Loan Application Form

Capital
Loan Account No. Application No. Date Branch Code

RBO Name

Employee ID Branch Name

For Office Use Only Aadhar No. (Mandatory for KYC Update Request)
(To be filled by Financial Institution) Application Type New

Employee ID Account Type Normal Simplified (for low risk customers) Small

1.0/ Details of Loan Applied

Unsecured Business Loan Secured Business Loan Loan Amount Applied for

Application Fee Paid Yes No Paid through Cheque/Demand Draft Cheque/Demand Draft No.

Bank name

Types of Loan Purpose Tenure in Years Frequency Mode of Payment

USBL Purchase of Looms/

Purchase of Machinery/
UEBL Purchase of Stock/Shop
Expansion/Renovation/
SBSL Purchase of Furniture for
Shop/Purchase of Medical
ESL Equipment

OTHERS OTHERS (Specify)

2.0/ Applicant Details Individual Proprietor Partnership Private Limited

Type of Business
Applicant Co-applicant

2.1 // Title

2.2 // Name

2.3 // Other Name/Popular Name

2.4 // Mother’s Name

2.5 // Date of Birth Age Age

2.6 // Father’s/Spouse’s Name

2.7 // Gender

2.8 // Education <10th 10th 12th Graduation <10th 10th 12th Graduation
 2.9 // Religion Hindu Muslim Christian Others Hindu Muslim Christian Others

2.10 // Main Occupation Businessman Salaried Farmer Businessman Salaried Farmer

Housewife Others Housewife Others

(Please Specify) (Please Specify)

2.11 // Proof of Identity PAN Card No. Aadhar Card No. Passport No. PAN Card No. Aadhar Card No. Passport No.
PAN Card, Aadhar Card Mandatory

Voter ID Card No. Driving Licence No. Ration Card No. Voter ID Card No. Driving Licence No. Ration Card No.

NREGA Job Card UID(Aadhaar) No. Other NREGA Job Card UID(Aadhaar) No. Other

2.12 // Proof of Address PAN Card Aadhar Card Passport No. PAN Card Aadhar Card Passport No.
PAN Card, Aadhar Card Mandatory
Voter ID Card Driving Licence Ration Card Voter ID Card Driving Licence Ration Card

NREGA Job Card Telephone Bill Electricity Bill NREGA Job Card Telephone Bill Electricity Bill

NREGA Job Card NREGA Job Card

3.0/ Contact Details

3.1 // Residence Address

PIN Own Rental PIN Own Rental

3.2 // Business Address

PIN Own Rental PIN Own Rental

3.3 // Landmark

3.4 // Village/Post Office/Via

Tahsil/Block/Taluk/
Mandal/District/Pin Code

3.5 Phone No. & Mobile No. Phone Phone

3.6 No. of Years at this Location

3.7 Correspondence Address Residence Business

4.0/ Loan Details (Existing & Previous 3 Years Loan)

Name of the Holder Purpose Amount Loan Tenure Current Outstanding Instalment Frequency of Instalment

ACPL Loan A/c No.

5.0/ Partner’s/Director’s Details (For Partnership/Private Ltd. Co.)

Name Profit Sharing/Share Holding Date of Birth PAN Instalment Mobile No.
6.0/ Details of Family Members

No. Name Date of Birth/Age Relation Occupation Income To be Covered under Insurance Suraksha (Yes/No)

No. of members in the Household ……………………………...………...…..... No. of Children ……………...…...…...…...…...…...…...………………………. No. of Dependents …………………………………………………..

7.0/ Other Income Generating Activities (Other Income Details)

Other Business 1 Other Business 2

1) Nature of Business

2) What is Your Role in Business

3) Monthly Income from the Business

8.0/ Details of Property to be Mortgaged

NAME OF OWNER: Type of Property Bungalow Row House Plot Flat Other

Uses of Property Self Family Tenants Rent p.m. Vacant Others

Purchase/Received From Builder Society Development Authority Gifted

Resale Self Construction Ancestral Others

Other Land Area Property Value Rooms available

Construction Stage To Commence Ready Current Stage

Construction Estimated Amount

9.0/ House Details

9.1 // Total Approximate Area (sq. feet)

9.2 // If Owned then by Whom Self Father Son Spouse Brother Others

1) I/We certify that the information furnished above and documents provided is true & accurate and no material information has been withheld/suppressed in case
any of the above information is found to be false or untrue or misleading or misrepresenting. I/We are aware that I/We may be held liable for it.
I/We understand that such information and document shall be used and refined upon by ACPL for the purpose of sanctioning and granting the loan.

2) I/We have read the application form and brochures and am/are aware of the terms and conditions of availing finance from ACPL.

3) I/We hereby authorise & give consent to ACPL to disclose without notice to me/us information furnished by me/us in application from related documents
executed or to be executed in relation to the facilities availed from ACPL to ACPL's other branches, subsidiaries, affiliates, credit bureaus rating agencies,
service providers, banks, financial institutions, government regulatory authorities or third parties for KYC information verification and credit risk analysis for
other related purpose that ACPL may deem fit. I/We am/are waiving the privilege of privacy of contract and such odds shall not amount to breach of any law
rule, regulation etc in force. I/We have been in compliance with all applicable laws and regulations and there is no litigation against me/us. I/We/Our firm/Our
Company has not been declared a defaulter or listed in the caution list by any Financial Institution/Bank including the Reserve Bank of India.

4) I/We confirm that no insolvency/winding up proceeding or suits for recovery of the outstanding dues or monies whatsoever for attachment of my/our assets or
properties and or nominal proceeding have been initiated or are pending against me/us and that/we have never been adjudicated insolvent by any court or
other authority.

5) I/We understand that sanction/grant of the loan is at the sole discretion of ACPL and ACPL shall be entitled to reject my/our application without assigning any
reason therefore further, disbursement of the loan will be subject to the execution of necessary documents, furnishing of securities and completion of other
formalities as required by ACPL I/We further agree that my loan transaction shall be governed by the rules of ACPL which may be in force from time to time.

Adani Housing Finance Pvt. Ltd.

1004/5, Level 10, C Wing 1, Bandra Kurla Complex, Bandra (E), Mumbai 400051

Loan Application Form Capital

 6) I/We confirm that loan shall be used for the stated purpose and will not be used for any speculative or antisocial purpose.

7) I/We undertake to inform ACPL in writing regarding any change in my/our residential or employment address.

8) I/We confirm having understood the terms & conditions applicable to this loan and accept the terms & conditions unconditionally and agree that these terms &
conditions may be changed by ACPL at any time and I/We will be bound by the amended terms & conditions.

9) ACPL may contact me via phone or e-mail/SMS with information or new product and service for top up loans or for selling of third party products or EMI and
other payment reminders and assist me in using any of ACPL's new offering irrespective of the outcome of this loan application.

10) I/We reserve the right to retain the photographs and documents submitted with this application and will not return the same to the applicant. I would like to
receive telephonic calls, or SMS on my mobile number mentioned in the application form or through any other communication mode for various loan scheme or
any loan other promotional schemes from ACPL, its employees, agents, and/or associates. I confirm that laws in relation to the unsolicited communication
referred in National Do Not Call registry (the NDNC registry) as laid down by TELECOM REGULATORY AUTHORITY OF INDIA LTD. will not be applicable for such
communication/calls/SMS/received from ACPL, its employees, agents or associates.

I/WE CONFIRM THAT THE EXECUTIVE COLLECTING MY APPLICATION/DOCUMENTS HAS INFORMED ME/US THAT

The interest will be charged on the principal amount of the loan advanced & outstanding from time to time, at the rate agreed between the parties & stated in
the loan documents. Processing fee/documentation fee and pre EMI interest (if applicable) also (non-refundable), as deemed fit by ACPL, will be charged
towards loan application and GST(as may be applicable) will be charged in connection with the loan. ACPL will not be liable for loss on account of delayed
receipt/incomplete documents. Defective applications will not be processed & ACPL shall not be responsible in any manner for the resulting delay or otherwise.
Documents/Photographs will not be returned under any circumstances. Approval of application is at sole discretion of ACPL. If my loan application is accepted
& or my loan is sanctioned, all or any disbursal may be made through mode of cheque/NEFT/RTGS & I shall provide all such necessary information to facilitate
the same. Quantum of the loan will be finally decided by ACPL & ACPL has not made any commitments to me/us regarding the same. Equated Monthly
Instalments (EMI) will be due on 5th of every month or any dated as decided by ACPL. Loan payment charges/prepayment/pre-closure as per demand of by ACPL
will be charged towards loan closure before end of tenure as mentioned loan documents. Loan payment charges/prepayment/pre-closure are levied or
calculated on the principal amount outstanding on the date of payment. The charges or such other amount as may be specified by ACPL in loan documents or
communicated to customer from time to time plus applicable taxes and or other statutory levies would be applicable including EMI(s) collection charges for
cash/cheque, stamp duty & other statutory charges as per applicable laws of the state.

I/We confirm that no payment in cash/bearer cheque or kind along with or in connection with this loan application has been collected from me/us & that
I/We have submitted self-attested copies of the documents listed in the check list below.

1st Applicant’s Signature 2nd Applicant’s/Guarantor’s Signature

Date Date

Place Place

Attestation/For Office Use Only

Description Proof Details Collected

2 Photographs of Customer Yes No

Voter ID Ration Driving PAN Aadhar Others

Yes No
Photo Card Card Licence Card Card (Specify)

Voter ID Ration Driving Telephone Electricity

Passport Yes No
ID
Ageproof
Proof Card Card Licence Bill Bill

UID NREGA Others

Yes No
Address Proof (Aadhaar) Job Card (Specify)

S.S.C certificate

Document Received Certified copies Driving Licence Others (Pls.Specify)

KYC Verification Emp. Name

carried out by
Emp. Designation
Emp. Code
Emp. Branch Emp. Signature Date
Approved Rejected

Branch Manager/Credit Officer Recommendation of the Loan Loan Amount Recommended Rs Date

ACKNOWLEDGEMENT
"Acknowledgement (Tear away acknowledgment (to be given to/retained by the Applicant)
Dear Sir/Madam,
This is to acknowledge receipt of your Loan Application Form No. Dated
We thank you for the same. Our representatives shall be in touch with you in connection with the same.
Sales Executive Name: ____________________________________ Sales Executive Signature
Phone No. : _________________________ Location :____________________ Date :_______________________

Key Terms & Conditions: • Repayment of loan is to be by way of Equated Monthly instalments ( EMI). • Interest is being calculated on monthly reducing balance. • Foreclosure charges are levied
/calculated on the balance principal outstanding of the loan (if applicable). Refer website for charges and fees for various purposes as notified & applicable from time to time. • Incomplete/
defective application will not be processed & Adani Housing Finance Pvt Ltd. shall not be responsible in any manner for resulting delay or otherwise. • For details of terms & conditions, please refer
to our website www.adanihousing.in | call on customer care toll free No. 1800 2100 444 or give a missed call to 79971 00444 or SMS “SMILE” to 79971 00444