI Current Account Opening Account Closure
Source Bank Name Total Tenure
Type Number Amount Consideration Amount Outstanding Date Date
Personal Not to
CIBIL 25000.00 0.00 10/31/2022 0.00 CIBIL
Loan consider

Obligation Account Sanction Obligation EMI Current Account Opening Account Closure
Source Bank Name Total Tenure
Type Number Amount Consideration Amount Outstanding Date Date
Personal Not to
CIBIL 2965000.00 2731850.00 09/21/2022 0.00 CIBIL
Loan consider

Obligation Account Sanction Obligation EMI Current Account Opening Account Closure
Source Bank Name Total Tenure
Type Number Amount Consideration Amount Outstanding Date Date
Personal Not to
CIBIL 3000000.00 0.00 05/27/2022 09/22/2022 0.00 CIBIL
Loan consider

Obligation Account Sanction Obligation EMI Current Account Opening Account Closure
Source Bank Name Total Tenure
Type Number Amount Consideration Amount Outstanding Date Date
Personal Not to
CIBIL 2214000.00 0.00 12/30/2021 05/30/2022 0.00 CIBIL
Loan consider

Obligation Bank Account Sanction Obligation EMI Current Account Opening Account Closure
Source Total Tenure
Type Name Number Amount Consideration Amount Outstanding Date Date
CIBIL Other 20000.00 0.00 12/30/2021 0.00 CIBIL Not to consider

Obligation Account Sanction Obligation EMI Current Account Opening Account Closure
Source Bank Name Total Tenure
Type Number Amount Consideration Amount Outstanding Date Date
Consumer Not to
CIBIL 20990.00 0.00 11/12/2021 05/08/2022 0.00 CIBIL
Loan consider

Obligation Account Sanction Obligation EMI Current Account Opening Account Closure
Source Bank Name Total Tenure
Type Number Amount Consideration Amount Outstanding Date Date
Consumer Not to
CIBIL 81000.00 0.00 10/02/2021 0.00 CIBIL
Loan consider

Obligation Account Sanction Obligation EMI Current Account Opening Account Closure
Source Bank Name Total Tenure
Type Number Amount Consideration Amount Outstanding Date Date
Personal Not to
CIBIL 1104999.00 340100.00 09/06/2021 0.00 CIBIL
Loan consider

Obligation Account Sanction Obligation EMI Current Account Opening Account Closure
Source Bank Name Total Tenure
Type Number Amount Consideration Amount Outstanding Date Date
Consumer Not to
CIBIL 5000.00 0.00 08/01/2021 11/03/2021 0.00 CIBIL
Loan consider

Obligation Account Sanction Obligation EMI Current Account Opening Account Closure
Source Bank Name Total Tenure
Type Number Amount Consideration Amount Outstanding Date Date
Personal Not to
CIBIL 2260000.00 0.00 07/19/2021 12/31/2021 0.00 CIBIL
Loan consider
Source Obligation Bank Name Account Sanction Obligation EMI Current Account Opening Account Closure Total Tenure
Type Number Amount Consideration Amount Outstanding Date Date
Personal Not to
CIBIL 2350000.00 0.00 12/04/2020 07/20/2021 0.00 CIBIL
Loan consider

Obligation Account Sanction Obligation EMI Current Account Opening Account Closure
Source Bank Name Total Tenure
Type Number Amount Consideration Amount Outstanding Date Date
Consumer Not to
CIBIL 10000.00 0.00 11/09/2020 05/06/2021 0.00 CIBIL
Loan consider

Obligation Account Sanction Obligation EMI Current Account Opening Account Closure
Source Bank Name Total Tenure
Type Number Amount Consideration Amount Outstanding Date Date
Consumer Not to
CIBIL 8000.00 0.00 10/19/2020 06/14/2021 0.00 CIBIL
Loan consider

Obligation Bank Account Sanction Obligation EMI Current Account Opening Account Closure
Source Total Tenure
Type Name Number Amount Consideration Amount Outstanding Date Date
CIBIL Credit Card 460000.00 58917.00 09/27/2020 0.00 CIBIL Not to consider

Obligation Account Sanction Obligation EMI Current Account Opening Account Closure
Source Bank Name Total Tenure
Type Number Amount Consideration Amount Outstanding Date Date
Personal Not to
CIBIL 2200000.00 0.00 09/09/2020 12/05/2020 0.00 CIBIL
Loan consider

Obligation Bank Account Sanction Obligation EMI Current Account Opening Account Closure
Source Total Tenure
Type Name Number Amount Consideration Amount Outstanding Date Date
CIBIL Credit Card 50000.00 31909.00 03/05/2020 0.00 CIBIL Not to consider

Obligation Account Sanction Obligation EMI Current Account Opening Account Closure
Source Bank Name Total Tenure
Type Number Amount Consideration Amount Outstanding Date Date
Personal Not to
CIBIL 1700000.00 0.00 01/03/2020 09/10/2020 0.00 CIBIL
Loan consider

Obligation Account Sanction Obligation EMI Current Account Opening Account Closure
Source Bank Name Total Tenure
Type Number Amount Consideration Amount Outstanding Date Date
Personal Not to
CIBIL 1500000.00 0.00 09/07/2019 01/04/2020 0.00 CIBIL
Loan consider

Obligation Account Sanction Obligation EMI Current Account Opening Account Closure
Source Bank Name Total Tenure
Type Number Amount Consideration Amount Outstanding Date Date
Personal Not to
CIBIL 290000.00 0.00 08/27/2019 09/21/2020 0.00 CIBIL
Loan consider

Obligation Account Sanction Obligation EMI Current Account Opening Account Closure
Source Bank Name Total Tenure
Type Number Amount Consideration Amount Outstanding Date Date
Consumer Not to
CIBIL 29900.00 0.00 08/19/2019 06/25/2020 0.00 CIBIL
Loan consider

Obligation Account Sanction Obligation EMI Current Account Opening Account Closure
Source Bank Name Total Tenure
Type Number Amount Consideration Amount Outstanding Date Date
Personal Not to
CIBIL 1438000.00 0.00 06/07/2019 09/09/2019 0.00 CIBIL
Loan consider

Obligation Account Sanction Obligation EMI Current Account Opening Account Closure
Source Bank Name Total Tenure
Type Number Amount Consideration Amount Outstanding Date Date
Personal Not to
CIBIL 500000.00 0.00 07/10/2018 06/10/2019 0.00 CIBIL
Loan consider

Obligation Account Sanction Obligation EMI Current Account Opening Account Closure
Source Bank Name Total Tenure
Type Number Amount Consideration Amount Outstanding Date Date
Consumer Not to
CIBIL 2748.00 0.00 05/28/2018 03/08/2019 0.00 CIBIL
Loan consider

Obligation Account Sanction Obligation EMI Current Account Opening Account Closure
Source Bank Name Total Tenure
Type Number Amount Consideration Amount Outstanding Date Date
Personal Not to
CIBIL 358599.00 0.00 12/14/2017 09/06/2021 0.00 CIBIL
Loan consider

Obligation Bank Sanction Obligation EMI Current Account Opening Account Closure
Source Account Number Total Tenure
Type Name Amount Consideration Amount Outstanding Date Date
Not to
CIBIL Credit Card 4166464305888331 120000.00 0.00 09/04/2017 11/25/2017 0.00 CIBIL
consider

Obligation Account Sanction Obligation EMI Current Account Opening Account Closure
Source Bank Name Total Tenure
Type Number Amount Consideration Amount Outstanding Date Date
Personal Not to
CIBIL SPLN60515472 1306999.00 0.00 08/25/2017 06/26/2019 0.00 CIBIL
Loan consider

Obligation Bank Account Sanction Obligation EMI Current Account Opening Account Closure
Source Total Tenure
Type Name Number Amount Consideration Amount Outstanding Date Date
CIBIL Credit Card 72000.00 0.00 04/26/2017 05/23/2018 0.00 CIBIL Not to consider
 Obligation Account Sanction Obligation EMI Current Account Opening Account Closure
Source Bank Name Total Tenure
Type Number Amount Consideration Amount Outstanding Date Date
Personal Not to
CIBIL 727000.00 0.00 04/21/2017 08/31/2017 0.00 CIBIL
Loan consider

Obligation Account Sanction Obligation EMI Current Account Opening Account Closure
Source Bank Name Total Tenure
Type Number Amount Consideration Amount Outstanding Date Date
Personal Not to
CIBIL 408000.00 0.00 08/23/2016 04/22/2017 0.00 CIBIL
Loan consider

Obligation Account Sanction Obligation EMI Current Account Opening Account Closure Total
Source Bank Name
Type Number Amount Consideration Amount Outstanding Date Date Tenure
Auto Loan Not to
CIBIL 340000.00 0.00 07/26/2016 09/29/2022 5601.00 CIBIL
(Personal) consider

Obligation Bank Account Sanction Obligation EMI Current Account Opening Account Closure
Source Total Tenure
Type Name Number Amount Consideration Amount Outstanding Date Date
CIBIL Credit Card 115000.00 0.00 07/25/2016 03/14/2020 0.00 CIBIL Not to consider

Obligation Bank Account Sanction Obligation EMI Current Account Opening Account Closure
Source Total Tenure
Type Name Number Amount Consideration Amount Outstanding Date Date
CIBIL Credit Card 115000.00 61462.00 07/25/2016 0.00 CIBIL Not to consider

Obligation Account Sanction Obligation EMI Current Account Opening Account Closure
Source Bank Name Total Tenure
Type Number Amount Consideration Amount Outstanding Date Date
Personal Not to
CIBIL 819000.00 0.00 02/13/2016 09/05/2017 0.00 CIBIL
Loan consider

Obligation Account Sanction Obligation EMI Current Account Opening Account Closure
Source Bank Name Total Tenure
Type Number Amount Consideration Amount Outstanding Date Date
Consumer Not to
CIBIL 25490.00 0.00 12/28/2015 01/21/2017 0.00 CIBIL
Loan consider

Obligation Account Sanction Obligation EMI Current Account Opening Account Closure
Source Bank Name Total Tenure
Type Number Amount Consideration Amount Outstanding Date Date
Personal Not to
CIBIL 750000.00 0.00 09/30/2015 02/16/2016 0.00 CIBIL
Loan consider

Obligation Bank Account Sanction Obligation EMI Current Account Opening Account Closure
Source Total Tenure
Type Name Number Amount Consideration Amount Outstanding Date Date
CIBIL Credit Card 258390.00 0.00 06/26/2015 0.00 CIBIL Not to consider

Obligation Account Sanction Obligation EMI Current Account Opening Account Closure
Source Bank Name Total Tenure
Type Number Amount Consideration Amount Outstanding Date Date
Personal Not to
CIBIL 437500.00 0.00 11/07/2014 10/03/2015 0.00 CIBIL
Loan consider

Obligation Account Sanction Obligation EMI Current Account Opening Account Closure
Source Bank Name Total Tenure
Type Number Amount Consideration Amount Outstanding Date Date
Personal Not to
CIBIL 200000.00 0.00 07/28/2014 05/26/2015 0.00 CIBIL
Loan consider

Obligation Account Sanction Obligation EMI Current Account Opening Account Closure
Source Bank Name Total Tenure
Type Number Amount Consideration Amount Outstanding Date Date
Consumer Not to
CIBIL 34697.00 0.00 07/15/2014 09/15/2014 0.00 CIBIL
Loan consider

Obligation Bank Account Sanction Obligation EMI Current Account Opening Account Closure
Source Total Tenure
Type Name Number Amount Consideration Amount Outstanding Date Date
CIBIL Credit Card 86000.00 0.00 06/25/2014 08/10/2021 0.00 CIBIL Not to consider

Obligation Account Sanction Obligation EMI Current Account Opening Account Closure
Source Bank Name Total Tenure
Type Number Amount Consideration Amount Outstanding Date Date
Consumer Not to
CIBIL 15900.00 0.00 12/29/2013 05/20/2014 0.00 CIBIL
Loan consider

Obligation Account Sanction Obligation EMI Current Account Opening Account Closure
Source Bank Name Total Tenure
Type Number Amount Consideration Amount Outstanding Date Date
Personal Not to
CIBIL 350000.00 0.00 09/26/2013 11/08/2014 0.00 CIBIL
Loan consider

Obligation Account Sanction Obligation EMI Current Account Opening Account Closure
Source Bank Name Total Tenure
Type Number Amount Consideration Amount Outstanding Date Date
Two-wheeler Not to
CIBIL 43900.00 0.00 05/25/2013 10/08/2014 2732.00 CIBIL
Loan consider

Obligation Account Sanction Obligation EMI Current Account Opening Account Closure
Source Bank Name Total Tenure
Type Number Amount Consideration Amount Outstanding Date Date
Personal Not to
CIBIL Loan 200000.00 0.00 07/28/2012 10/08/2013 0.00 CIBIL consider

Obligation Account Sanction Obligation EMI Current Account Opening Account Closure
Source Bank Name Total Tenure
Type Number Amount Consideration Amount Outstanding Date Date
Personal Not to
CIBIL 150000.00 0.00 08/24/2009 04/24/2012 0.00 CIBIL
Loan consider

Obligation Bank Account Sanction Obligation EMI Current Account Opening Account Closure
Source Total Tenure
Type Name Number Amount Consideration Amount Outstanding Date Date
CIBIL Credit Card 69000.00 0.00 08/09/2008 02/04/2021 0.00 CIBIL Not to consider

Obligation Bank Account Sanction Obligation EMI Current Account Opening Account Closure
Source Total Tenure
Type Name Number Amount Consideration Amount Outstanding Date Date
CIBIL Credit Card 0.00 0.00 08/09/2008 0.00 CIBIL Not to consider

Obligation Bank Account Sanction Obligation EMI Current Account Opening Account Closure
Source Total Tenure
Type Name Number Amount Consideration Amount Outstanding Date Date
CIBIL Credit Card 250.00 0.00 12/31/2007 11/06/2009 0.00 CIBIL Not to consider

Obligation Account Sanction Obligation EMI Current Account Opening Account Closure
Source Bank Name Total Tenure
Type Number Amount Consideration Amount Outstanding Date Date
Personal Not to
CIBIL 81000.00 0.00 08/29/2007 10/15/2009 0.00 CIBIL
Loan consider

Obligation Bank Account Sanction Obligation EMI Current Account Opening Account Closure
Source Total Tenure
Type Name Number Amount Consideration Amount Outstanding Date Date
CIBIL Credit Card 18000.00 0.00 08/20/2007 11/01/2008 0.00 CIBIL Not to consider

Obligation Bank Account Sanction Obligation EMI Current Account Opening Account Closure
Source Total Tenure
Type Name Number Amount Consideration Amount Outstanding Date Date
CIBIL Credit Card 27000.00 0.00 07/30/2007 0.00 CIBIL Not to consider

Obligation Bank Account Sanction Obligation EMI Current Account Opening Account Closure
Source Total Tenure
Type Name Number Amount Consideration Amount Outstanding Date Date
CIBIL Credit Card 188000.00 0.00 01/15/2007 0.00 CIBIL Not to consider

Obligation Bank Account Sanction Obligation EMI Current Account Opening Account Closure
Source Total Tenure
Type Name Number Amount Consideration Amount Outstanding Date Date
CIBIL Credit Card 8826.00 0.00 07/10/2006 09/08/2008 0.00 CIBIL Not to consider

Obligation Bank Account Sanction Obligation EMI Current Account Opening Account Closure
Source Total Tenure
Type Name Number Amount Consideration Amount Outstanding Date Date
CIBIL Credit Card 8000.00 18.00 12/22/2005 0.00 CIBIL Not to consider

Obligation Bank Account Sanction Obligation EMI Current Account Opening Account Closure
Source Total Tenure
Type Name Number Amount Consideration Amount Outstanding Date Date
CIBIL Credit Card 17000.00 0.00 11/16/2005 04/08/2007 0.00 CIBIL Not to consider

Obligation Bank Account Sanction Obligation EMI Current Account Opening Account Closure
Source Total Tenure
Type Name Number Amount Consideration Amount Outstanding Date Date
CIBIL Credit Card 0.00 0.00 07/30/2005 08/02/2005 0.00 CIBIL Not to consider

Obligation Bank Account Sanction Obligation EMI Current Account Opening Account Closure
Source Total Tenure
Type Name Number Amount Consideration Amount Outstanding Date Date
CIBIL Credit Card 150000.00 0.00 07/29/2005 12/29/2018 0.00 CIBIL Not to consider

Obligation Bank Account Sanction Obligation EMI Current Account Opening Account Closure
Source Total Tenure
Type Name Number Amount Consideration Amount Outstanding Date Date
CIBIL Credit Card 0.00 0.00 03/15/2007 03/28/2009 0.00 CIBIL Not to consider

Banking Details

Income Details

Documents Shared
Applicant Type Applicant Name Document Type Document Name Uploaded Date and Time

Declaration

I/We declare that I/we am/are resident Indians and that all the particulars and information given in the application form are true, correct and they shall form the basis of
any loan Kotak Mahindra bank limited (KMBL) may decide to grant me/us. I/We undertake to inform KMBL regarding any change in my/our above mentioned details and
to provide any further information that KMBL may require. I/We further agree that my/our loan should be governed by the terms of the loan agreement executed between
KMBL and myself/ourselves. I/We authorize KMBL and its affiliates to use information from this application for administrative purpose. I/We understand that KMBL
reserves the rights at its sole discretion to reject this application without providing any reasons. I/We authorize KMBL, its group companies and their agents to exchange
or share all the information relating to me and my repayment history with banks, financial institutions, credit bureaus, agencies, statutory bodies etc. as may be required
or as they deem fit. I/We agree that I/we will not utilize the money(ies) receive under the loan agreement(s) for any purpose which are prohibited under any law for the
time in being inforce including but not limited to investment(s) in capital market(s). The Borrower and/or Co-Borrower(s) shall be liable to pay all the charges, fees and/or
interest as prescribed by KMBL. I/We agree that the processing fees collected upfront, shall not be refunded if my/our application for loan is rejected by KMBL on any
ground whatsoever or once the loan has been sanctioned by KMBL, irrespective of whether I/we finally avail the same.

I/We are aware that any new phone number, mobile number, email id provided by an existing Customer while opting for any product of KMBL (eg–Credit Card, Personal
Loan etc) shall be automatically updated in the records of KMBL in lieu of the phone number, mobile number, email id provided at the time of opening the account or
previously registered with KMBL. All further intimations / communications pertaining to the Bank Account shall also be sent by KMBL only to the new phone number,
mobile number, email id and no intimations / communications shall be sent to the phone number, mobile number, email id provided at the time of opening the Bank
Account or previously registered with KMBL.C25

This application form along with the supporting documents shall be the property of KMBL and in case the application is rejected, the documents given to KMBL in
connection with this application including, but not limited to photocopies of original documents, signature verification, address verification and bank details shall remain
with KMBL. The Personal Loan applicant hereby expressly authorizes the Bank to obtain the Personal Loan applicant’s credit reports from the Credit Information Bureau
of India Limited (CIBIL) or any other Credit Information Companies as and when the same is required by the bank for the purposes of Credit verification or the purpose of
the credit review of the Personal Loan applicant.

Applicant(s) understand that the limit/amount of loan, if approved by the Bank, will be mentioned in the Loan Agreement.

I authorize Kotak bank to share my details with any other third party or vendor, appointed by bank for online verification.

I agree to receive notifications on whatsapp from bank regarding my loan information.

Date and Time of E-Acceptance

Place

Signature of Applicant Signature of Co-Applicant (If

applicable)