This Agreement is being electronically executed between L&T Finance Limited and the

LTFS Borrower as specified in the agreement. This Stamp Paper forms integral part of
the following agreement

Signature Not Verified

Signed by : DS L AND T FINANCE LIMITED
Reason : Loan Agreement
Date : 2022-11-25 17:55:28 IST
This Agreement is being electronically executed between L&T Finance Limited and the
LTFS Borrower as specified in the agreement. This Stamp Paper forms integral part of
the following agreement

Signature Not Verified

Signed by : DS L AND T FINANCE LIMITED
Reason : Loan Agreement
Date : 2022-11-25 17:55:28 IST
 Stamp Reference#78AB414093

THIS AGREEMENT is executed at the place and date mentined in the Schedule hereti BETWEEN

THE PERSON/S as more particularly described in the Schedule (hereinafter referred to as “the Borrower”)
AND L&T Finance Limited, a Non-Banking Finance Company registered with Reserve Bank of India and
incorporated under the Companies Act, 1956 having its registered office at 15th Floor, ‘PS SRIJAN Tech Park’,
Plot No 52, Block DN, Sector-V, Salt Lake City, Kolkata – 700 091, District 24-Parganas (North), India ,
hereinafter called “the Lender” (which term shall, unless excluded by or repugnant to the subject or context, be
deemed to mean and include its successors, affiliates and assigns)

WHEREAS:

A. The Lender is engaged in business of Loan and advances and the Borrower/s has/ have requested
the Lender to advance the Loan to the Borrower/s of the amounts specified in the Schedule attached
hereto and on the basis of confirmations of the Borrower, the Lender has agreed to grant; and
B. The parties hereto desire to record the terms and conditions in relation to the proposed loan and
certain other matters related thereto in the manner hereinafter contained.

NOW THIS AGREEMENT WITNESS as under:

1. Terms

1.1. Upon the representation and information provided by the Borrower in the application for the loan
made to the Lender, the Lender hereby agrees to lend to the Borrower the sum specified in the
Schedule hereto for the personal requirements of the Borrower, which loan is hereinafter referred to
as the "Loan".
1.2. This Agreement and the Schedule as signed by the Borrower and the Lender shall form one single
Agreement and shall be read in conjunction with each other.
1.3. This Agreement shall come to an end upon the Lender having, to its satisfaction, received all dues
and outstanding, and payments, required to be made by the Borrower to the Lender as per the terms
herein

2. Payment of Loan, Interest and Other Charges

2.1. The Lender grants to the Borrower upon the terms and subject to the conditions mentioned in this
Agreement, a Loan for the Loan Amount and for the Tenure as set out in the Schedule. The Borrower
shall pay to the Lender Interest on the Loan at the rate (“Internal Rate of Return”/ “IRR””) specified in
the Schedule. The Interest shall be calculated and payable from the disbursement date.
2.2. The mode of repayment of the Loan along with Interest and other charges shall be by the way of
ECS and/or other electronic mandates, the Borrower hereby authorizes the Lender to present the
ECS and/or other electronic mandates until the entire Loan Amount, outstanding under this
Agreement has been repaid in full
2.3. In the event of the Borrower making any default in payment of the Loan installments or any other
charges or monies due and payable by the Borrower to the Lender under this Agreement, the Lender
may at its discretion charge Additional Interest at the rate/s as specified in the schedule/s on such
defaulted amounts.
2.4. In the event of the due date being a bank holiday or otherwise a declared or undeclared non-working
day, the working day immediately preceding the due date shall be deemed to be the due date and
Borrower shall arrange to ensure that the Lender realizes the monies on such deemed due date.

3. Prepayment:

The Birriwer can prepay the Lian afer six (6) minths frim date if frst disbursement at the sile discretin if the
Signature Not Verified
Lender and may be subject ti cinditins, including payment if prepayment charges as specifed in Schedule hereti;
Signed by : DS L AND T FINANCE LIMITE
Reason : Loan Agreement
Date : 2022-11-25 17:55:28 IST
Stamp Reference#78AB414093

4. Part Prepayment

The Birriwer can make part prepayment if the Lian at any tme during tenure if the Lian. Hiwever, part prepayment
if the Lian can be made inly twice in a year and shall be maximum 25% if the remaining iutstanding principal
amiunt.

5. Deal Cancellation Charges:

In case the Birriwer cancels the Lian afer disbursement but befire frst installment if the Lian, the Lender may at its
discretin charge such amiunt as specifed in the schedule.

6. Borrower's Confirmation

The Birriwer hereby agrees, declares and cinfrms that:

6.1. The Birriwer's ibligatin ti pay all Lian installments, Interest and all ither charges & minies payable under
ir pursuant ti this Agreement, shall be absilute and uncinditinal.
6.2. The Birriwer shall bear all such impists, dutes and taxes (including interest and ither taxes if any) as may be
levied frim tme ti tme by the Givernment ir any ither authirity pertaining ti ir in respect if the said
Lian.
6.3. The Lender is at liberty ti furnish any partculars pertaining ti the Birriwer ti any statutiry authirity, ciurt
if law, credit ratng agencies and / ir any ither party in its nirmal ciurse if business.
6.4. The Birriwer is nit in default, ir breach if any if the terms if this Agreement and/ir any if the ither Lian
Dicuments; and ni Event if Default is subsistng, nir is there any event ir circumstance subsistng which
cinsttutes, ir is likely ti cinsttute an Event if Default and/ir a default under any dicument binding in the
Birriwer ir any if its assets.
6.5. The Birriwer shall furnish and create such security frim tme ti tme in favir if ir fir the beneft if the
Lender if such value, in such firm and in such manner, as may be deemed ft by the Lender, firthwith upin
being si required by the Lender. The Lender shall alsi have the right ti stpulate any ither and further terms
and cinditins that it may deem ft at any tme priir ti ir afer the grant if the Lian, which shall be binding
in the Birriwer.
6.6. The Lender shall in its sile discretin appripriate any minies paid by the Birriwer ti the Lender tiwards the
dues under this Agreement ir under any ither facilites availed by the Birriwer frim the Lender.
6.7. In the event if the Birriwer withhilding taxes in the interest as per any statute in firce at the tme if such
payment (TDS), the Birriwer shall furnish ti the Lender a certfcate if such TDS within 45 (Firty fve) days
frim the end if the quarter in which deductin is made. In case, if the Birriwer is nit depisitng tax
deducted ti the exchequer and/ir, afer depisitng, nit issuing TDS Certfcate ti the Lender within the
prescribed tmeline ir if the amiunt deducted is nit refected in Firm 26 AS, then the Lender reserves the
right ti reciver the said tax aling with interest as levied by Incime Tax Department ti the Lender.
6.8. The Birriwer hereby agrees that the Security PDC has been issued by the Birriwer in favir if the Lender and
may be used by the Lender in the event if default under this Lian ir any ither lian availed by the Birriwer
in future. In case there is an event if default under this Lian, priceedings under Sectin 138 if Negitable
instrument Act, 1881 can be initated against the Birriwer by the Lender basis the Security PDC issued by the
Birriwer in favir if the Lender fir the lian.

7. Events of Default

An event if default shall iccur hereunder, if the Birriwer:

Signature Not Verified

Signed by : DS L AND T FINANCE LIMITE
Reason : Loan Agreement
Date : 2022-11-25 17:55:28 IST
Stamp Reference#78AB414093

7.1. Fails to pay the Loan installments, Interest and all other monies payable or part thereof within the
stipulated time, whether demanded or not, or any other charge or payment required hereunder within
7 days of their becoming due;
7.2. Fails to perform or observe or carry out any other covenant, condition or agreement to be performed,
observed, or carried out by the Borrower hereunder or under any other document furnished to the
Lender in connection herewith, and such failure or breach continues unremedied for a period of 14
days after written notice is sent to the Borrower;
7.3. Shall commit an act of bankruptcy or becomes insolvent or bankrupt or make an assignment for the
benefit of creditors, or consents to the appointment of a Trustee or a Receiver, or either a Trustee or
Receiver shall be appointed for the Borrower or for a substantial part of Borrower's property without
the Lender's consent, or if bankruptcy, reorganization, insolvency shall be instituted by or against the
Borrower, voluntarily or otherwise;
7.4. Shall do or take such steps as to cause an adverse material change in its own acts or otherwise, and
as a result thereof, the capacity of the Borrower to service the Loan Installments, Interest and other
charges and monies payable under this Agreement, in the opinion of the Lender, stands jeopardized;
7.5. Shall be in default under any other subsisting agreement executed with the Lender or any other Bank
or any other Financial Institution and such default has not been remedied or rectified to the
satisfaction of the Lender.
7.6. Makes or is deemed to have made any representation or warranty in or pursuant to this Agreement
and such representation or warranty is or proves to have been incorrect in any material particular or
in any material respect or leads to the inference that there has been misinformation supplied by the
Borrower or concealment of necessary or essential information by the Borrower based on which the
Lender has been prompted to act and enter into this Agreement.

8. Consequences in the event of default

8.1. On the occurrence of any of the events specified above, without any notice to the Borrower, the
Lender shall have right to: Terminate this Loan agreement forthwith
8.2. Recover from the Borrower the arrears of monies due and unpaid up to the date of termination and
such other future installments for the unexpired period, had this agreement continued
8.3. Initiate legal action as available under applicable laws
8.4. Give suitable publicity and such particulars of the Borrower as the Lender may deem fit

9. Securitization & Assignment

The Lender shall have absilute discretin, piwer and authirity ti assign, sell ir transfer in any manner, in while ir in
part, and in such manner and in such terms, as the Lender may decide, including reserving a right ti the Lender ti
retain its piwer hereunder ti priceed against the Birriwer and/ir Guarantir in behalf if the purchaser, assignee,
transferee, any ir all iutstanding and dues if the Birriwer, ti any third party if the Lender’s chiice withiut reference
ti ir withiut writen intmatin ti the Birriwer and/ir Guarantir. Any such actin and any such sale, assignment ir
transfer shall bind the Birriwer and Guarantir ti accept such third party as creditir exclusively ir as a jiint creditir
with the Lender ir a creditir exclusively with a right ti the Lender ti cintnue ti exercise all piwer hereunder in
behalf if such third party and ti pay iver such iutstandings and dues ti such third party and/ ir ti the Lender, as the
Lender may direct. The third party shall have the authirity if the Lender ti cillect the dues. Such securitiatin shall
nit in any way impinge upin any ither rights if the Lender ir the Birriwer and shall nit add any additinal liability ir
fnancial burden in the Birriwer than itherwise privided by the terms if this Agreement. The Birriwer hereby
agrees ti execute necessary dicuments ti facilitate the said assignment, transfer and sale by the Lender.

10. Arbitration

Any questin dispute ir diference that arises between partes ir any if them tiuching ir cincerning this agreement ir
any cinditin herein cintained ir as ti the rights, dutes ir liabilites if partes hereti ir any if them either during the
cintnuance if the agreement ir afer terminatin ir purpirted terminatin hereif shall be referred ti the sile
Arbitratir ti be appiinted by the Lender, accirding ti the privisiins if Arbitratin & Cinciliatin Act, 1996 and rules
thereunder and any amendment thereti frim tme ti tme shall apply. The award if the arbitratir shall be fnal,
cinclusive and binding in all the partes, and all the partes undertake ti carry iut the award immediately withiut any
delay. The venue if the arbitratin shall be Kilkata ir any such place as the Lender may at its discretin decides.
Signature Not Verified
Signed by : DS L AND T FINANCE LIMITE
Reason : Loan Agreement
Date : 2022-11-25 17:55:28 IST
Stamp Reference#78AB414093

11. Jurisdiction

This agreement shall be giverned by and cinstrued in all respects with the Indian laws and the partes hereti agree
that any mater ir issue arising hereunder ir any dispute hereunder shall be subject ti the exclusive jurisdictin if the
ciurts at Kilkata ir any such place as the Lender may at its discretin decides.

12. Indemnity

The Birriwer shall indemnify the Lender and shall always keep the Lender indemnifed, safe And harmless in respect if
any actins, claims, cists, damages, demands, expenses, lisses and liabilites made against, sufered ir incurred by the
Lender arising directly ir indirectly frim ir in cinnectin with–

12.1. Any failure by the Borrower to comply with the provisions of this Agreement and/or;
12.2. Any liability including third party liability and/or;
12.3. Any claims, losses, demands, actions, costs, expenses and liabilities incurred or suffered by the
Lender by reason of the representations and warranties given by the Borrower being false or untrue
in any material respect

13. Miscellaneous

13.1. Notices - Any communication/notice/letter/document/statement to be sent by the Lender to the

Borrower shall be in English and can be sent through the SMS, WhatsApp, Email Address of the
Borrower, details of which are provided in the Schedule of this Agreement. In the event the Borrower
does not have an Email Address, the B o r r o w e r ma y v i s i t t he n e a r e s t b r a n c h o f f i c e of th e
L e n d e r f o r s u ch communication/notice/letter/document or statement. Further if the Borrower
requests for any information, the same will be provided to the Borrower’s Email address or contact
details as mentioned the Schedule hereunder or the Borrower will be informed to visit the branch.
Any change in the Email Address shall be duly notified by the Borrower to the Lender within 7
(seven) days of such change.
Any communication/notice/letter/document to be sent by the Borrower to the Lender shall be in
English and sent to the Email Address of the Lender or visit the nearest branch office of the Lender.
The Lender shall also have the right to communicate any change in the terms and conditions to
this Agreement by SMS at the mobile number provided by the Borrower. Any change in the
mobile number of the Borrower shall be intimated by the Borrower to the Lender. The Lender
hereby confirms that any change in the Interest Rate and charges will be effected only prospectively.
13.2. The Borrower agrees that the Lender can contact the Borrower as per Telecom Regulatory
Authority of India (TRAI) guidelines for service related promotions in anytime in future.
13.3. The parties hereby acknowledge and agree for the electronic execution of this Agreement, using
Aadhaar Based Electronic Signature. The parties hereby further irrevocably agree and undertake that
that this electronically executed Agreement is legally binding and enforceable upon the parties and
the validity of this Agreement shall not be challenged on any ground(s) whatsoever, including its
mode of execution being electronic in nature
13.4. Notwithstanding anything contained in this, the Lender reserves the right, without
assuming any liability and without any prior notice, to unconditionally revoke, cancel, alter, modify or
change, at any time the Loan sanctioned / commitments made at its sole discretion for any reason
whatsoever.
13.5. The Schedules atached herewith shall be deemed ti be part if the Agreement as in the privisiins thereif
were set iut herein in extensiin.
13.6. Any amendment(s), midifcatin(s), revisiin(s) , he Agreement, Schedule(s), thereti, dicuments and
cillateral dicuments shall be in writng, which writng shall firm an integral part this Agreement withiut the
need ti enter inti any supplementary agreement.
13.7. The Birriwer undertakes ti furnish ti the Lender, any such infirmatin called fir by the Lender during the
pendency if the Lian and shall nit in any way keep the same in abeyance. The Birriwer agrees that it shall
be discretinary in the part if the Lender ti cinsider such nin-furnishing if infirmatin ti be an Event if
Default in part if the Birriwer.
13.8. Nitwithstanding any ither privisiins if this Agreement and any rights available ti the Lender under the
applicable laws, Lenders in cimpliance with RBI’s Clarifcatin in Prudental nirms in Incime Recignitin,
Asset Classifcatin and Privisiining pertaining ti Advances dated Nivember 12, 2021 as amended frim
tme ti tme and /ir as required/ directed by RBI (IRBI IRACP Norms”), shall classify and nitfy the Facility as
an iverdue acciunt under day-end pricesses in the Due Date as per Lender’s internal pricesses.
13.9. Additinally, subject ti the RBI IRACP Nirms and applicable laws, Lender(s) shall classify the Facility as SMA ir
NPA in the relevant Due Date in accirdance with the day-end pricess filliwed by the Lender(s).Signature The SMA irVerified
Not
Signed by : DS L AND T FINANCE LIMITE
Reason : Loan Agreement
Date : 2022-11-25 17:55:28 IST
Stamp Reference#78AB414093

NPA classifcatin date and asset classifcatin status if the Facility shall be as in the date if the Lender(s)
day-end pricess fir the said Facility.
13.10. Fir the purpise if clarity statng beliw an example:
If the due date if a lian acciunt is March 31, 2021, and full dues are nit received befire the lending
insttutin runs the day-end pricess fir this date, the date if iverdue shall be March 31, 2021. If it cintnues
ti remain iverdue, then this acciunt shall get tagged as SMA-1 upin running the day-end pricess in April
30, 2021 i.e. upin cimpletin if 30 days if being cintnuiusly iverdue. Accirdingly, the date if SMA-1
classifcatin fir that acciunt shall be April 30, 2021. Similarly, if the acciunt cintnues ti remain iverdue, it
shall get tagged as SMA- 2 upin running day-end pricess in May 30, 2021 and if it cintnues ti remain
iverdue further, it shall get classifed as NPA upin running day-end pricess in June 29, 2021."

14. Covenants on Environmental, Social and Governance (ESG) practces b the Borrower

14.1 The Birriwer agrees and undertakes ti act, ti the extent and as applicable, in cimpliance and cinsistent with
the ILTFS Cide if Cinduct” as may be amended frim tme ti tme by LTFS as privided in the ifcial website if
LTFS (www.lts.cim) in the manner and ti the satsfactin if LTFS, and applicable laws if the jurisdictin if the
Birriwer.

14.2 The Birriwer understands that cimpliance as privided under this clause is essental ti the terms if the
Facility granted by the Lender.

IN WITNESS WHEREOF, the Borrowers and Co-Borrowers hereby set their hands to digitally
execute these presents the day and year first hereinabove written.

SCHEDULE

Loan Agreement Date & Place : 2022-11-25 17:54:18 Dhing

15th Fliir, ‘PS SRIJAN Tech Park’, Plit Ni 52, Blick DN, Sectir-V, Salt
Address of the Lender :
Lake City, Kilkata – 700 091, District 24-Parganas (Nirth)

Name of the Borrower : A dul Malek

VILL./TOWN- DONGAR PAR P.S.- MOIRABARI, SUB-DIVN-

Address of the Borrower :
MORIGAON 782126 Dhing Assam

Email Address of the Borrower : mujaharulislam967@gmail.com

Consttuton of the Borrower : Individual

Loan Amount (In fgures) : Rs.83450

Loan Amount (In words) : Rs.Eightb Three Thousand Four Hundred Fifb Rupees Onlb

Tenure (in months) : 18 Months

EMI Amount (In fgures) : Rs.5206.00

EMI Amount (In words) : Rs.Five Thousand Two Hundred Six Rupees Onlb Onlb

1st Estmated EMI Date : 2023-01-03

Processing Fee : 0.00 Signature Not Verified

Signed by : DS L AND T FINANCE LIMITE
Reason : Loan Agreement
Date : 2022-11-25 17:55:28 IST
Stamp Reference#78AB414093

CLI Amount : Rs.940.00

Hospicash Amount : Rs. 450.00

BPC Amount : Rs.560.00

Mode of Repabment : Aadhar Mandate

Rate of Interest
: 15.00% p.a.
(Reducing balance basis)

Pabment Terms : Arrears Monthlb

Installments : Equated

ECS Bounce Charges : Rs. 350/- + GST

Additonal Interest : 3% of the EMI per month

Prepabment Charges : 5% of principal outstanding + GST

Exact Due Date for Repabment of

As per the Repabment Schedule elow
Loan

Frequencb of Repabment As per the Repabment Schedule elow

Breakup etween Principal and

As per the Repabment Schedule elow
Interest

More partcularlb mentoned under “Classifcaton of Assets” under

Example of SMA/NPA Classifcaton
the head “Miscellaneous”

The exact date of commencement of

repabment of Loans with As per the Repabment Schedule elow
moratorium facilitb

ANNEXURE

Installment No. Installment Date Installment Amount Principal Amount Interest Amount

This Repayment Schedule is only indicatie in natuuee The fnal Repayment Schedule shall be shaued with the Bouuoweu
at a lateu stagee

*The fust due date and last due date may change based on uepayment schedulee EMI due date may iauy by OneTTwo
months post disbuusemente

**For Consumer Loans, all repayment mandates collected are Image Based Mandates.

Signature Not Verified

Signed by : DS L AND T FINANCE LIMITE
Reason : Loan Agreement
Date : 2022-11-25 17:55:28 IST
Underwritten
by
Stamp Reference#78AB414093

Application Form - ‘Group Care 360° Scheme’

Scheme for Scheme for L&T Finance Limited Loan Customers)

To be flled by Applicant in CAPITAL LETTERS only. Use Black ink

For Office Use Onlb

Acciunt Number : 0033201700129585 Tital Premium (Incl. GST) : 940.00

Transactin ID : Date if Transactin :
_________________________ Lian Acciunt Number : C022112302017180
Branch Name : PUNJAB NATIONAL BANK Branch Cide :
CHIL Intermediary Name : CHIL Intermediary Cide:
Lian Tenure : 18 (minths) Lian Type :: _

Proposer Details

Mr./Ms.

Name : Abdul Malek

Address :VILL./TOWN- DONGAR PAR

P.S.- MOIRABARI, SUB-DIVN- MORIGAON

State : Assam City : Dhing

Pin Cide : 782126

Date if Birth : ________1966-11-06_____________________________ Mibile : 8876020526

Landline : Alternatve Number :

E-mail : mujaharulislam967@gmail.cim

AADHAR Ni. :

Signature Not Verified

Signed by : DS L AND T FINANCE LIMITE
Reason : Loan Agreement
Date : 2022-11-25 17:55:28 IST
Stamp Reference#78AB414093

Marital Status : Incime:

Mither’s Maiden Name :

Nominee Details

Name : Mujaharul islam

Date if Birth : 02/Jan/1994 Relatinship with Pripiser : SON

Appiintee Name : Appiintee DOB : __________________________________

(Only where the Niminee is if age 18 years ir less)

Care Health Insurance Limited (Firmerly Religare Health Insurance Cimpany Limited) Registered Ofce: 5th Fliir, 19 Chawla
Hiuse,Nehru Place,
New Delhi-110019 Cirresp. Ofce: Unit Ni. 604 - 607, 6th Fliir, Tiwer C, Unitech Cyber Park, Sectir-39, Gurugram-122001
(Haryana)
Website: www.careinsurance.cim E-mail: custimerfrst@careinsurance.cim Call us: 1800-102-4488
CIN: U66000DL2007PLC161503 UIN: RHIHLGP20126V011920 IRDAI Registratin Ni. - 148

In the event if death if the applicant any payment due under the Certfcate if Insurance shall becime payable ti the niminee
pripised in this
firm. The receipt if the priceeds by the niminee wiuld be sufcient discharge ti the Care Health Insurance Limited (Insurer).
Niminee fir all
ither persin(s) pripised ti be insured shall be the applicant himself.

Details of the Person to e Insured (Including Applicant)

Name Date if Birth Gender Relatinship with

:Abdul Malek 1966-11-06 Male SELF

Plan Optons

Sum Insured : 80000.00 Premium Including GST: 940.00 Tenure: __18(minths)____________________

Declaraton

I hereby declare that:-

All pripised members are in giid health and entrely free frim any mental ir physical impairments ir defirmites,
disease/cinditin. Nine if
the pripised members are habitual cinsumer if alcihil, tibacci, gutka ir any recreatinal drugs.
Ni pripised member is invilved in any haiardius actvity, iperatng heavy machinery, handling haiardius material, wirking at
heights /
Signature Not Verified
Signed by : DS L AND T FINANCE LIMITE
Reason : Loan Agreement
Date : 2022-11-25 17:55:28 IST
Stamp Reference#78AB414093

undergriund / cinstructin sites, iil rigging, near high viltage, high temperature, wirking in aircrafs ir sea-giing vessels, armed
firces ir
partcipate in adventure spirts/actvites.

Yes Ni

Date :23/Niv/2022 Place :Dhing Signature : __________

For Claims & Refund Purpose

I/We hereby authiriie Care Health Insurance Limited ti pay directly ti L&T Finance Limited, tiwards my iutstanding dues fir
EMI Pritectin Beneft subject ti the maximum limit as per Plan Opted against the lian birriwed vide lian acciunt ni. frim L&T
Finance Limited iut if the claim priceeds ir premium refunds under the pilicy issued by Care Health Insurance Limited in my/iur
name.

Care Health Insurance Limited (Firmerly Religare Health Insurance Cimpany Limited) Registered Ofce: 5th Fliir, 19 Chawla
Hiuse,Nehru Place,
New Delhi-110019 Cirresp. Ofce: Unit Ni. 604 - 607, 6th Fliir, Tiwer C, Unitech Cyber Park, Sectir-39, Gurugram-122001
(Haryana)
Website: www.careinsurance.cim E-mail: custimerfrst@careinsurance.cim Call us: 1800-102-4488
CIN: U66000DL2007PLC161503 UIN: RHIHLGP20126V011920 IRDAI Registratin Ni. - 148

Signature Not Verified

Signed by : DS L AND T FINANCE LIMITE
Reason : Loan Agreement
Date : 2022-11-25 17:55:28 IST
 Stamp Reference#78AB414093

HDFC ERGO General Insurance Company Limited

Sarv Suraksha Plus (Group) Enrollment Form for Personal Loan customers of L&T Finance

(All fields are mandatory and fill in CAPITALS only)

PROPOSER DETAILS

Proposer Mr./ Ms. /Mrs. _Abdul Malek__

(First Name) (Middle Name) (Last Name)

Address: ___VILL./TOWN- DONGAR PAR P.S.- MOIRABARI, SUB-DIVN- MORIGAON_________

City: ___Dhing______________________ Pincode: __782126______________________ Gender: ___Male___
State: ______________________________________________________________________________________________ Date of Birth: 1966-11-06____
Tel.(Resi.) __________________________________________ (Off.): _____________________________________ Mobile No. ____8876020526___
E-mail: _____mujaharulislam967@gmail.com____________ Occupation Salaried / Self employed _______________
Income Details Annual Income (in Rs) _______________________________________________________________________________________________________

NOMINEE DETAILS

Name of Nominee: ______Mujaharul islam_____________________________

Relationship ______________________________________________________ Date of Birth: __02/Jan/1994___________________
Tel.(Resi.) ____________________________________________ (Off.): _______________________________________ Mobile No. ________________________
Amount of insurance accepted ________________________________________________________Relation with proposer will be applicant _SON __________________________________

Period of Insurance : 18 Months Loan Account Number: ___ C022112302017180_______________________________________________________________________

COVERAGE DETAILS
t
Policy Period - From – Risk inception date will be premium received date, To – will be based calculated as per Period of Insurance
Coverage Sum Insured/ Sum Insured Limits Sum Insured
Hospital Cash - Accident only INR 1250.00 per Day for 30 Days
Hospital Cash - Illness only INR 1250.00 per Day for 30 Days
Optional Cover – Hospital Cash –illness only
Waiting Period modification Option – 30 Days 0 Years
Waiting Period modification Option – 2 Years 0 Years
Waiting Period modification Option – 4 Years 0 Years

PREMIUM OPTION

I propose to opt for Sarv Suraksha Plus (Group) cover from HDFC ERGO General Insurance Company Limited for the tenure of 18 Months, the premium amount for which is Rs 450.00 (inclusive of GST).

TERMS AND CONDITIONS

Declaration & Warranty on behalf of all Persons proposed to be insured: I/Weherebydeclareonmybehalfandonbehalfofallpersonsproposedtobeinsuredthattheabovestatementsaretrueandcompleteinallrespects to the best of my knowledge and that I/We am/are
authorized to propose on behalf of these otherpersons.I understand that the information provided by me willform the basis of insurance policy,is subject to the Board approved under writing policy of the Insurance company and that the policy will come into force
only after full receipt to the premiumchargeable. I/WefurtherdeclarethatI/Wewillnotifyinwritinganychangeoccurring in the occupationorgeneralhealthofthelifetobeinsured/proposerafterthe proposal has been submitted but before communication of the risk acceptance
by thecompany. I/Wedeclareandfurtherconsenttothecompany.Seekingmedicalinformationfrom any hospitalwhoatanytimehasattendedon thelifetobeinsured/proposeror from any past or present employer concerning anything which affects the physical and
mentalhealthof the lifeto be assured/proposerand seeking information fromanyinsurance company to whichan app licationorinsurance on the life to be assured/proposer has been made for the purpose of underwriting the proposal and /or claim settlement.
I/Weauthorizethecompanytoshareinformationpertainin g tomyproposalincluding the medicalrecordsforthesole purposeofproposalunderwriting and/ or claimssettlement and with any Governmental and/or RegulatoryAuthority.Note:The liab ility of
thecompanydo esn ot commence untilthe acceptance of the proposal has been formally intimatedby theinsured andfull premium has been realized by the company. We are under no obligation to accept any proposal for insurance. TheProposeragrees that the
receipt of theProposal Form by HDFC ERGO General Insurance Company Limited along withthepremium paymentdoes nottantamount to the acceptance of the Proposal for insurance by HDFC ERGO General Insurance Company Limited and does not result in a
concluded contract of insurance. The acceptance of the Proposal for insurance shall be at theCompany’ssoleandabsolutediscretionanduponfullrealizationofthepremiumpayment. IntheeventofacceptanceoftheProposalforinsuranceby HDFC ERGO General
Insurance Company Limited, such acceptance shall be specifically intimated to the Proposer by HDFC ERGO General Insurance Company Limited along with the date from which the insurance Cover shall become effective. HDFC ERGO General Insurance
Company Limited shall not be liable for any claim in respect of an event giving rise to a claim covered under the Policy of Insurance that has occurred prior to policy issuance is not covered under this policy (Your proposal form will be considered after HDFCERGO
General Insurance CompanyLimited receives premium payment.)
Fraud Warning: This policy shall be voidable at the option of the Company in the event of mis-representation, mis-description or non-disclosure of any material particulars by the Proposer. Any person who, knowingly and with intent to fraud the insurance
company or any other person, files a proposal for insurance containing any false information, or conceals or the purpose of misleading, Information concerning any fact material thereto, commits a fraudulent insurance act, which will render the policy voidable at
the sole discretion of the insurance company and result in a denial of insurance benefits.
Anti-Rebating Warning: As per Section41oftheInsuranceAct1938,asamended,the practice of rebating is prohibited, as follows: No person shall allow or offer to allow, either directly or indirectly, as an inducement to any person to take out or renew or continue
an insurance policy in respect to any kind of risk relating to live s rpropertyinIndia,anyrebateofthewholeorpartofthecommissionpayableoranyrebateofthepremiumshownonthe policy, nor shall any person taking out or renewing or continuing a policy acceptance
rebate, except such rebate as may be allowed in accordance with the published prospectus or tables of the insurer. Violation of Section 41 of the Insurance Act 1938, as amended, shall be punishable with a fine which may extend to Rs.10 Lakhs.

Place: _Dhing______________________ Date: ____23/Nov/2022___________ Signature: ___________________________

AGENT’S DECLARATION

I,_______________________________________________________________(Full Name) in my capacity as an Insurance Advisor/ Specified Person of the Corporate Agent/Authorized employee of the Broker/Relationship Officer, do
hereby declare that I have explained all the contents of this Proposal Form, Including the nature of the questions contained in this Proposal Form to the Proposer including statement(s), information and response(s) submitted by him/her in
this Proposal Form to questions contained herein or any details sought here in will form the basis of the Contract of Insurance between the Company and the Proposer, if this Proposal is accepted by the Company for issuance of the Policy. I
have further explained that if any untrue statement(s)/ information/response(s) is/are contained in this Proposal Form/ including addendum(s), affidavits, statements, submissions, furnished/ to be furnished, the company shall have the right to
vary the benefits which may be payable and further more if there has been a non-disclosure of any material fact, the policy issued to his/her favor pursuant to this Proposal may be treated by the Company as null and void and all premiums
paid under the Policy may be forfeited to the company. License No. (Advisor/Corporate Agent/Broker/Relationship Officer)

Place: ______((cityCurrent)___________ Date:______ 23/Nov/2022______ Signature of the Proposer:___________________________________

Signature Not Verified

Signed by : DS L AND T FINANCE LIMITE
Reason : Loan Agreement
Date : 2022-11-25 17:55:28 IST
 Stamp Reference#78AB414093

ACKNOWLEDEGEMENT – CUSTOMER COPY

Ms. / Mrs. __________________________________________________________________________________________Cheque No: ____________ Dated ________ Drawn on ___________Bank for a sum of Rs. ___________________
towards payment of premium on behalf of HDFC ERGO General Insurance Company Ltd.

Neither the submission to us of a completed proposal for insurance nor any payment for any policy sought obliges us to agree to issue a policy, which decision is and always shall be in our sole and absolute discretion. If we accept a proposal
for insurance, it shall be subject to the policy terms and conditions and we shall have no liability to make any payment if premium is not received by us in full and in time, or is not realized. If we do not accept the proposal, we will inform you
and refund any payment received from you without interest within next 15 days

Date___23/Nov/2022____________ Signature & seal _____________________

Group TakeCare Insurance - Enrollment Form

Proposer Information
Proposer Name Abdul Malek
VILL./TOWN- DONGAR PAR P.S.- MOIRABARI, SUB-DIVN- MORIGAON 782126 Dhing
Address with Pin Code
Assam

Mobile No. 8876020526 Email ID mujaharulislam967@g

mail.com
Date of Birth 1966-11-06 Gender Male
Nominee Name Mujaharul islam Relationship with Insured SELF
Aadhaar Number PAN

Insured Information
Insured
#1 Insured #2
Abdul
Insured name Malek Mujaharul islam
1966-11-
DOB 06 02/Jan/1994
Gender Male
Relationship with Proposer SELF SON

Date from which the policyholder has been continuously obtaining health
insurance cover in India without break

Risk Details
Period of Insurance: From (DD/MM/YYYY) To Midnight (DD/MM/YYYY)
Does the individual proposed to be insured form part of one Group or Association or Corporate body? Yes /No

Coverage Details
Features, Benefts, EEclusions and Claim process
Tele-consultation: 12 per year, pharmacy: INR 750 per year, Health check-up for 2 members
Features
per year, emergency assistance: Unlimited per year, Face Scan: Unlimited per year
MaEimum Days
Member Cover Self+1 NA
covered
Age Policy Tenure 2 years
Pre EEisting Covered
Waiting period 10 days
Disease from Day1

EEclusions (Please refer to Policy wordings for detailed eEclusions)

Claims to be availed in cashless mode through IL TakeCare app only. Downloading the app is
mandatory.
Claims Process
Please note: There shall be no carry forwarding of left sum insured for the next year

Policy Tenure : 2
Premium eEcluding GST INR 1271/- Premium including GST INR 1500/-
Yr

1. I/We hereby give my/our consent to enrol me/us into Group TakeCare Insurance policy underwritten by ICICI
Lombard General Insurance Co. Ltd. (IRDA Reg No 115) Signature Not Verified
Signed by : DS L AND T FINANCE LIMITE
Reason : Loan Agreement
Date : 2022-11-25 17:55:28 IST
Stamp Reference#78AB414093

2. I/We agree to abide by the Terms & Conditions of the policy and provide my consent to share my personal
details, as required, regarding my enrolment into the policy with the Insurer
3. I/We, hereby declare that I/We have read all the Features, Benefts, Exclusions and Claim Process of Group
TakeCare Insurance product and would like to voluntarily opt for the same
4. I/We, the undersigned hereby declare that the above statements and particulars are true, accurate and
complete and I/We declare and agree that this declaration and the answers given above shall be held to be
promissory and shall be the basis of the contract between me/us and the Insurance Company
5. I hereby confrm that the premium towards my insurance cover will not be borne by any third party entity /
person(s), with the exception of my spouse, parents, children, siblings or employer

Insured Signature: Date: 23/Nov/2022

Insured Name: Abdul Malek Place: Dhing

Disclaimer: This is a group product and the benefts opted are as chosen by the group administrator for its
members

Key Fact Statement

(i) Loan amount Rs. 83450

(ii) Total interest charge during the entire tenure of the loan Rs. 10258.00
(iii) Other up-front charges
Rs. 3450.00
(a) Processing fees Rs. 0.00
(b) Insurance charges Rs. 2890.00
(c) Others (if any) Rs. 560.00
(iv) Net to be disbursed amount
Rs. 80000.00
(v) Total amount to be paid by the borrower
Rs. 93708.00
Annualized Percentage Rate - Effective annualized interest
(vi)
rate
9.02%
(vii) Tenor of the Loan (in months/days) 18 Months
(viii) Repayment frequency by the borrower Monthly
(ix) Number of instalments of repayment 18
(x) Amount of each instalment of repayment Rs. 5206.00
Details about contingent charges
Rate of annualized penal charges in case of delayed
(xi)
payments (if any) 36%
(xii) Rate of annualized other penal charges (if any) NA
Other disclosures
Cooling-off/ look-up period during which Borrower shall
(xiii) 3 days
not be charged any penalty on prepayment of loan
Details of LSP acting as recovery agent and authorized to
(xii) To be provided when loan default occurs
approach the borrower

Name, designation, address and phone number of nodal Cintact Ni: +91 7264888777
(xiii) grievance redressal officer designated specifically to deal Email id: custimercare@lts.cim
with FinTech/ digital lending related complaints/ issues htps://www.lts.cim/grievance-redressal.html

Signature Not Verified

Signed by : DS L AND T FINANCE LIMITE
Reason : Loan Agreement
Date : 2022-11-25 17:55:28 IST