TVS CREDIT SERVICES LIMITED

(All fields are mandatory)

Cross Sell Personal Loan Application Form
Regd. Office: Chaitanya, No. 12, Khader Nawaz Khan Road, Nungambakkam, Chennai- 600006

Corp. Office: No.29, Jayalakshmi Estates, Third Floor, Haddows Road, Nungambakkam, Chennai- 600006 Application Date : 1 1 1 1 2 0 2 2

SCE Code: SCE Name:

Portfolio: UT CT TT CP Application No.:

Prospect No.: 3 0 7 8 C P 0 0 4 6 3 4 4

Location Code/Name: 3 0 7 8 / R O W B

Applicant Type: Borrower Co-Borrower CKYC Number.:

Sourcing / Asset / Scheme Details

Programme Category: C R O S S S E L L P L

Parent Agreement No.: W B 3 0 7 8 C D 0 7 9 4 5 2 5

Tenure(months): 2 4 EMI: (Rs.): 5 7 6 2 Customer IRR (Fixed % p.a.): 2 6 . 2 2

Processing Fees(Rs.): 3 8 5 0 Other Charges(Rs.): Stamping Charges(Rs.):

(Inclusive of GST)

Total Loan Amount(Rs.): 1 1 0 0 0 0 Total EMI's: 1 3 8 2 8 8

Repayment Type: ECS ACH PDC DRE Preferred EMI Date:

Special Insurance: KOTAK CREDIT SHIELD Total DP Amount: 4 8 5 0 Premium with: DP LA

Premium Amount(Rs.): 1 0 0 0 Nominee Name: M A M T A K U M A R I

Health Insurance: Bharati Axa Premium with: DP LA Premium Amount(Rs.):

Nominee Name:

Borrower Details

Title: Dr. Mr. Mrs. Ms.

Name: R A K E S H C H O U D H U R Y

Father's/Spouse's Name: R A M E S H C H O U D H U R Y

Mother's Name:

Gender: M A L E DOB: 0 3 0 1 1 9 7 5

Residence Status: Owned Rented Leased

Residential Address: RATIBATI RATIBATI CT BARDDHAMAN ROTIBATI WEST BENGAL

Bardhaman Taluk: Chelod B.O Town: Raniganj Municipality

District:

Landmark: Near NORTH POINT SCHOOL CHANDA State: WB Pincode: 713339

No. of years in Residence: No. of Dependents: Educational Qualification: HSC

Mobile No.: 9733778191 Alternate Mobile No.: Religion: HINDU

Personal Email ID:

Employment Type: Salaried Self-Employed Agriculture

IP Address :47.11.210.154
Digitally signed using OTP (8387) sent to mobile number
OTP Time :2022-11-11 19:09:36
9733778191 and verified on 2022-11-11 19:09:36
Mobile No :9733778191
Borrower's Signature
Latitude :23.6687395
Logitude :87.038847
Office/Business Name: SUNMOONS DECORATORS

Customer Profile/Designation:

Office/Business Address: RATIBATI RATIBATI CT BARDDHAMAN ROTIBATI WEST BENGAL RATIBATI RATIBATI CT BARDDHAMAN

District: Bardhaman Taluk: Town: Chelod B.O

Landmark: Near NORTH POINT SCHOOL CHANDA State: WB 713339

Pincode:

Office Contact No: 9733778191 Monthly Income(Rs.):

Permanent Address: RATIBATI RATIBATI CT BARDDHAMAN ROTIBATI WEST BENGAL

District: Bardhaman Taluk: Raniganj Municipality Town: Chelod B.O

Landmark:
Near NORTH POINT SCHOOL CHANDA State: WB Pincode: 713339

Contact No.: 9733778191 PAN No.:

Banking Details and Pre-sanction Documents

Bank Account: Yes No

Bank Account No.: 3 7 8 4 2 1 1 9 2 3 3

IFSC Code: S B I N 0 0 0 4 7 7 7

Identity Proof: Voter Id Driving Licence Aadhar Passport

Address Proof: Voter Id Aadhar Driving Licence LPG Electricity Bill

PAN PAN Form60 Attested bank statements for the past 3 months

References
Reference 1 Reference 2

Relationship with Relationship with

Name: AYUSH CHOUDHURY RELATIVE Name: MAMTA KUMARI RELATIVE
Borrower: Borrower:
Address: Address:

City: Pincode: City: Pincode:

Mobile No.: 9297930837 Mobile No.: 9297930838

Declaration / Undertaking
I/We confirm having received, read and understood the terms and conditions including scheme details of the loan explained and unconditionally agree that the terms
and conditions may be changed by TVS Credit at any time. I/We affirm that all the particulars and information and details given/filled in this application form are true,
correct, complete and up-to-date in every manner and that I/We have not withheld any information whatsoever from TVS Credit.

I/We agree to receive SMS, telephonic calls, emails, or through any other mode of communication, the various schemes, plans, and offers provided by TVS Credit, and
I/We am/are aware 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 will not be applicable for such communication/calls/SMS received from TVS Credit, its employees, agents and/or associates.

I/We authorise TVS Credit Services Ltd. and all its group companies and their agents to exchange, share or part with all the information and details relating to my/our
existing loans and/or repayment history to other TVS group companies, banks, finance institutions, credit bureaus, agencies, statutory bodies etc as may be required
or as they may deem fit and shall not hold TVS Credit or any of its group companies or its/their agents/representatives liable for use/sharing of this information.

I/We confirm that I/we have been made aware of the terms and conditions of the loan to which I/we agree unconditionally and I/we have not made any payment in
cash, bearers cheques or of any other kind along with or in connection with this application form to any person collecting or assisting with my/our application form nor
have I/we received any gift/discount or any other commitment not mentioned in the loan agreement by TVS Credit or any of its authorised agents/representatives.

I/We understand and acknowledge that mere submission of this application form does not entail approval of the loan from TVS Credit and that TVS Credit shall have
the absolute discretion to reject my/our application without specifying reasons for the same and without notification.

I/We agree to pay any amount as may be applicable on the levy of Goods and Service Tax on the loan amount.
IP Address :47.11.210.154
Digitally signed using OTP (8387) sent to mobile number
OTP Time :2022-11-11 19:09:36
9733778191 and verified on 2022-11-11 19:09:36
Mobile No :9733778191 Borrower's Signature
Latitude :23.6687395
Logitude :87.038847
 I/We concede that the TVS Credit shall increase or decrease the credit limit as per its internal policy and criteria at its sole discretion from time to time and I/we
understand that no dispute with respect to the same can be made.

I/We shall pay a processing fee (non-refundable), if any, charged towards the loan application.

I/We agree to pay the Broken Period Interest (BPI) if applicable. (BPI is the interest charged up to the start of the EMI schedule, from the date of disbursement of the
loan).

I/We agree that pre-payment of the loan amount is not allowed for the first 6 months from the date of disbursement of loan.

I/We affirm that I/we have submitted all the self-attested, necessary documents mentioned in the checklist along with the photographs.

I/We agree to notify TVS Credit in case of any change of address of employment or of residence, or of nature of employment, so mentioned by me/us in the
application form.

I/We agree to the terms and conditions of the e-agreement, if any, in case of online filing of this application.

I hereby declare/confirm that my KYC details available in the records of TVS Credit remain unchanged and are correct. (Applicable only when New KYC not
collected)

Important Note
Kindly Note:
• TVS Credit will decide the quantum of the loan at its sole discretion • TVS Credit reserves the right to reject any application, without assigning any reasons • TVS Credit may
request for additional documents other than those collected in this connection • TVS Credit reserves the right to retain photograph and documents submitted along with the
application form and shall not return the same • the Equated Monthly Instalment (EMI) in connection with the loan will be due as per the schedule of the loan agreement • TVS
Credit shall not be liable for loss or delay in the receipt of documents • Incomplete, defective application will not be processed and TVS Credit shall not be responsible in any
manner for the resulting delay or otherwise • All post dated cheques are to be issued favouring TVS Credit Services Limited only.

• The decision to give a loan and the interest rate applicable to each loan account is assessed on a case-to-case basis, based on multiple parameters such as the type of the
asset being financed, borrower profile, and repayment capacity, borrower’s other financial commitments, past repayment track record, if any, the security for the loan as
represented by the underlying assets, loan-to-value ratio, mode of payment, tenure of the loan, geography (location) of the borrower, end use of the asset etc.

•.The customer unconditionally agrees to the terms and conditions which may be changed by the company at any time, with due notice , and the customer will be bound by
the amended terms and conditions.
*Other terms and conditions apply.

Schedule of Charges

Processing Fee: As per scheme; Statement of account: Rs. 500/-;Change in repayment frequency: Rs. 1000/-for each instance; Pre-payment charges:a) Remaining loan
tenure is 12 months - 3% on principal outstanding b) Remaining loan tenure 12-24 months - 4% on principal outstanding c) Remaining loan tenure is 24 months - 5% on
principal outstanding; Bounce charges per instance: Maximum of Rs. 750/-; Stamp Duty: As per state laws; Loan cancellation and re-booking charges:Rs. 1000/-; loan
cancellation charges: Cross Sell Personal Loans:0 days to first EMI date,tenure less than or equal to 12 months - 3%, tenure between 12-24 month -4%, tenure greater
than 24 months - 5%+ BPI(Broken Period Interest); Penal Interest: 3% per month on the unpaid EMI will be charged from the due date; Duplicate repayment schedule:
Rs. 500/-; Cheque swapping charges: Rs. 500/- per swap; Duplicate No due certificate / No objection certificate: Rs. 500/-;Legal, re-possession and incidental charges:
At actuals; Visit charges: Rs. 150/-per visit (applicable when collection executive visits customer place for collection); Service Charges: At actuals; Loan re-schedulement
charges: 3%

Name of the Borrower: RAKESH CHOUDHURY

IP Address :47.11.210.154
Digitally signed using OTP (8387) sent to mobile number
OTP Time :2022-11-11 19:09:36
9733778191 and verified on 2022-11-11 19:09:36
Mobile No :9733778191
Latitude :23.6687395
Logitude :87.038847
 TVS CREDIT SERVICES LIMITED
Cross Sell Personal Loan Agreement
Regd. Office: Chaitanya, No. 12, Khader Nawaz Khan Road, Nungambakkam, Chennai- 600006
Corp. Office: No. 29, Jayalakshmi Estates, Third Floor, Haddows Road, Nungambakkam, Chennai-600006

1.DEFINITIONS
For the purposes of the Master Terms and Conditions, capitalised words shall have the meaning as set-out herein below:
“Applicable Law(s)” - shall mean, any statute, law, regulation, ordinance, rule, judgment, rule of law, order, decree, clearance, approval, directive, guideline, policy, requirement, or other governmental
restriction or any similar form of decision, or determination by, or any interpretation or administration of any of the foregoing by, any statutory or regulatory authority whether in effect as of the date of
the loan or thereafter and in each case as amended;
“Bounce Charges” means an amount payable by the Customer to the Lender as a penalty where the cheque(s) issued by the Customer is not honoured by the clearing bank or the EMI mandate is
dishonoured;
“Commercial Terms” shall mean the terms of the loan issued and communicated by the Lender to the Customer by way of any of the contact options and includes the EMI, tenure, interest, fees,
charges and such other requisite particulars;
"Broken Period Interest (BPI)" - shall mean the interest charged up to the start of the EMI schedule from the date of disbursement, which shall be paid by the Customer/Borrower separately in
advance.
“Contact Options” shall mean and include use of any telephone (either through human interface or AVR), fax, e-mail, short messaging service (SMS), mobile applications, online customer portal and/
or other options as made available by Lender to its Customer(s) from time to time for availing loan(s)/ services from the Lender;
“Customer/Borrower” means an individual (including his/her legal representatives, administrators, executors and heirs, and shall be construed so as to include his/her permitted assigns and
permitted transferees) who has been sanctioned a loan by the Lender pursuant to his/her request for such loan;
“Customer’s Account” refers to the designated bank account of the Customer which is duly registered/notified with/to the Lender, from time to time;
“Customer’s Dues” means and includes the outstanding principal amount of the loan, interest on the loan, together with all other interest, all fees, costs, charges, expenses and stamp duty and all
other sums whatsoever payable by the Customer to the Lender in accordance with this master terms and conditions and any other documents executed by the Customer in relation to the loan;
“Due Date(s)” means the date(s) on which any amounts in respect of Customer’s dues (including the principal amount of the loan or its interest and/or any other monies), fall due and payable in the
form of EMIs as accordingly specified in the commercial terms; and/or other transaction documents executed by the Customer in relation to the loan. If the due date falls on a day which is a holiday,
the payment is to be made on the immediately preceding working day;
“ECS” or “NACH” refers to electronic clearing services or electronic payment services, participation in which has been consented to in writing by the Customer, for facilitating the payment of EMI, fees
and other applicable charges to the Lender in connection with the loan availed by the Customer;
“Effective Date” shall mean the date of first disbursement of the loan in case the loan is disbursed in part, otherwise the date of disbursement of the loan;
“Equated Monthly Instalments” or “EMI” shall mean the amount payable every month on such date(s) specified in the loan term sheet for the term of the loan by the Customer to the Lender
comprising of interest, or as the case may be, principal amount of the loan and/or interest to amortise the loan;
“Lender/ Company” shall mean TVS Credit Services Limited (including its successors and assigns), a non-banking finance company, registered under the Companies Act, 1956 , having its registered
office at Chaitanya, No.12,Khader Nawaz Khan Road,Nungambakkam, Chennai–600006
“Loan” shall mean the amount of loan availed by the Customer from Lender in connection with the purchase of the product or receipt of services including to meet personal expenses or otherwise for
any other requirement from time to time as per the commercial terms and also include any top-up/enhancement of any existing loan so availed by the Customer from the Lender;
“Loan Term Sheet” means the document provided to the Customer by the Lender, containing the commercial terms in relation to the loan and confirmed, executed and accepted by the Customer;
“Master Terms and Conditions” means collectively the terms and conditions set out herein and any other terms applicable in connection with the loan or any further or future loans or in relation to the
usage of the InstaCard, as amended and/or modified by the Lender from time to time;
“Notified Number” in relation to the Lender shall refer to such mobile number so notified by the Lender to the Customer/ or as specified in the commercial terms or the website and in relation to the
Customer shall refer to such mobile number as communicated by the Customer to the Lender or such number which has been maintained as per the records kept by the Lender;
“Notified Email” in relation to the Lender shall refer to such email address so notified by the Lender to the Customer/ or as specified in the commercial terms or the website and in relation to the
Customer shall refer to such email address as communicated by the Customer to the Lender or such e-mail address which has been maintained as per the records kept by the Lender;
“Penal Interest” means an additional interest payable by the Customer to the Lender as a penalty in case of delay/default in payment of EMI/ any other dues/charges forming a part of Customer’s
dues;
“RBI” shall mean the Reserve Bank of India;
“Transaction Documents” shall mean any other document including that of such forms as may be necessary that may be executed by and between the Lender and the Customer in relation to the
loan; Valid Confirmation shall mean the acceptance of the Master Terms and Conditions and the Loan Term Sheet by (i) Entering the Transaction Code (ii) Clicking on the “I Accept” button at the end of
the Master Terms and Conditions as available in the link or otherwise using any of the Contact Options (as may be decided by the Lender from time to time at its sole discretion)
“Website” shall mean and refer to www.tvscredit.com
The Customer and the Lender are collectively referred to as "Parties" and individually as a "Party"
2. SCOPE :
2.1 In addition to the terms set out in the loan term sheet, and such other conditions as may be agreed between the Lender and the Customer, the master terms and conditions shall govern the loan
availed.
2.2 This master terms and conditions, in itself, do not create, transfer or record any right or obligation of the Lender, and is to be read along with the provisions of the loan term sheet.
2.3 The loan may be granted to the Customer as per the terms of the master terms and conditions and other transaction documents. The loan will be granted at the sole discretion of the Lender and
shall be subject to the following conditions:

(a) The Customer is not an undischarged insolvent or has not at any time been adjudged as an insolvent, has not at any time suspended payment to his/her creditors or has not at any time made a
composition with them; or has not at any time been convicted by a court of law for any offence.

2.4 The Customer agrees that the master terms and conditions may be amended and/or modified and/or supplemented from time to time at the sole discretion of the Lender due to any reason
whatsoever including that of any change in the market conditions and the Customer shall be obliged to comply with such revised master terms and conditions. The revised master terms and
conditions may be accessed and downloaded by the Customer from the website or emailed or posted by the Company shall be deemed to construe as sufficient intimation to the Customer. Such
revised master terms and conditions shall hold true, valid and applicable with respect to the loan and for any other credit facility that may be availed by the Customer.

3. PURPOSE AND DISBURSEMENT OF LOAN:

3.1 The loan may be granted by the Lender to the Customer for such amount for the purpose of purchase of any product or receipt of any service which are legally valid or to meet personal
expenses or otherwise as may be specified in the commercial terms. The Customer may avail the loan in one or more tranches as and when the Customer wishes.

3.2 Subject to the terms and condition contained herein, the Borrower(s) agrees to borrow from the Company and the Company agrees to lend to the Borrower the sum specified in the loan term
sheet, hereto. The loan may be disbursed in full or in instalment or in such other manner as may be decided by the Company on the terms and conditions and the purpose as stated /contained in
this agreement and /or in the Borrower’s application for the loan. The loan may be disbursed to such other person(s) as may be designated by the Borrower(s); Provided however that
disbursement if any made by Company to the aforesaid designated person(s) shall not affect the obligations of the Borrower(s) in relation to the loan and such disbursement of the loan to the
designated person(s) shall be deemed to be the loan granted to and availed by the Borrower(s).

3.3 The Borrower(s) shall pay interest on the loan amount at the rate specified in the loan term sheet. The interest on the loan shall be calculated on a daily basis with monthly interest on the
outstanding principal balance. The interest on the loan shall begin to accrue from the date of issuance of loan cheque. The Company will disburse by cheque/ECS transfer/NEFT/RTGS/SI)
irrespective of the time taken for transit, collection, realisation of the cheque by the Borrower(s) or his bank. The interest levied on the loan shall be the same as mentioned in the schedule and
shall remain fixed till the term of the loan agreement unless mandated by the Reserve Bank of India or any other competent authority, or changes in the money market, which shall be binding on
the Borrower(s).
3.4 Acceptance of the Loan Application form and Master terms and conditions by the customer :
(i) Pursuant to a call being made either by the Customer or the Lender at any of the Notified Number, a request/offer for a Loan may be made by the relevant Parties to one another;

For TVS CREDIT SERVICES LIMITED

L. Sayee Krishnan(5000937) IP Address :47.11.210.154

Digitally signed using OTP (8387) sent to mobile number
OTP Time :2022-11-11 19:09:36
Head - Credit Ops & Central Ops 9733778191 and verified on 2022-11-11 19:10:36
Mobile No :9733778191
Authorised Signatory Borrower's Signature
Latitude :23.6687395
Logitude :87.038847
 TVS CREDIT SERVICES LIMITED
(ii) Upon verification of the Customer’s identity (as per KYC norms) by the Lender, the Customer will receive a weblink containing the link to the Master Terms and Conditions and Commercial
Terms (as hosted on the Customer’s online portal/Website) (“Transaction Link”) on his/her Notified Number and/or Notified Email ID, the Transaction Link may also contain a specific numeric
code (“Transaction Code”);
(iii) Once the Customer has read and understood the terms and conditions provided in the Transaction Link and if the same is acceptable to him/her, he/she shall convey his/her acceptance by
clicking on the “I Agree” button at the end of the Master Terms and Conditions and/ or entering the Transaction Code at a Merchant counter or on the Lender’s online portal/website.

(iv) Pursuant to a Valid Confirmation by the Customer either by way of the mechanism detailed above, the Loan shall be deemed to have been disbursed once the Loan (in its entirety or its part
thereof) is credited into the Merchant Account or the Customer’s Account as the case may be and as agreed upon between the Parties and specified in the Commercial Terms.

(v) Notwithstanding anything provided to the contrary, in the event of any erroneous disbursement by the Lender, for any reason whatsoever, the Customer hereby agrees unconditionally to
cooperate with Lender, assist the Lender in taking all steps and actions that may be required and in executing such letters or documents as the Lender may require to make modifications to
such erroneous disbursement.

3.5 Interest, Charges and Fees:

(a) The annual rate of interest as applicable to each loan obtained by the Customer from time to time shall be communicated to the Customer before the approval of such loan(s) by the Lender in
writing if not specified in the commercial terms. Interest in respect of each loan will start accruing in favour of the Lender on and from the respective effective date until the repayment of the
loan and all monies due and payable by the Customer in respect of the loan, including interest, fees, penalties etc. Interest shall be computed on the basis of a year comprising of three hundred
and sixty five days.

(b) The Customer confirms that he will pay the Broken Period Interest (BPI), if applicable at the time of the disbursement of the loan. TVS Credit will deduct the same from the disbursement
amount.
(c) The Customer confirms that he has reviewed and understood the internal guiding principles and interest rate model of as the Lender available on the website/specified in the commercial
terms for the purpose of determining and calculating rate of interest.

(d) The interest, charges and other fees payable by the Customer on any loan may be modified at the discretion of the Lender. The Lender shall ensure that any changes in interest and other
charges shall be effected only prospectively and due notice of the same shall be provided to the Customer.

3.6 Repayment
(a) The Customer shall repay the loan, interest and all applicable charges in specified number of monthly instalments of the equal amount throughout the tenure of such loan (hereinafter referred to
as Equated Monthly Instalment (“EMI”) in the manner and as specified in the commercial terms.
(b) The Customer shall continue to pay the EMIs not later than than on the respective due dates for each such loan regardless of whether the purpose for which the loan is obtained could or could
not be achieved and/ or any other circumstance whatsoever.
(c) The Customer undertakes that he/she has given or shall give ECS/ NACH mandate or any other electronic or other clearing mandate in favour of the Lender in respect of the EMIs to be paid on
respective due dates as agreed to, in the Commercial Terms (“EMI mandate”).

(d) The Customer shall ensure availability of sufficient funds in the Customer’s account/bank account on which EMI mandate has been provided to the Lender, and shall not close such bank
account and/or issue any instructions to stop/suspend such EMI mandate.

(e) Any dispute or difference of any nature whatsoever shall not entitle the Customer to withhold or delay payment of any EMIs or any other amounts in clear violation of the EMI mandate so
provided earlier.

(f) All sums payable by the Customer to the Lender shall be paid without any deductions whatsoever. Credit/discharge for any payments made by the Customer shall be given only on realisation of
the amounts so paid.

3.7 Other conditions of loan:

(a) In respect of any delayed payments, any sums received by the Lender from the Customer shall be appropriated first against payment towards overdue EMIs, and thereafter against the bounce
charges and/or penal interest or any other charges under the master terms and conditions.
(b) Notwithstanding anything stated elsewhere in the master terms and conditions, the EMI, any amounts outstanding under the loan or the Customer’s dues (or any of its part thereof) shall be
payable by the Customer to the Lender on demand. Further, the Customer shall also provide a demand promissory note to the Lender in respect of repayment towards Customer’s dues.
(c) The Customer shall be exclusively responsible to take possession and get the delivery of the product from the merchant and the Lender shall not be liable for any delay in delivery or non -
delivery of the product and/or with respect to the quality, condition, fitness, suitability or otherwise whatsoever of the product.

(d) The grant of a loan as per the master terms and conditions and other transaction documents shall create a relationship of debtor and creditor as between the Customer and the Lender and shall
not, under any circumstance, be deemed as a service rendered/to be rendered by the Lender. Accordingly, the provisions of the Consumer Protection Act, 1986 (“said Act”) shall not apply to the
transaction forming subject of the master terms and conditions and the Customer waives any right to seek any remedies under the said Act.

(e) In case of receipt of request from the borrower for transfer of borrowal account, the consent or otherwise i.e.objection of the Company, if any, shall be conveyed within 21 days from the date of
receipt of request.

3.8 Covenants by the Customer

(a) The Customer covenants that at all times he/she shall:
(i) Comply with the applicable laws;
(ii) Do all such things and execute all such writings as may be necessary from time to time for duly or more perfectly securing the repayment of the loan;
(iii) Notify the Lender in case of any change in Customer’s registered KYC or bank account details so communicated/ provided earlier to the Lender, immediately. In relation to the same, the
Customer may have to provide supporting documents in the manner as determined and specified by the Lender from time to time;
(iv) Not to default or delay in the payment of the EMI or Customer’s dues beyond the due dates
(b) Additional covenants for use of contact options in relation to the availing of the loan
(i) The Customer authorises the Lender to accept all the instructions/ applications/ requests made by Customer through any of such contact options opted by the Customer for the purposes of
considering, granting, approving, or disbursing the loan by the Lender, as the case may be, as per this master terms and conditions. Further, the Customer agrees and confirms that all
documents (including but not limited to the loan term sheet) sent by the Lender to the Customer over any of the contact options shall be valid and binding on the Customer.

(ii) The Customer agrees that the phone number, e-mail address and other details provided by the Customer, for availing contact options or for any call-back is owned by and belong to the
Customer only. The Customer understands and agrees that accepting instructions, or approving the loan, through any of the contact options shall at all times be subject to the sole discretion
of the Lender and that the Lender may, at its sole discretion, refuse to act based on such instructions.

(iii) The Customer acknowledges that the range of services/ loan provided over the contact options may change from time to time. The Customer agrees that the Lender may add or discontinue
anytime all or any of the contact options for granting loan and other related services by sending notice/ communication to the Customer.
(iv) The Customer confirms that the Lender has the absolute right to make changes in the terms and conditions for availing all or any of the contact options.
(v) The Customer irrevocably and unconditionally consents to the Lender recording of all the Customer’s electronic communication (e.g. telephone calls, electronic mail, SMS, mobile application
or other) and storage of electronic media by the Lender and accepts such recordings and electronic media as evidence with regard to acceptance of all the commercial terms.
(vi) The Customer confirms that he is fully aware of and consents to the risks associated with transmitting instructions for obtaining loan/ funds transfer via contact options. The Customer agrees
that confirmation of the Customer’s identity, will be sufficient evidence for the Lender to identify the Customer and to act upon the Customer’s instructions.

For TVS CREDIT SERVICES LIMITED

IP Address :47.11.210.154
L. Sayee Krishnan(5000937) Digitally signed using OTP (8387) sent to mobile number
OTP Time :2022-11-11 19:09:36
Head - Credit Ops & Central Ops 9733778191 and verified on 2022-11-11 19:10:36
Mobile No :9733778191
Authorised Signatory Latitude :23.6687395 Borrower's Signature

Logitude :87.038847
 TVS CREDIT SERVICES LIMITED
4. EVENT OF DEFAULT AND CONSEQUENCES OF EVENT OF DEFAULT:
4.1 An ‘Event of Default’ shall be deemed to have occurred if:
(a) An EMI or any payments due by the Customer has not been paid on the relevant due date;
(b) The Customer does not comply with its obligations contained in the master terms and conditions and/or transaction documents executed by the Customer in relation to availing of the loan;
(c) It is found that the Customer has made any misrepresentations to the Lender and/or the merchant;

(d) The product purchased out of the proceeds of the loan is confiscated, attached, taken into custody by any official, authority or other person made subject to any proceedings, or is disclaimed,
endangered, stolen or damaged or bodily injury is caused to any third party by accident or the services availed by the Customer does not meet his requirement or satisfaction;

(e) The Customer dies, becomes insolvent/ compounds with his creditors or permits any attachment or sequestrations or other process against any of his/her assets or properties; or
commits any criminal offense which will attract punishment of 3 (three) or more months under Indian Penal Code, 1860 and/or
(f) The Customer commits any default under any other terms and conditions/agreements so executed with the Lender in relation to any other credit facility/service availed from the Lender.
4.2 Upon the occurrence of an event of default, the following are without prejudice to the other remedies available under law or in equity:
(a) In case of default by reason of dishonour of the cheque or EMI mandate provided by the Customer, when used or presented by the Lender towards repayment of Customer’s dues, the Lender
shall levy

(i) Penal interest per month as specified in the loan agreement, application form for every such default till such default continues and is not rectified by the Customer and

(ii) Bounce charges as applicable from time to time for per month/per default.
(b) In case of delay in payment by the Customer of any EMI due to any other reason, the Customer shall be liable to pay a penal interest as specified in the Schedule of charges. The aforementioned
remedies shall be available to the Lenders notwithstanding any other remedies that may be available specifically under Section 138 of Negotiable Instruments Act, 1881 or Section 25 of the
Payment and Settlement Systems Act, 2007 or under other provisions of applicable law.

(c) Notwithstanding anything specified hereinabove, upon an event of default, the Customer’s dues shall forthwith become payable to the Lender, without any notice to the Customer; and if the
Customer fails to pay the Customer’s dues or any part thereof, the Customer undertakes to forthwith surrender to the Lender or its representatives, the product or any other asset of the
Customer of value sufficient to satisfy the Customer’s dues or part thereof not paid by the Customer and Lender shall, on behalf of Customer, be entitled to alienate/dispose off the same and
adjust the proceeds against the Customer’s dues. In case even after such realisation, there still remains any amount due and payable by the Customer, the same shall be paid to the Lender by
the Customer forthwith. The Lender also reserves the right to present for payment any cheque/EMI mandate so received by the Lender previously, until all monies due and payable to the
Lender are fully paid up to the Lender.

5. DISCLOSURES:
5.1 The Lender shall, as it may deem appropriate and necessary, be entitled to, without any specific consent or authorisation from the Customer, disclose all or any:
a) Information and/or data relating to the Customer;
b) Information and/or data relating to the loan;
c) Obligations assumed/to be assumed by the Customer in relation to the loan under the loan term sheet/ transaction link;

d) Event of default, if any, committed by the Customer in discharge of the aforesaid obligations,
e) To the Credit Information Bureau (India) Limited (“CIBIL”) or any other existing or future credit bureaus/credit reference agencies or any third party agency for the purpose of availing any
support services. CIBIL and/or any other agency, authorised by RBI to do so, may use and/or process the aforesaid information and/or data disclosed by the Lender in any manner as it may
deem fit. CIBIL and/or any other agency, authorised by the RBI to do so, may furnish for consideration, the processed information and/or data or products thereof prepared by it to the Lender
or other financial institutions and/or other credit grantors or registered users, as may be specified by RBI in this behalf. All information and/or data furnished by the Customer to the Lender
from time to time shall be true and correct.

5.2 The Customer confirms that the Lender may also disclose any information / documents relating to the Customer to the Lender’s group companies for any promotional purposes

6. DISPUTE RESOLUTION AND JURISDICTION:

6.1 If any dispute, difference, or claim arises between any of the Borrowers and the Lender in connection with the Facility or as to the interpretation, validity, implementation, or effect of the Facility
Documents or as to the rights and liabilities of the parties under the Facility Documents or alleged breach of the Facility Documents or anything done or omitted to be done pursuant to the
Facility Documents, the same shall be settled by arbitration by a sole arbitrator to be appointed by any of the following institutions:
a) The Council for National and International Commercial Arbitration having its office at Unit No.208, 2nd Floor, Beta Wing, Raheja Towers, Nos.113-134, Anna Salai, Chennai – 600002
(or)
b) Centre for Online Resolution of Disputes having its office at F-14, 3rd Cross, Manyata Residency, Manyata Tech Park, Bengaluru – 560045
(or)
c) Madras Alternative Dispute Resolution Centre having its office at C-40, 2nd Floor, 2nd avenue, Anna Nagar West, Chennai-600040.
(or)
d) Madras Arbitration solutions LLP having its office at 11/6, Francis Joseph Street, Parrys, Chennai- 600001.
(or)
e) Jus Arbitri & Infinite Legal Service LLP, New No.14, Old No.11/1, P.A.N Rajarathinam, 4th Lane, G.A.Road, Old Washermenpet, Chennai, Tamil Nadu 600021
(or)
f) Any arbitral institution designated under the provisions of the Arbitration or Conciliation Act, 1996 (“the Act”) or any panel of arbitrators maintained under the provisions of that Act.

6.2 Hereinafter referred to as (“Institution”) in accordance with the rules of the Institution as prevailing and as amended from time to time.
6.3 The arbitration proceedings shall be based on documents only which shall be conducted through exchange of e-mail and/or any other mode of electronic communication as permitted by the
rules of the Institution or through an online dispute resolution by the web portal offered by the Institution. The parties hereby agree that the arbitral proceeding shall be conducted in electronic
mode and all pleadings and documents will be exchanged electronically. There shall be no in-person and/or oral hearings except in certain exceptional circumstances as the sole arbitrator may
deem fit upon the request of either of the parties. In such instances, the hearings shall be conducted virtually at the sole discretion of the arbitrator. The seat of arbitration for all purposes shall be
deemed to be at such place is Chennai. The language of arbitral proceedings shall be English.

6.4 In the event the arbitrator to whom the matter is originally referred, resigns or dies or is unable to act for any reason, the Institution shall appoint another person in his/her place to act as an
arbitrator who shall proceed with the reference from the stage at which it was left by his/her predecessor.

6.5 The arbitrator so appointed shall have the power to pass an award and also to pass interim orders/directions as may be appropriate to protect the interest of the parties pending the resolution of
the dispute. A certified copy of the award passed by the arbitrator, a digitally signed copy of the same or a scanned copy of the same shall be sent to the parties through e-mail or any other
electronic mode including the web portal as the Institution deems fit which shall be considered as a signed copy.

6.6 All notices, processes and communications between the parties with respect to the arbitration proceedings shall be through e-mail or any other mode of communication permitted by the
Institution notwithstanding the notice clause contained in the Agreement which shall continue to apply to all other communications between the parties.
6.7 It shall be the responsibility of the Lender and Borrower(s) to maintain sufficient space in the e-mail account and/or in any other mode of electronic account(s) and also to have supporting
applications/software in their computer/mobile/any other electronic device to access the electronic documents sent to them. It shall also be the responsibility of the Lender and Borrower(s) to
save the emails in the address book. The delivery of emails to spam, promotion, etc., shall also be a deemed delivery.

6.8 The Chennai courts shall have exclusive jurisdiction in respect of matters arising under this Agreement including any application for setting aside the award/appeal and the Lender/ Borrower(s)
shall not object to such jurisdiction. The arbitration shall be conducted under the provisions of the Arbitration and Conciliation Act, 1996 together with its amendments, any statutory modifications
or re-enactment thereof for the time being in force. The award of the arbitrator shall be final and binding on all parties concerned. The cost of arbitration shall be borne by the Borrower.

For TVS CREDIT SERVICES LIMITED

IP Address :47.11.210.154
L. Sayee Krishnan(5000937) Digitally signed using OTP (8387) sent to mobile number
OTP Time :2022-11-11 19:09:36
Head - Credit Ops & Central Ops 9733778191 and verified on 2022-11-11 19:10:36
Mobile No :9733778191
Authorised Signatory Borrower's Signature
Latitude :23.6687395
Logitude :87.038847
 TVS CREDIT SERVICES LIMITED
7. SET-OFF:
7.1 Notwithstanding anything contained in the agreement, the Company shall have lien over all the assets of the Borrower(s) in the Company's control and right of set off against any monies due to
the Company from the Borrower(s), even in case of default in instalments.
7.2 The Company shall exercise the right under this clause on the remaining claims by giving a notice in writing along with the full particulars about the remaining claim made and the conditions with
which the company is entitled to retain securities till the relevant claim is settled.

8. NOTICES:
Any notice given to either of the party under this master terms and conditions shall be in writing. Such notice shall be deemed to have been duly given or made:
(a) In respect of the Lender- when it is delivered by hand, mail or telegram at Lender’s registered address or at such other address as the Lender shall have designated by notice to the Customer;
(b) In respect of the Customer-if any email is sent to the Customer’s notified email id or a SMS or a message through whatsapp or such identical mobile applications or any other electronic mode
(as decided by the Lender from time to time) is sent to Customer’s notified number or when a notice is delivered by hand, mail or telegram at such address as communicated by the Customer
to the Lender from time to time.

9. TENURE AND TERMINATION:

9.1 The master terms and conditions shall continue to apply to the Customer until all Customer's dues are paid in full to the complete satisfaction of the Lender. The master terms and conditions
shall deemed to have been terminated once Customer has paid all EMIs and entire dues.

10. MISCELLANEOUS:
10.1 The contents of the master terms and conditions have been fully explained to, in the language understood by the Customer at the time of availing of the loan.
10.2 Any statement of account furnished by the Lender regarding the balance amount due and payable by the Customer under the master terms and conditions shall be accepted by and be binding
on the Customer, and shall be conclusive proof of the amounts due from the Customer to the Lender. [Without prejudice to the above, if the Customer desires to question any statement or any
part thereof, the Customer shall furnish to the Lender full details of the same within 15 (fifteen) days of the receipt of the statement by the Customer, and the Lender may consider the same and
the Customer shall not be entitled to object thereafter on any ground whatsoever. It is however clarified that the Customer shall not be entitled to delay any payment of EMI on the ground of the
statement of account furnished by the Lender being inaccurate or on any such other ground].

10.3 The Lender has framed a fair practices code and it is available on the website.
10.4 The obligations of the Customer under the master terms and conditions along with the loan term sheet are independent and severable. If any obligation is found not enforceable by a court of
law, for any reason, the Customer shall continue to remain bound by the other obligations stipulated in such other documents specified herein.

10.5 The rate of penal interest, service charges and other charges payable and/or agreed to be paid by the Customer under the master terms and conditions are reasonable and acceptable to the
Customer.

10.6 The Lender shall at anytime be entitled to assign, sell, securitise, discount or transfer all or any part of Lender’s rights and obligations under the loan and the master terms and conditions, to any
person(s)/ entity by mere intimation/ notice to the Customer and in such manner as the Lender may deem appropriate from time to time. The Customer shall not be entitled to assign or in any
manner transfer any rights or obligations under the master terms and conditions.

Acceptance by the Borrower

I RAKESH CHOUDHURY the Borrower(s) herein, have read the entire agreement and shall agree to be bound by all the conditions including
the commercial terms included in the below term sheet herein. The aforementioned agreement and other documents have been explained to me in the language
understood by me and I have been provided with copies of the loan agreement, attachments and enclosures thereto.:

Loan Term Sheet

Application Reference No./ Loan Account No.: 3 0 7 8 C P 0 0 4 6 3 4 4

TVS Credit Corporate Office Address: T V S C R E D I T S E R V I C E S L T

D , J A Y A L A K S H M I E S T A T E S , 2 9 , H A D

D O W S R O A D , C H E N N A I .

Name and address of the Borrower (if there is any change)

Name: R A K E S H C H O U D H U R Y

Address: R A T I B A T I R A T I B A T I C T B A R D D H A M

A N R O T I B A T I W E S T B E N G A L

Loan Amount (Rs.): 1 1 0 0 0 0

Customer IRR[(fixed % p.a) calculated on monthly reducing balance method]: 2 6 . 2 2 Tenure(months): 2 4

Schedule of Charges
Processing Fee: As per scheme; Statement of account:Rs. 500/-;Change in repayment frequency: Rs. 1000/- for each instance; Pre-payment charges: a) Remaining loan
tenure is 12 months - 3% on principal outstanding b) Remaining loan tenure is 12-24 months - 4% on principal outstanding c) Remaining loan tenure is 24 months -5% on
principal outstanding; Bounce charges per instance: Maximum of Rs. 750/-; Stamp Duty: As per state laws; Loan cancellation and re-booking charges: Rs. 1000/-; Loan
cancellation charges: Cross Sell Personal Loans: 0 days to first EMI date,tenure less than or equal to 12 months- 3%, tenure between 12-24 month-4%,tenure greater than
24 months- 5%+ BPI(Broken Period Interest); Penal Interest: 3% per month on the unpaid EMI will be charged from the due date; Duplicate repayment schedule:Rs.500/-;
Cheque swapping charges: Rs. 500/- per swap; Duplicate No due certificate/No objection certificate: Rs. 500/-;Legal, re-possession and incidental charges: At actuals;
Visit charges: Rs. 150/-per visit (applicable when collection executive visits customer place for collection); Service Charges: At actuals; Loan re-schedulement charges: 3%

For TVS CREDIT SERVICES LIMITED

IP Address :47.11.210.154
L. Sayee Krishnan(5000937) Digitally signed using OTP (8387) sent to mobile number
OTP Time :2022-11-11 19:09:36
Head - Credit Ops & Central Ops 9733778191 and verified on 2022-11-11 19:10:36
Mobile No :9733778191 Borrower's Signature
Authorised Signatory
Latitude :23.6687395
Logitude :87.038847
 TVS CREDIT SERVICES LIMITED

Loan Repayment Schedule

EMI Due Dates:

Disbursement Date EMI Cycle Date

1st to 15th 3rd of the subsequent month

16th to 31st 3rd of next to next month

"Repayment Schedule will be basis Disbursement Date & will be sent along with Welcome Letter."

Demand Promissory Note

Date: 11/11/2022

Place: ROWB

ON DEMAND I, RAKESH CHOUDHURY S/O or D/O or W/O RAMESH CHOUDHURY jointly & severally and unconditionally

promise to pay to TVS Credit Services Limited (“TVS CREDIT”), having its registered office at Jayalakshmi Estates, No. 29,Haddows Road, Chennai -600006

the sum of Rs. 110000 / (Rupees ONE LAKHS TEN THOUSAND RUPEES only)
, or order

together with interest thereon at the rate of 26.22 % per annum (Fixed IRR) computed with monthly interest for the value received. Presentment for payment,

and protest of the note are here by unconditionally and irrevocably waived. Where there is more than one Signatory hereto the liability of each signatory is joint and

Revenue Stamp
Rs.1/-
Authorised Signatories as follows:

For Borrower:

Name of the Borrower: RAKESH CHOUDHURY

(Signature)

IP Address :47.11.210.154
Digitally signed using OTP (8387) sent to mobile number
OTP Time :2022-11-11 19:09:36
9733778191 and verified on 2022-11-11 19:10:36
Mobile No :9733778191
Latitude :23.6687395
Logitude :87.038847
 TVS CREDIT SERVICES LIMITED

SANCTION LETTER
Scheme & Details
Prospect Number 3078CP0046344
Customer Name RAKESH CHOUDHURY
Sanction Date 11/11/2022
Cust IRR (% p.a. fixed - calculated on monthly reducing balance method) 26.22
Loan Amount (PL) (A) (Rs.) 110000
Credit shield / Non Credit shield Premium with Loan (B) (Rs.) 0
Total Loan amount ( A+ B) (Rs.) 110000
Tenure (Months) 24
EMI (Rs.) 5762
Processing Fees & Other charges (C) (Rs.) 3850
Stamping and other Charges (D) (Rs.)
Credit Shield / Non Credit shield Premium with DP (E) Rs. 1000
Total Down payment (C+D+E) (Rs.) 4850
Pending Charges of prevoius loan(WB3078CD0794525)-Adjusted 0
Mode of Payment ONLINE

* The EMI Start date/End date printed above may vary to an extent of 1 month based on the date of disbursement of the loan.
* Pending Charges amount may vary based on the deleyed days & the amount will be deducted from Disbursal Value as explained and consented
by you

Schedule of charges:

Charges Amount Amount

Processing fees As per Scheme
Statement of account Rs.500/-
Change in repayment frequency Rs.1000/- for each instance
a) Remaining loan tenure is 12 months - 3% on principal outstanding
Pre-payment charges: b) Remaining loan tenure is 12-24 months-4% on principal outstanding
c) Remaining loan tenure is 24 months - 5% on principal outstanding
Bouncing charges per instance Maximum of Rs.750/-
Stamp duty As per state laws
Broken Period Interest (BPI) * At actuals
Loan cancellation and re-booking charges Rs.1000/-
Cross Sell Personal Loans:0 days to first EMI date
Tenure less than or equal to 12 months-3%,
Loan cancellation charges
Tenure between 12-24 months-4%,
Tenure greater than 24 months-5%+BPI(Broken Period Interest)
Penal Interest 3% per month on the unpaid EMI will be charged from the due date
Duplicate repayment schedule Rs.500/-
Cheque swapping charges Rs. 500/- per swap
Duplicate No due certificate / No objection certificate Rs.500/-
Legal, re-possession and incidental charges At actuals
Visit charges Rs.150/- per visit (applicable when collection executive visits customer place for
Service charges At actuals
Loan re-schedulement charges 3%
Rs.450/-
Mandate rejection service charges (Charges will be levied if new mandate form is not registered within 30 days from the date of
rejection of previous mandate form by Borrower’s bank for any reasons whatsoever.)

* Broken Period Interest (BPI) will be charged separately if applicable :

BPI is the interest charged up to the start of the EMI schedule, from the date of disbursement of the loan, which shall be paid by you separately in
advance. TVS Credit will deduct the same from the disbursement amount. The BPI value will be mentioned in the Welcome Letter provided to
you.
I confirm the receipt of 'TVS Credit Services Limited' Terms and conditions governing this loan

Received, Read & Understood

Name of the Borrower

Signature

This sanction letter is a system generated letter. No physical signature is required.

IP Address :47.11.210.154
Digitally signed using OTP (8387) sent to mobile number
OTP Time :2022-11-11 19:09:36
9733778191 and verified on 2022-11-11 19:10:36
Mobile No :9733778191
Latitude :23.6687395
Logitude :87.038847
 “FORM NO. 60 [See second proviso to rule 114B]
Form for declaration to be filed by an individual or a person (not being a company or firm) who does not have a permanent
account number and who enters into any transaction specified in rule 114B
1 First Name R A K E S H C H O U D H U 2 Date of Birth/ Incorporation of declarant

Middle Name D D M M Y Y Y Y

Surname 0 3 0 1 1 9 7 5

3 Father’s Name (in case of individual) First Name R A M E S H C H O U D H U R

Middle Name

Surname

4 Flat/ Room No. 5 Floor No.

6 Name of premises 7 Block Name/No.

RATIBATI RATIBATI CT BARDDHAMAN
8 Road/ Street/ Lane 9 Area/ Locality
ROTIBATI WEST BENGAL
10 Town/ City 11 District 12 State
Chelod B.O Bardhaman WB

13 Pin code 14 Telephone Number (with STD code) 15 Mobile Number

713339 9733778191

16 Amount of transaction (Rs.) 1 1 0 0 0 0 In case of transaction in joint

18 names, number of persons
17 Date of transaction 1 1 1 1 2 0 2 2 involved in the transaction
19 Mode of transaction: Cash Cheque, Card, Draft/Banker’s Cheque, Online transfer, Other
Aadhaar Number issued by UIDAI
20
(if available)

If applied for PAN and it is not yet generated enter D D M M Y Y Y Y

21
date of application and acknowledgement number

If PAN not applied, fill estimated total income (including income of spouse, minor child etc. as per section 64 of Income-tax Act, 1961)
22
for the financial year in which the above transaction is held
a Agricultural income (Rs.)

b Other than agricultural income (Rs.) 2 5 0 0 0

Details of document being produced in Document code Document identification Name and address of the authority issuing the
23 support of identify in Column 1 (Refer number document
instruction overleaf) 01 ********5292 Unique Identification Authority of India

Details of document being produced in Document code Document identification Name and address of the authority issuing the
24 support of address in Columns 4 to 13 number document
(Refer Instruction overleaf) 16

Verification
RAKESH CHOUDHURY
I, _______________________________________________ do hereby declare that what is stated above is true to the best of my knowledge
and belief. I further declare that I do not have a Permanent Account Number and my/ our estimated total income (including income of spouse,
minor child etc. as per section 64 of Income-tax Act, 1961) computed in accordance with the provisions of Income-tax Act, 1961 for the
financial year in which the above transaction is held will be less than maximum amount not chargeable to tax.
Verified today, the ______________
11 NOVEMBER 20_____
day of ______________ 22
Place: Bardhaman
(Signature of declarant)
Note:
1. Before signing the declaration, the declarant should satisfy himself that the information furnished in this form is true, correct and complete
in all respects. Any person making a false statement in the declaration shall be liable to prosecution under section 277 of the Incometax
Act, 1961 and on conviction be punishable,-
(i) in a case where tax sought to be evaded exceeds twentyfive lakh rupees, with rigorous imprisonment which shall not be less than six
months but which may extend to seven years and with fine;
(ii) in any other case, with rigorous imprisonment which shall not be less than three months but which may extend to two years and with
fine.
2. The person accepting the declaration shall not accept the declaration where the amount of income of the nature referred to in item 22b
exceeds the maximum amount which is not chargeable to tax, unless PAN is applied for and column 21 is duly filled.

IP Address :47.11.210.154
Digitally signed using OTP (8387) sent to mobile number
OTP Time :2022-11-11 19:09:36
9733778191 and verified on 2022-11-11 19:10:36
Mobile No :9733778191
Latitude :23.6687395
Logitude :87.038847
 Kotak Group Assure (UIN :107N051V03) Kotak Complete Cover Group (UIN :107N018V05)
Kotak Group Sheild (UIN :107N050V03)
Membership Form cum Declaration of Good Health
IMPORTANT NOTE : Any additional text written or qualification given in the form would make it invalid.
Policy Number : GA000017, GA000133, GA000239, GA000244, GA000333, GA000286,
Name of the Policyholder : TVS Credit Services Limited GA000391, GA000392, GA000393,GA000186, CC000057/CD000098

PLAN DETAILS :
Sum Assured( ): Premium( ): Cover Term : 2Y/3Y/4Y/5Y Plan Option : Easy Group Shield Easy Group Assure
Premium Payment Term : Single Pay Limited Pay Regular Premium Premium Payment Mode : Single Yearly Half Yearly Quarterly Monthly
Cover Type : Single Life Joint Life Interest Rate : Benefit Multiplier : 100% 110% 120% Moratorium Period :
LIFE ASSURED'S DETAILS
Loan Account No : 3078CP0046344 Customer ID :

Member Name : Mr. / Ms RAKESH CHOUDHURY Date of Birth : 03/01/1975

Address : RATIBATI RATIBATI CT BARDDHAMAN ROTIBATI WEST BENGAL Gender : M F

Name of Joint Life Insured ( If any) : Mr. / Ms.
Date of Birth : Gender : M F Relationship with Member :

NOMINEE DETAILS (needs to be a major i.e. above 18 years of age and should be one of the following: Husband, Wife, Son, Daughter, Father, Mother, Brother, Sister, Grandfather or Grandmother.)
Name : MAMTA KUMARI

Relationship to Life to be Insured : Wife

* Incase of Nominee being a Proprietor/Partnership Firm/Limited Company the above condition would not apply.
Do yout bit for green world & Switch to e-communication. Kindly ( ) if you would like to receive your communication only through electronic mode

DECLARATION OF GOOD HEALTH

I hereby declare that :
1. I am in good health and perform all my routine activities independently
2. I have never had any physical defect, deformity or disability (means inability to function normally, physically or mentally) affecting my day to day activities.
3. I have never undergone nor have I been advised to undergo any major surgical procedure.
4. I have never suffered and am not currently suffering from:
a) High Blood Pressure, Heart Attack or any other Heart Disease; b) Stroke, Paralysis in any form, or any other Cerebrovascular Disease;
c) Diabetes or any other Endocrinal Disease, Kidney Disease; d) Any Chronic Liver Disease or any Cancer or Cancerous growth;
e) Any Lung Disease (eg. Chronic Obstructive Pulmonary Diseases, TB, Parenchymal lung Disease, Pulmonary Embolism etc).
f) Blood Disorders, Gastro-Intestinal Diseases, or any other disorder of the bones, spine or muscle;
g) Any Mental or Psychiatric condition, Epilepsy, any Genetic Disease or any disease related to central nervous system (disease related to brain);
h) HIV / AIDS or AIDS related complications.
5. In the last 2 years, I have not –
a) Have a reduction in weight (of more than 10 kgs) b) been continuously hospitalised for more than 7 days (other than fractures of leg or arm).
c) undergone any investigations (including basic radiological and blood tests) other than normal Health Check-ups and Insurance Medicals, or
d) had adverse result for any blood tests, X-Rays, ECG, Stress Test, Biopsies, CT Scan, MRI, Ultrasonography or 2D / 3D Echo etc.
6. I do not engage or intend to engage in any business, sport or occupation or any hobby of a hazardous nature.
7. For Females Lives Only: a) I am currently not pregnant. I am not suffering from or nor have suffered from any complication of pregnancy.
b) I am not suffering from or nor have suffered from any diseases of breast/ uterus/ cervix?
Following questions are applicable ONLY for "Kotak Complete Cover Group Plan"
8. I have not had any proposal and / or policy for life, health, accident or critical illness, including renewals / revivals therefor, declined or deferred by any insurance company in India or Overseas.
I do not engage or intend to engage in any business, sport or occupation or any hobby of a hazardous nature.
9. I have never been diagnosed with any form of internal or external congenital anomaly or defect. i.e. any condition(s) which is present since birth, and which is abnormal with
reference to form, structure or position.
DECLARATION BY THE MEMBER
I further declare that the above statements are true and complete in every respect related to my health and will form the basis of granting insurance cover to me, from Kotak Mahindra Life Insurance Company
Ltd.[KLI]. I further hereby agree and give my consent to, the Policyholder for use of the contents of this declaration by KLI for examining and processing any claim arising, in respect of the insurance cover that
may be provided to me under the referred group policy.
I hereby confirm that my intent to participate in the above plan for the Policyholder's customers is purely on a voluntary basis, I confirm and I confirm and agree that the insurance cover, if provided, will be
governed by the provisions of the Insurance Act, 1938 and the Policy Contract under which the cover will be offered to me. I agree and understand that if I contract any of the above diseases between
submitting this document and the date of commencement of the cover, I shall not be covered under the policy. I have also not withheld any material information or suppressed any fact. I undertake to notify KLI
('The Company') of any change in my state of health or occupation or any decisions subsequent to the signing of this declaration form and before the acceptance of the risk by the Company. I understand and
agree that if any untrue statement be contained herein, I, my heirs, executors, administrators or assignees shall not be entitled to receive any benefits which may be provided to me on the faith of this
declaration, including, inter alia the aforesaid insurance cover. I understand and acknowledge that insurance cover shall be as per terms and conditions detailed in the Policy Contract issued by KLI in favour of
the policyholder and that KLI's decision in respect of all aspects of the referred group life insurance plan shall be final & binding. I hereby agree to and authorize the Policyholder / my Doctor / Hospital / Local,
State, Central authority / Dealer / Distributor /my Employer to divulge or convey any information or particulars relevant to this Form / my admission into the referred Group Insurance Policy to KLI at any point
during the continuance of my cover hereunder including any claim under the said Policy. I also permit KLI to approach me directly for any clarification related to this proposal and resulting policy I further agree
that in case of fraud / misrepresentation by me, the Policy will be treated in accordance with the Section 45 of the Insurance Act,1938 and amendments there to from time to time.
Place : Date : 11/11/2022 Signature/Right Thumb impressions of life to be insured
AUTHORISATION OF CLAIM PAYMENT (applicable only for Regulated Entities*)
I authorise KLI to apply the benefits under this policy, first towards the loan outstanding, by paying the same directly to the Policyholder and the balance, if any, may be paid to myself and/or my nominee/legal
heirs, as the case may be. I certify that this authorization is being effected in consideration of a loan obtained from the Policyholder. I further certify that the loan outstanding amount as confirmed by the
Policyholder shall be considered as final and binding. I declare that the receipt of the benefits by the Policyholder and/or my nominee/ legal heirs shall be a valid and sufficient discharge of KLI's liabilities with
respect to the life cover provided to me.
*Regulated Entities shall include: I. (a) Reserve Bank of India (“RBI”) regulated Scheduled Banks (including co-operative Banks), (b)NBFCs having Certificate of Registration from RBI or (c)National Housing
Bank (“NHB”) regulated Housing Finance Companies (d) National Minority Development Finance Corporation (NMDFC) and its State Channelizing Agencies (e) Small Finance Banks regulated by RBI; II.
Other Entities shall include the entities other than Regulated Entities.
Place : Date : 11/11/2022 Signature/Right Thumb impressions of life to be insured
DECLARATION WHERE SCRIBE IS INVOLVED (COMPULSORY FOR ALL DECLARATIONS SIGNED IN ANY VERNACULAR LANGUAGE)
I _________________________________________________________ (full name of scribe) have explained to the borrower the contents of this form in his own language and he/ she has fully understood the
same. Also, I have explained that if any untrue statement is contained herein, the borrower, and/or the heirs, executors, administrators, assignees of the borrower shall not be entitled to receive any benefits,
including, inter alia, benefits under any insurance policy procured on the faith of this Form.
Place : Date : Signature of the Scribe :

Place : Date : Witness / Policyholder Authorized Signatory :

Section 41 of the Insurance Act, 1938 states: (1) No person shall allow or offer to allow, either directly or indirectly, as an inducement to any person to take or renew or continue an insurance in respect of
any kind of risk relating to lives or property in India, any rebate of the whole or part of the commission payable or any rebate of the premium shown on the policy, nor shall any person taking out or renewing or
continuing a policy accept any rebate, except such rebate as may be allowed in accordance with the published prospectuses or tables of the insurer: (2) Any person making default in complying with the
provisions of this section shall be liable for a penalty which may extend to ten lakh rupees. Section 45 of the Insurance Act, 1938 States: The provisions of Section 45 of the Insurance Act, 1938 are
applicable in the above contract. Please refer to Section 45 either on our website or contact our intermediary or visit the nearest branch for the full text. Free Look Period : The member is offered 15 days free
look period from the date of receipt of the Certificate of Insurance wherein the Member may choose to return the Certificate of Insurance within 30 days of receipt if s/he is not agreeable with any of the terms
and conditions of the plan and receive the applicable refund amount.

Kotak Mahindra Life Insurance Company Ltd. (Formerly known as Kotak Mahindra Old Mutual Life Insurance Ltd.).; CIN : U66030MH2000PLC128503, Regn. No.: 107, Regd. Office: 2nd Floor, Plot# C-
12, G-Block, BKC, Bandra (E),Mumbai- 400 051. Website: http://insurance.kotak.com Email:clientservicedesk@kotak.com. Toll Free No.–1800 209 8800 Ref No.KLI /19-20/Mar-55
Trade Logo displayed above belongs to Kotak Mahindra Bank Limited and is used by Kotak Mahindra Life Insurance Company Ltd. under license.
Digitally signed using OTP (8387) sent to mobile number 9733778191 and verified on 2022-11-11 19:10:36