2/6/24, 6:41 PM Consumer Finance Application Form

BAJAJ FINANCE LIMITED ("BFL") - Consumer Finance Application Form

Application Form No. : A100236458
CKYC No/KIN :
Deal ID : A100236458
Customer ID :
Date : 06/02/2024

PERSONAL DETAILS

Name of the Applicant : Selladurai Muthusamy

Father's/ Spouse's name : Muthusamy
Mother's Name : Vellayammal
Date of Birth : 1975-02-11
Gender : Male
Marital Status : Married
Nationality : Indian
Monthly Income : Rs 15000-25000
PAN or Form 60 (in case PAN is : SAJPS3065J
not allotted)
Identification Document (POI) : Aadhaar
POI Document Number : 1035

POI Document Expiry Date :

Purpose of Loan : Purchase of Consumer Durable Product

CONTACT DETAILS

Residence Type : Self Owned

Type of Proof Of Address (POA) : Aadhaar
POA Document number : 1035

POA Document Expiry Date :

Is OMC/NFCC Customer : false
Current Address : S/O: Muthusamy 4/183 VADUGAPATTY Valayappatti
Area/Locality : Valayappatti
Landmark : COLANY
City : NAMAKKAL
Pin Code : 637020
State : TAMILNADU
Mobile No. : 9894400672
Alternate Number : 9047323729

Email ID :
Preferred Mailing Address : Residence

EMPLOYMENT/ BUSINESS DETAILS

Employment Type : Salaried

Consent Details : Accepted, IP Address : 103.91.85.5, Language Name : English, Application Number : B238199515, Date & Time: 2024-02-06 18:41:20, Mobile Number: 9894400672
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Qualification : 12th Standard & below

Name of the Company/ Business : OTHERS
Nature of business : Builders
Designation : Others
Office/Business Address : 4/183,Vadugapatty Colony, Namakkal
Area/Locality : Namakkal Tami nadu
City : NAMAKKAL
Pin Code : 637020 NAMAKKAL
State : TAMILNADU
Office Phone : 9894400672

Official Email ID :

PRODUCT DETAILS

Applied Loan amount : ₹ 23999

MAIN PRODUCT DETAILS

Sr. No. Product Name Premium/ Product Price

1 Y200 5G(8256G) - VIVO-MOBILE Rs23999 ₹ 23999

GENERAL TERMS AND CONDITIONS

I hereby agree and confirm:

1. That, (i) I am at least 18 years of age, (ii) can understand, read and write in the English language, (iii) have read and understood the Application Form,
and Master Terms and Condition in relation to the Loan available on Master Terms & Conditions (https://www.bajajfinserv.in/master-tncs-applicable-
for-cd-loans-and-emi-card.pdf) and (iv) agree to be bound by the same
2. That I am applying for Finance Facility from Bajaj Finance Ltd ("BFL") as stated in this Application Form.
3. To submit and execute any/all documents, in such form and manner as may be required by BFL in relation to this Application Form and/or related
products
4. I shall make payment of the applicable fee and/or charges, as specified herein by BFL with respect to this loan application and as more specifically
detailed under Annexure I, below or which also can be accessed at https://www.bajajfinserv.in/all-fees-and-charges
5. Authentication/Acceptance: The mode of authentication/acceptance may be done by me through any one of the following modes, namely:
a. By Physical execution: The documentation will be signed by me in person and the same shall be relied and acted as my explicit written
instruction/consent by BFL; OR
b. By Electronic authentication: By checking the “I Agree” button at the end of the Application Form and by submitting the one-time password (“OTP”)
sent by BFL, or authentication/execution by any other electronic mode, I confirm my acceptance on the Application Form, Most Important Terms
and Conditions(“MITC”) and Master Terms and Conditions (“Master Terms”) in relation to the Loan through electronic means and the same shall be
relied and acted upon by BFL.
6. CKYC Consent
a. I hereby authorize BFL to verify/ check/ obtain/ download/ upload/ update/ retrieve/ receive my KYC details from/with the Central KYC
Registry(CERSAI): (i) by verifying such details through the CKYC number (i.e. KYC Identifier Number- KIN) provided by me or (ii) by obtaining
such CKYC number/KIN, through details shared by me for this Application Form.
b. I hereby consent for receiving information from Central KYC Registry through SMS/Email on the above registered number/email address provided
by me.
7. Aadhaar based authentication (Aadhaar eKYC) or verification (Aadhaar OKYC) facility provided by Unique Identification Authority of India
“UIDAI”
a. CONSENT : At my own discretion, I voluntarily opt to perform and avail Aadhaar based authentication (eKYC) or verification (OKYC) from
UIDAI and hereby submit to the BFL, the physical copy of Aadhaar card / physical e-Aadhaar / masked Aadhaar / Aadhaar Secure QR code / offline
electronic Aadhaar xml as issued by UIDAI (Aadhaar), Aadhaar number, Virtual ID, e-Aadhaar, Aadhaar Letter, XML file, date of birth, Aadhaar holder
name, photo, demographic information, face authentication details and/or biometric information (collectively, “Information”) for the purpose of
establishing my identity / address proof or in the capacity of guardian of my minor child’s identity / address.
I am informed by the BFL that in connection with Aadhaar e-KYC or Aadhaar OKYC services, BFL shall share Aadhaar number and/or biometrics with
CIDR/UIDAI , and in response, the CIDR/UIDAI shall share with BFL, the authentication data or verification data such as Aadhaar Holder Name, Date

Consent Details : Accepted, IP Address : 103.91.85.5, Language Name : English, Application Number : B238199515, Date & Time: 2024-02-06 18:41:20, Mobile Number: 9894400672
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of Birth, Address, Photo, and Registered Mobile Number.

Further, I hereby declare that my above-mentioned current address as stated in this Application Form is true and correct, in the event such an address
differs from the address updated as per Aadhaar fetched using e-KYC authentication facility provided by the Unique Identification Authority of India
(UIDAI).
b. PURPOSE : I for myself/as guardian of minor child, authorise and give my consent to the BFL, for following informed purposes:
i. Above mentioned information shall be used for KYC and periodic KYC updation process as per the PML Act, 2002 and rules thereunder and RBI
guidelines, or for establishing my identity, carrying out my identification, e-KYC, or OKYC, or Yes/No Authentication, demographic or other
authentication/verification/ identification as may be permitted as per applicable law, for all accounts, facilities, services and relationships
of/through the BFL, existing and future.
ii. Collecting, sharing, storing, preserving Information, maintaining records and using the Information and authentication/verification/ identification
records: (a) for the informed purposes above, (b) as well as for regulatory and legal reporting and filings and/or (c) where required under
applicable law;
iii. producing records and logs of the consent, Information or of authentication, identification, verification etc. for evidentiary purposes including
before a court of law, any authority or in arbitration.
c. I further understand that Aadhaar number and core biometrics will not be stored/ shared except as per laws/regulations and for CIDR/UIDAI
submission.
d. In case of OKYC, I shall share the Share Code or confirm on the auto populated shared code, as the case may be for successful XML file download
and upload as contemplated under applicable law to complete my offline KYC process.
e. I am informed by the BFL, that the submission of Aadhaar is not mandatory, and there are alternative options for KYC and establishing identity
including by way of physical KYC with officially valid documents other than Aadhaar. All options were given to me.
8. CONSENT DATA AND INFORMATION SHARING FROM FOR DIGILOCKER PROVIDED BY MeIT (Ministry of Electronics and
Information Technology)
I authorise and give my consent to the BFL to obtain, share and store Certified Copy of Officially Valid Documents (OVD) or equivalent e-documents
of OVD including documents issued through secured cloud based Digilocker platform of MeIT for the purpose of availing Financial Products from
BFL.
9. CONSENT FOR ADDITIONAL DETAILS
I hereby authorise and give my consent to the BFL to verify/check/obtain/download/upload/update/retrieve/receive my following details: (i) profession
or (ii) income or (iii) financial details or (iv) location or (v) IP address or (vi) photographs of residence/business premises or (vii) alternative mobile
phone number or (viii) alternate residence address or (ix) any other additional information as deemed fit by BFL through details shared by me for this
Application Form and Loan Agreement.
10. eMandate Registration with eSignature
In the event I opt for mandate registration with eSignature through biometric authentication, I agree/authorize BFL as under:
i. that BFL and its Assigns to (a) use my Aadhaar/Virtual ID(as applicable) for the purpose of digitally signing eMandate and (b) authenticate my
Aadhaar/Virtual ID through OTP or Biometric for authenticating my identity through Aadhaar Authentication system of UIDAI for obtaining my
eKYC through Aadhaar based eKYC services of UIDAI, for the purposes of digitally signing eMandate.
ii. that BFL will be sharing certain details such as Mandate Start Date, Mandate End Date, Monthly Amount to be debited, my personal details etc.,
to my bank either on its own or through service provider for registration of mandate and I authorize BFL to share said details.
iii. to debit my account basis the payment instructions as confirmed by me herein and agree that such debit shall not be disputed by me for any
reason, whatsoever.
iv. that during the tenure of my relationship with BFL, the mandate shall NOT be cancelled by me, excepting when the relationship is terminated by
me.
v. that my bank may charge mandate processing charge and hence my Bank account could be debited with the mandate processing charges, basis the
authorization given by me to the bank and I will not hold BFL and its Assigns liable or responsible for any fees and charges levied/collected from
my Bank on account of registration of mandate or dishonour of mandate(s).
11. I also authorize BFL:
a. To use, verify, exchange, share or part with all information and details as provided by me to BFL’s group companies/business partners/permitted
assigns, affiliate/subsidiaries/agents/ service provider/representatives/empanelled merchants (collectively referred to as “Assigns”) and any third
party including but not limited to, banks, financial institutions, credit bureaus, telecommunication companies, statutory bodies, empanelled
merchants, Central KYC Registry, Protean eGov Technologies Reserve Bank of India, GST Portal, CIBIL/CRISIL/any credit rating agency/credit
information company(CIC), Information Utility, NSDL e-Governance Infrastructure Limited (NSDL)/UTI Infrastructure Technology and Services
Limited (UTIITSL), UIDAI for purposes such as, including but not limited to customer verification and due diligence, personalization of products or
services, credit rating, data enrichment, analysis, marketing or promotion of BFL services or related products or that of its Assigns or for enforcement
of my obligations and I shall not hold BFL/its Assigns liable for the use/storage/sharing of the data and informations as stated above. I am aware and
I agree that my Aadhaar details such Aadhaar Number, registered mobile Number, and registered email ID will be masked by BFL before sharing to
its permitted Assigns and/or any third party as per laws/regulations.
b. To seek/obtain any other information, generate periodic reports relating to me either by itself and/or from any third party.

Consent Details : Accepted, IP Address : 103.91.85.5, Language Name : English, Application Number : B238199515, Date & Time: 2024-02-06 18:41:20, Mobile Number: 9894400672
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c. To procure/avail my CIBIL report and provide it to me by deducting applicable charges for the same.
12. I hereby expressly authorise BFL, its group companies, affiliates and/or business associates and their respective representatives to send me
communications regarding loans, insurance and their respective products and/or services (collectively “Other Products”) through telephone
calls/SMSs/emails/post/bots/bitly etc. including but not limited to promotional communications. I agree and understand that such Other Products if
availed, are governed by their own set of terms and conditions, which shall be in addition to and not in derogation to the terms and conditions prescribed
by BFL herein. I understand that I can at any time opt not to receive any telecommunication;
13. I hereby declare that all the information voluntarily furnished by me is true, correct and complete. I will not hold BFL or any of its officials responsible
in case of any incorrect information provided by me.
14. That no insolvency proceedings or suits for recovery of outstanding dues, monies or property (ies) and/or any criminal proceedings have been initiated
and/or are pending against me.
15. I have not received any request for or made any payment in cash, bearers cheques or of any other kind in connection with this Application
Form from/to any person.
16. That BFL has the absolute discretion, to accept or reject this loan application, as it may be deemed fit by BFL at any time, either before or after
verification.
17. I hereby expressly consent for taking my photo/video along with the invoice and product evidencing the conduct of loan transaction by me and that such
photo/video is unconditionally agreed to be stored and preserved for a period of at least five (5) years or otherwise from the date of closure of my
account and/or as the law/regulations may so mandate, whichever is higher.
18. That this Application Form, its contents and information/details provided by me, from time to time, as part of this application, may be submitted to:
a. BFL, its subsidiaries and affiliates of BFL, any service provider/third party/ legal entity with whom BFL may have business relationship and/or in
reference to rendering services in connection with the product(s) availed by me and/or for promoting/marketing various products and services.
b. To any Regulator, Court, Law enforcement agency, Quasi-Judicial authority etc. on a need basis.
19. That all the particulars, information and details provided in this Application Form and the documents submitted by me are true, correct, complete and
up-to-date in all respects and that I have not withheld any material information. I shall keep BFL updated of any change in the information provided by
me, specifically KYC details, Bank details, etc. and in case any of the above information is found to be false or untrue or misleading or misrepresenting,
I am aware that I shall be held liable for the same and I will not hold BFL liable for any consequences that may arise owing to any delay/lapse on the my
part.
20. Interest Rate Methodology-
Interest rate applicable for consumer durable Loans varies from 0% to 36% basis the BFL’s internal credit and risk policy and as per an algorithmic
multivariate score card which includes following variables (inclusive and not exhaustive):
(i) Interest rate risk (fixed vs floating loan), Credit and default risk in the related business segment (iii) Historical performance of similar homogeneous
clients (iv) Profile of the borrower (v) Industry segment, (vi) Repayment track record of the borrower, (vii), Nature and value of collateral security, (viii)
Secured Vs unsecured loan, (ix) Subvention available, (x) Ticket size of loan, (xi) Bureau Score, (xii), Tenure of Loan, (xiii) Location delinquency and
collection performance and (xiv) Customer Indebtedness (other existing loans)
The aforesaid variables may be revised from time to time.
21. BFL Customer Care Contact details:
For any queries, visit our website https://www.bajajfinserv.in/reach-us. Select the < Email Us > tab and follow the directions to get your query
resolved.

OFFICIALLY VALID DOCUMENTS (OVDS) OR DEEMED TO BE OVDS

OVDs or Deemed to be OVDs (to be taken in case address mentioned on OVDs is not the current address). In cases where Deemed to be OVD is submitted
towards current address, applicant shall submit an OVD updated with current address within a period of three months of submission of Deemed to be
OVD)
List of Officially Valid Documents (OVDs): Passport, Driving License, Aadhaar (First Eight Digits of Aadhaar number to be redacted/masked), Voter's
Identity Card issued by the Election Commission of India, Job Card issued by NREGA duly signed by an officer of the State Government, Letter issued by
the National Population Register containing details of name and address
List of Deemed to be OVDs (DOVDs): Utility bill which is not more than two months old of any service provider (electricity, telephone, post-paid mobile
phone, piped gas, water bill), Property or Municipal tax receipt, Pension or family pension payment orders (PPOs) issued to retired employees by
Government Departments or Public Sector Undertakings, if they contain the address, Letter of allotment of accommodation from employer issued by State
Government or Central Government Departments, statutory or regulatory bodies, public sector undertakings, scheduled commercial banks, financial
institutions and listed companies and leave and licence agreements with such employers allotting official accommodation

ANNEXURE I : FEES, CHARGES AND INTEREST LEVIED BY BFL

Processing Fees Mandate Rejection Charges
Upto ₹ 1017 (Inclusive of applicable taxes) collected upfront ₹ 450/- per month from the first instalment due date for mandates rejected
by customers bank until the new mandate is registered

Consent Details : Accepted, IP Address : 103.91.85.5, Language Name : English, Application Number : B238199515, Date & Time: 2024-02-06 18:41:20, Mobile Number: 9894400672
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Upfront Interest Transaction Fee

Upto ₹ 1017 collected upfront from the customer and more particularly ₹147 (Inclusive of applicable taxes) will be collected along with 01st
mentioned in respective Loan Term Sheet/Charge slip. instalment.
Convenience Fees ** "Transaction fees" refers to sum payable by customer (i) who does not
hold valid EMI card; (ii) to whom the loan is facilitated; and (iii) at the
₹ 117/- (Inclusive of applicable taxes) will be collected along with 01st time of making payment of first EMI/upfront payment as part of loan
instalment transaction.
Loan Enhancement Fees Credit Suraksha Fees
₹ 117/- (Inclusive of applicable taxes) for temporary increase in EMI card ₹ 117/- (Inclusive of applicable taxes) if applicable levied on certain set
limit for the loan transaction. Same will be charged only for increase in of Customers who are facilitated with loan for purchasing mobile devices
limit in excess of Rs. 999/- to be collected along with 01st instalment. and where Bajaj Finserv Credit Suraksha application is installed on such
CIBIL Transunion Report Fees (If Availed) mobile devices which will enable BFL to put restrictions on usage of
device in the event of default by Customer
₹ 46/- (Inclusive of applicable taxes) will be collected along with 01st
instalment EMI Network Card Fee (If Availed)

Pre-payment Charges ₹ 530/- (Inclusive of applicable taxes)

Full Pre-payment : NIL Add-on EMI Network Card Fee (If Availed)
Part Pre-payment : NIL, Any time post disbursement of loan ₹ 199/- (Inclusive of applicable taxes)
Penal Interest EMI Network card Annual fee
Delay in payment of Monthly instalment shall attract penal interest at ₹ 117/- (Inclusive of applicable taxes) for each card availed
the rate 42% per annum applicable on the Monthly Instalment Annual fee will only be charged to the respective Card holders who have
outstanding, from the respective due date until the date of receipt of not availed any loan using such Card in the preceding year. The duration of
monthly instalment. the preceding year is calculated 12 months from last year’s validity month,
Health EMI Network Card Fee (If Availed) which is printed on the face of your respective Card. For example, If the
Card is issued in the month of February 2019 (referred to as ‘Member
₹ 999/- (Inclusive of applicable taxes)
Since’, on the Card) the date for payment of the annual fee will be March,
Bounce Charges 2020.
In case of default of repayment instrument ₹ 500/- per bounce will be
levied.

“Additional cess/ taxes, if any, will be applicable on all charges as per the respective State Laws as may be applicable from time to time.”
The aforementioned charges/fees may be modified by Bajaj Finance Limited from time to time upon prior intimation via Acceptable Means of
Communication from Bajaj Finance Limited in this regard.

I hereby expressly authorise BFL, its group companies, affiliates and/or business associates and their respective representatives to send me promotional
communications regarding loans, insurance and their respective products and/or services through telephone calls/SMSs/emails/post/bots/bitly, etc. I
understand that I can at any time opt not to receive any telecommunication

By clicking on "I Agree" below, button and/or by entering the one-time password (OTP) sent by BFL and/or by providing physical signature, I hereby
apply for Loan from Bajaj Finance Limited and confirm that all the particulars, information and details mentioned in this Application Form are true and
correct.

Selladurai Muthusamy
(Name of Applicant) Signature

BFL/CF/Dig/AppF/English/2023/May/V1

Signature Not Verified

Digitally signed by DS BAJAJ FINANCE
LIMITED 1
Date: 2024.02.06 18:41:51 +05:30
Reason: Security
Location: Pune

Consent Details : Accepted, IP Address : 103.91.85.5, Language Name : English, Application Number : B238199515, Date & Time: 2024-02-06 18:41:20, Mobile Number: 9894400672
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