Application cum Declaration form for availing Staff OD Facility

From To
…………………………….. Zonal Office / FGM Office / CO Retail Assets
Department

Through:
……………………………..….….Branch / Office

S.No. Particulars
1 Name of the Applicant
2 SR No
3 Designation / Present Position
4 Scale
5 Present Office
6 Date of Birth
7 Date of Joining the Bank
8 Date of Confirmation
9 Date of Retirement
No. of Completed YEARS of Service in
10 the Bank (including Probation period)
11 Remaining YEARS of Service
12 Limit Requested
13 Availing Branch
14 Purpose of the loan
Whether applying under Diminishing
15 Drawing Limit? YES or NO
Whether the limit applied is FRESH or
16 ENHANCMENT?
17 In case of FRESH
• Existing Salary Account
Number
• OD to be availed at (Branch)
18 In case of Enhancement,
• Existing OD Account Number

• Existing Limit
• Date of Last Sanction
• Branch of Existing OD
• OD – to be availed Branch
Salary Details for the month of _____________________ (Latest):

CIF No. Existing Salary Account No.

Basic Amt Rs. Gross Amount Rs.
Total Deductions Rs. Net Salary Rs.
Other EMIs, if any (NOT included under Facility: EMI Amount in Rs.
Salary Deductions) 1. 1.
2. 2.
3. 3

Whether the applicant has remained without pay Yes/No

exceeding one month in the past one year?
If yes,
• Period:
• Reasons thereof:

In the past one year, whether there is a history of Yes/No

cheque bounces from accounts of the applicant
for not maintaining sufficient balance. If Yes, details of occasions of cheque
bounces due to maintenance of insufficient
(Please attach separate sheet if space is not balance, in the past one year.
sufficient to furnish the details)

DECLARATION :

I, ……………………………………………………… hereby declare / undertake that

a) The particulars furnished in the above application and annexure to the above application
are correct to the best of my knowledge and I have not concealed any material fact
relevant to the sanction of the overdraft facility.
b) I have fully understood the Scheme guidelines, terms and conditions governing the
overdraft facility scheme to staff members and undertake to abide by the same.
c) I will utilize the Overdraft facility only for Bonafide purposes.
d) I will maintain 40% Net Take Home Pay after all deductions towards all loans/Advances /
statutory dues payable from time to time during the tenor of the OD facility, including
interest component on the full eligible limit of OD facility.
e) I confirm that ALL repayments towards my Staff Loans are being deducted from my
salary (except the EMIs listed in the application).
f) I confirm that all my Loan Accounts are being linked with my Salary Account / CIF
number.
g) I also abide and undertake to the Bank ‘s right to change, modify, alter, amend, repeal or
vary from time to time any clause(s) /Terms and conditions incorporated in the Scheme.

Date: Signature of the Applicant

Details of Direct liabilities to the Bank:
S.No. Nature of Loan Branch A/c No DL Balance Overdue if
Name any
1. PF
2 Refundable PF
3 Special Clean Loan
against PF
4 Special Clean Loan
marriage against
PF
5 Consumer loan
( Including Interest)
6 Flood loan
7 Loan form Staff Co
operative Society
8 SVL ( Incl.Int)
9 SHL( Inlc.Int.Accr )
10 Home loan
11 Loan Against NSC
12 Int. Free salary/
festival advance
13 Educational loan
14 Loan Against Title
deeds
15 Computer loan
16 IB Vehicle loan
17 ESPS Loan
18 Others if any Specify
Total

Signature of the Applicant

Branch Manager’s / Department Head’s Recommendation:

I hereby certify that the details furnished above are true and correct to the best of my knowledge
and belief and the proposal is in accordance with the terms and conditions of the scheme. I
recommend that the facility applied for may be sanctioned. I also certify that there are no
overdues in any of the other loan accounts of the employee. I confirm that the above employee
is not under Loss of Pay / on leave without pay facility.

Date: Branch Manager/Department Head