DEPOSIT APPLICATION FORM (Resident Individual)

BAJAJ FINANCE LIMITED

Date: 24/11/2023 Code 100418 Sub Code Sourcing Channel Partner SFDC Ref No. 36463044 Application Form No 71389110

To be filled by Bajaj Finance Ltd employee or authorised distributor

I/We apply for fresh or renewal(old deposit ID ( )of deposit

Mode of Payment (Not applicable for renewal application)

Beneficiary Name: Bajaj Finance FD, Note: Cancelled cheque mandatory for online transfer of funds
RTGS/NEFT IFSC: INDB0000006
Cheque/UTR no. 10101209080000812
(all the 6 digits after B are zeroes)
Bank A/c No.: ZBAJAJFD Cheque/Transaction date (dd/MM/yyyy) : 23/11/2023
(No space in Z, Bajaj and FD)#
Bank Name: IndusInd Bank, Bank Account No 00000040118996861
Nariman Point, Mumbai

IFSC SBIN0015996
Account payee cheque favoring
Cheque “Bajaj Finance Ltd. Bank name STATE BANK OF INDIA
A/c 00070350006738”
(Name of 1st holder shall appear on the CHANAKYA LAW COLL NR BUS
cheque. Else bank statement required) Branch STAND PATNA 800001

#Numerical account number replaced with IndusInd Bank exclusive collection code – “ZBAJAJFD”.
For your benefit, maturity proceeds are paid to your same bank account. However, you can change your bank account later by submitting a request and a cancelled
cheque to us.

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Deposit Details

Deposit Amount Deposit Amount Deposit period Tenor

(in figures) (in words) (Months) (in words)

One Lakh Rupees Only Fifteen Months

50,000 1,00,000 12 24 36 48
2,00,000 3,00,000 60 (Recommended)
5,00,000 15 Other Tenor
Other

Interest Payout Instruction Instruction on maturity

At maturity alongwith principal Renew Principal + Interest(Recommended)

(Recommended for maximum savings)
Renew Principal only
Annually Half-yearly
Quarterly Monthly Pay at maturity (default if not selected)

Deposit payable to: First Holder Anyone or Survivor

Note: First Holder will be treated as default option in case of single applicant or in case no option chosen.

First Applicant Details(mandatory)

New Customer (please fill in the KYC form given in page 6)
Existing Customer (Customer ID) Or Deposit ID

If you are an existing BFL customer, your customer ID can be found on Fixed Deposit receipt, or in Experia=>My profile=>Personal details using your mobile number
and OTP to login. In case of existing customer, if there is a change in any KYC information, please fill in the KYC form given in page 6
CKYCR No./ KIN (non mandatory) If you are a mutual fund investor, you will get
it from the AMC. You can also get it from your credit card issuer
Name Mr SAHIL SUMAN
(Mr./Ms./Mrs.) First Middle Last
Guardian's Name
(if applicant is minor) First Middle Last
Date of Birth (dd/MM/yyyy) : 18/01/1999 Mobile Number 8969252427
PAN/Form 60 (in absence of allotment of PAN) IOAPS8495P
TDS waiver Yes (attach applicable form 15 G/H)
Note: you can also update forms 15 G/H later through our customer service portal Experia. Refer clause 9 (i), (ii) and (iii) in T&C .

Category(Tick as applicable) Relative of Director Director or Promoter of BFL Employee Senior Citizen(60 years or above)
Shareholder(DP/Client ID ) PEP Relative of PEP

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Second Applicant Details (Cannot be minor)
New Customer (please fill in the KYC form given in page 6)
Existing Customer (Customer ID) Or Deposit ID

If you are an existing BFL customer, your customer ID can be found on Fixed Deposit receipt, or in Experia=>My profile=>Personal details using your mobile number
and OTP to login. In case of existing customer,, if there is a change in any KYC information, please ask for a separate KYC Form from your Bajaj Finance
representative/authorised partner.
CKYCR No./ KIN (non mandatory) If you are a mutual fund investor, you will get
it from the AMC. You can also get it from your credit card issuer
Name
(Mr./Ms./Mrs.) First Middle Last
Date of Birth (dd/MM/yyyy) : Mobile Number
PAN/Form 60 (in absence of allotment of PAN)(mandatory)

Nomination to Deposit: Form DA 1: u/s 45 QB of RBI Act 1934(Highly recommended to nominate)

Should you need time to make up your mind, you can nominate later
I/We above named depositors at current address in your records, nominate the following person to whom in the event of my/our/minor’s
death the amount of this deposit may be returned by Bajaj Finance Limited:
1. * Name and Address of the Nominee:Mr. SUNIL SUMAN
S O SUNIL KUMAR SUMAN WARD NO 08 NEAR TANGAUL MIDLLE
SCHOOL SANCHIPATTI HAJIPUR VAISHALI BIHAR 844101, VAISHALI,
BIHAR, 844101
Relationship with depositor FATHER
Please enter Date of Birth of the Nominee in DD/MM/YYYY 01/08/1971 .
2. * As the Nominee is minor on this date, I/We appoint (Name, Address and Age of guardian)
--- to
receive amount of the said deposit on behalf of the nominee in event of my/our/minor’s death during the minority of the nominee .

Did you know:Once nominee becomes major, the guardian details become null and void

Signature/thumb impression of all applicants with date:

Mandatory for First Applicant Mandatory for Second Applicant
49.36.136.92 | 23-11-2023 04:17:00

In case of thumb impression, 2 witnesses name and signature are required Name of nominee should be same as that appearing on valid ID Proof of the nominee.
Witness1 Witness2

signature and employee code of sourcing employee

The contents of the application form were explained
to the applicant/ co applicant in ............................... language.

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 Thank you for trusting us
Provisional Receipt (Please see overleaf) Application Number 71389110
Name of Applicant SAHIL SUMAN
Cheque/UTR no. 10101209080000812
Amount INR One Lakh Rupees Only Fifteen Months ROI 7.21% Tenor
CHANAKYA LAW COLL NR BUS STAND PATNA
Bank name STATE BANK OF INDIA Branch 800001
Bank account number 00000040118996861 Account type
IFSC SBIN0015996 Transaction date (dd/MM/yyyy) : 23/11/2023

Write to us at wecare@bajajfinserv.in or call our IVR on 8698 01 01 01

*This Provisional Receipt is valid only till the issuance / rejection of the Fixed Deposit Receipt
For BAJAJ FINANCE LTD

Applicants' Consent and Confirmation

I/We hereby state that all particulars, information and details provided above together with documents submitted to Bajaj Finance Limited ("BFL") are true, correct and up to date and I/We am/are obliged to keep

BFL immediately updated of any change in the information provided by me in this Application Form. I/We hereby authorize BFL to pay the interest and Deposit amount upon maturity or upon the payment

frequency selected by me/us, as the case may be, using the available online banking payment system, to the bank account stated by me/us in this Application or into such other bank account as may be instructed

by me/us ( jointly) in writing to BFL during the term of the Deposit. I/We state that the amount being deposited is not out of borrowed funds or funds acquired by accepting deposits from any other person or

through any illegal or wrongful means. I/We conrm that I/we have read and understood the detailed terms and conditions annexed to this Application including the interest rate and other charges, the nancials and

other statements/particulars/representations furnished by BFL and after careful consideration, I/we am/are making the deposit with the BFL at my/our own risk and volition. I/We state that the rst named depositor

mentioned in this application should be treated as the payee for the purpose of deduction of tax, under Section 194 A/195 of the Income Tax Act, 1961, as may be applicable.. I authorize BFL to use, verify,

download, exchange, share or part with all information relating to this application with credit bureaus/credit reference agencies, its group companies, business partners with whom BFL has business relationship,

nancial institutions, Credit Information Companies ('CIC'), NeSL, NSDL, Central KYC Registry (CERSAI) or any authorized third-party agency as BFL may deem necessary or appropriate for use or processing

of the said information and shall not hold BFL (or any of its group companies or its/ their agents/representatives) liable for use/sharing of the information as stated above and to seek/obtain any other information,

relating to me, from any third party. In the event I/w am/are found to be an existing customer of BFL, I/we authorize BFL to use my/our existing KYC registered with BFL for this application. I/we agree that in

case of joint xed deposit with a survivorship clause, in the event of death of one of the depositors, BFL shall be discharged by paying the Fixed Deposit proceeds prematurely to the survivor/s on request. I/We

further afrm that the payment of proceeds of such deposits to either one of us represents a valid discharge of the BFL's liability. The FATCA/ CRS declaration will be considered as per the KYC form submitted

separately.

CKYC Consent –

a) I/ We hereby authorize BFL to verify/check/obtain/download/upload/update my/ our KYC details from/with the Central KYC Registry (CKYCR):

1) by verifying such details through the CKYCR number (i.e. KYC Identier / KYC Number- KIN) provided by me/ us or

2) by furnishing such other details of Applicant, as may be permitted by CKYC Registry or

3) by obtaining such CKYCR number/KIN, through details shared by me/ us for this Application Form

b) I/ We hereby consent for receiving information from Central KYC Registry through SMS/Email on my/ our registered number/email address.
Mandatory for First Applicant Mandatory for Second Applicant
49.36.136.92 | 23-11-2023 04:17:00

In case of thumb impression, 2 witnesses name and signature are required Name of nominee should be same as that appearing on valid ID Proof of the nominee.
Witness1 Witness2

signature and employee code of sourcing employee

The contents of the application form were explained
to the applicant/ co applicant in ............................... language.

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 Know Your Customer (KYC) and FATCA/CRS Form - Each applicant to fill this form

*For an existing customer,the information and documents furnished herein will supersede the information and documents submitted earlier.

Type Of Applicant First Second

Applicant Details Mr Ms Mrs Gender Male Female Third Gender

Name of applicant SAHIL SUMAN

Recent Coloured
Father/Mother/Spouse Name SUNIL KUMAR SUMAN NA NA Photograph

Please do not
Current Address staple
S O SUNIL KUMAR SUMAN WARD NO 08 NEAR TANGAUL MIDLLE SCHOOL
SANCHIPATTI HAJIPUR VAISHALI BIHAR 844101

City VAISHALI State BIHAR

PIN 844101
Permanent Address (tick here if permanent address is same as current address)

City State

PIN

Landline (STD Code) Landline No. Mobile (mandatory) 8969252427

Email ID sahilmicro51@gmail.com

Annual Income: Up to Rs. 15 Lakhs Rs. 15 Lakhs – Rs.50 Lakhs above Rs.50 Lakhs

Marital Status: Married Unmarried Others

Occupation: Self-employed/Business Private sector Job Public Sector Job Govt. Job Retired

Professional Student Others

Qualification: Undergraduate Graduate Post-Graduate Others

Relative of PEP Politically Exposed Person(PEP)

FATCA/CRS declaration
Are you a Citizen or national of any country outside India? Yes No If Yes then provide country

Are you a Tax resident of any country outside India? Yes No

If Yes, please provide country and Tax identification No (TIN) or functional equivalent

Country of Birth City of Birth

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Officially Valid Document Deemed to be OVDs**

Proof of Identity (PoI) Proof of Address (PoA) PoI/ PoA No. Expiry Date Documents

Utility bill (not more

Aadhaar * Aadhaar Card*
than two months old)
Property/Municipal tax
Valid Passport Valid Passport
receipt
Pension or Family
Valid Driving Licence Valid Driving Licence
Pension
Voter ID Card Voter ID Card Letter of allotment of
Letter issued by accommodation from
NREGA Job Card employer issued by SG/CG,
National Population Register
Statutory/Regulatory bodies,
**First 8 digits of Aadhaar PSU, SCB, FIs & Listed Co.
No. must be and LL agreement with such
blackened/redacted before NREGA Job Card
employers allotting official
submission to BFL accommodation

** Customer shall submit OVD updated with current address within a period of three months of submitting deemed OVDs

Applicant Consent/ Confirmation

I hereby state that all particulars, information and details provided above
togetherwith documents submitted to Bajaj Finance Limited ("BFL") are true, correct
and up to date and I am obliged to keep BFL immediately updated of any change in
the information provided by me herein. In case any of the above information is found Applicant's Signature/Thumb Impression
to be false or untrue or misleading or misrepresenting, I am aware that I will be solely In case of thumb impression above:
Witness1:
held liable for it
To the best of my knowledge, I confirm that this application is not in contravention of
anyAct, Rules, Regulations or any statute of legislation or any notifications/directions
Witness2:
issued by anyGovt. or Statutory authority from time to time
I consent for sharing my information including KYC details with Central KYC
Records Registry (CKYCR) namely Central Registry of Securitisation Asset
Reconstruction and Security Interest (CERSAI) and Credit Information Companies BFL Employee:
(CICs). Further to that I consent to receive information from CKYCR through SMS/
E-mail on the above registered number/ e-mail address
I certify that the information provided above is in accordance with section 285BA of
the Income Tax Act, 1961 read with Rules 114F to 114H of the Income Tax Rules,
1962. I undertake to inform BFL timely and in writing, any change in status of my
citizenship, nationality ortax residence

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