Bajaj Finance Limited ("BFL") - Personal Loan Application Form

5/16/24, 4:25 PM Personal Loan - Application Form
Bajaj Finance Limited ("BFL") - Personal Loan Application Form

Application no. - B2C000071956169
SECTION 1
Loan Details
Required Loan amount : ₹ 126000.0
Required Loan Tenure (In Months) : 39.0
Product Type : Personal Loan
Purpose of Loan : Personal Use
Type of Loan : NEW
Loan Variant : Term Loan
Customer ID (For existing Customers) : 69064804
Applicant Details
Name of the Applicant : ARCHNA DIXIT
Father's name : ARCHNA DIXIT
Mother's name : DIXIT
Spouse's name(if applicable) : NA
Date of birth : 15/3/1975
Qualification : Other
Consent Details : Accepted IP Address : 2402:3a80:4389:be6e:f9f9:dc4d:60e0:d32e Language Name : EnglishApplication Number : B2C000071956169
Date & Time: 2024-05-16 16:25:30Mobile Number: 9899520417
Email ID:
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Gender : Male  Female Transgender
Marital status :  Married Unmarried Others
Telephone No. : NA
Mobile : 9899520417
Alternate mobile number :
Personal Email Id :
Residence type : Owned by Self/Spouse
Residing duration (in : NA

Months)
Current Residence : H. NO.-B27/6 BLOCK-B EAST DELHI KRISHNA NAGAR EAST DELHI DELHI
address
Landmark : DELHI
City : DELHI
Pincode : 110051
State : DELHI
Address proof : OVD-Aadhar/ Enrollment
PAN : IAPPD7336N
CKYCR Number/ KIN (KYC : NA

Identification Number)
Documents :  PAN + 1 OVD
Form 60 (in case PAN is not allotted) + 1 OVD
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Officially Valid Document : NA

(OVD) ID - NA
Expiry: NA
Deemed OVD :
Nationality : Indian
Preferred Language : ENGLISH
Employment/Business Details - Applicant
Company Sector : NA
Employment Type : Salaried with PF deductible
Name of Company / Business : SHRINGAR BEAUTY PARLOUR
Designation : NA
Years in current employment : NA
Total Work Experience : NA
Gross Annual Income : NA
Nature of Work : Other Professions
Official Email ID : NA
Office / Business address : SHRINGAR BEAUTY PARLOUR KRISHNA NAGAR
Landmark : NA
City : DELHI
Pincode : 110051
State : DELHI
Telephone No. : NA
Website : NA
Residence cum Office : No
Permanent Residential Address - Applicant
Same as Current Residence
Contact Person Name : ARCHNA DIXIT
Relationship with Applicant : Self
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Mobile : 9899520417
Address proof :
Address :
Area/Locality : NA
Landmark : NA
City :
State :
Pincode :
Bank Account Details
Account Type : Savings
Bank Name : STATE BANK OF INDIA
Bank Account No. : 30851955834
Bank IFSC : SBIN0001573
Branch & Address : KRISHNA NAGAR,
Reference Details
Reference 1 name : NA
Mobile number : NA
Reference 2 name : NA
Mobile number : NA
SECTION 2
Interest Rate Methodology
Interest rate applicable for unsecured Personal Loans 13% p.a. to 38% p.a., may vary basis the BFL’s internal credit and risk policy and
as per algorithmic multivariate score card which includes following variables (inclusive and not exhaustive):
a. Interest rate risk (fixed vs floating loan)
b. Credit and default risk in the related business segment
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c. Historical performance of similar homogeneous clients
d. Profile of the Borrower(s)
e. Industry segment
f. Repayment track record of the Borrower(s)
g. Secured Vs Unsecured loan
h. Nature and Value of collateral Security,
i. Subvention available
j. Ticket size of loan
k. Bureau Score
l. Tenure of Loan
m. Location delinquency and collection performance
n. Customer Indebtedness (other existing loans)
The aforesaid variables may be revised from time to time as per the BFL’s past performance in a given loan portfolio.
General Terms and Conditions
I hereby agree, confirm and authorize:
1. To apply for a personal loan facility ('Loan') from Bajaj Finance Limited ('BFL') for my personal use, as stated in this application
("Application Form"). I understand and confirm that not to use the Loan for any illegal, speculative, nefarious, fraudulent or
unlawful purposes.
2. The loan/credit facility to be provided by BFL may be either in the form of term Loan or one of the variants or a combination of
such variants from the following options:(a) Flexi Term Loan; or (b) top Up loan/Additional Loan or (c) requested for conversion of
existing loan variant to other loan variant; or (d) Flexi Hybrid Loan; or (e) Term Loan/Personal / Unsecured loan, (f) Consolidation
and balance transfer of his/her Outstanding Consumer Durable Loan.
3. I hereby acknowledge that:
a. I have read or have been explained and understood, the features, obligations of the Loan as provided in Detailed Terms and
Conditions, accessible on [https://www.bajajfinserv.in/forms-centre (https://www.bajajfinserv.in/forms-centre)] ("Detailed
Terms");
b. The Loan availed, would be subject to payment of all Fees / Charges as mentioned in the Annexure I and such other fees /
Charges as may be prescribed by BFL ("Initial Fees and Charges")
c. The revision of Initial Fees and Charges and such other additional fees/charges as may be introduced by BFL ("Revised
Charges"), may be notified by BFL on its website [https://www.bajajfinserv.in/all-fees-and-charges
(https://www.bajajfinserv.in/all-fees-and-charges)] and which shall constitute sufficient notice to me;
d. The Revised Charges as stated above, shall supersede the Initial Fees and Charges and I shall be bound by such Revised
Charges.
4. I shall submit and execute all documents including KYC documents/other documents in such form and manner as may be
required by BFL in relation to my Application Form.
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5. CKYC Consent
a. I hereby authorize BFL to verify/ check/ obtain/ download/ upload/ update/ retrieve/ receive my KYC details from/with the
CKYC Registry: (i) by verifying such details through the CKYC number (i.e. KYC Identifier/ KYC 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 (CKYCR) and BFL through SMS/Email on the registered
number/email address provided by us
6. Consent for additional details
I hereby authorise BFL to verify/check/obtain/download/upload/update/retrieve/receive my following details: (i) profession or

(ii) income or (iii) financial details or (iv) geographic 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
7. I hereby declare I have carried out my E – KYC and that I am providing Current Address which is different from the Address
details available in the Identity Information under the Central Identities Data Repository maintained by the Unique Identification
Authority of India (UIDAI).
8. I authorize BFL to use and/or share all information and details as provided by me on the Bajaj Finserv App, the Application Terms
and the Loan Terms and Conditions and in relation to my existing loans and/or repayment history 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, Reserve Bank of
India, GST Portal, CIBIL/CRISIL/any credit rating agency/credit information company, Information Utility, Protean eGov
Technologies Ltd /UTI Infrastructure Technology and Services Limited (UTIITSL), Unique Identification Authority of India (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 your obligations and I shall not hold BFL/its Assigns liable for the use/sharing of the information as stated
above. In furtherance of the same, I authorise BFL/its Assigns to seek/obtain any other information, generate periodic reports
relating to me either by itself and/or from any third party;
9. 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 of Birth, Address, Photo, and Registered Mobile Number.
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.
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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.
10. 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.
11. eMandate Registration with eSignature

In the event I opt for mandate registration with eSignature through biometric authentication, I agree/authorize BFL as under:
a. 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.
b. 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.
c. 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.
d. 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.
e. 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).
12. I hereby confirm that all the information and details including but not limited to financials/bank statements, KYC details
provided/to be provided by me pursuant in support of my application or to be shared with any third party, including the Central
KYC Registry, are true, correct and up-to-date. I have not withheld any material information that may be required by BFL. I
undertake to immediately keep BFL updated of any change in the information provided by me, specifically KYC/CKYC details,
Bank details, change of my address/co-ordinates 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.
13. I authorize BFL to use my existing details and KYC documents/data for KYC compliance, if any, for this application and in case of
any changes in my registered KYC or bank account details, I shall update about the same & submit the updated KYC to BFL.
14. 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.
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c. To procure/avail my CIBIL report and provide it to me by deducting applicable charges for the same.
15. 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.
16. That I have read and understood the Detailed Terms and understand the applicability of the same on availing the Loan and
hereby agree to be bound by the same at all times including any additions/amendments thereto from time to time. I agree to
keep myself updated of any revisions in the Detailed Terms as may be communicated by BFL through any Acceptable Means of
Communication (as defined in the Detailed Terms).
17. I hereby expressly consent for taking my photo/video 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 the loan and/or as the law/regulations may so mandate, whichever is higher.
18. That I shall be liable to pay Broken Period Interest/ Pre Monthly Insalment-Interest from the Date of Disbursal (as defined in the
Detailed Terms), on the Loan.
19. 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.
20. 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.
Communication Terms
By clicking on "I Agree" below, I hereby expressly authorise BFL/ its representatives/agents/ its business partners/its group
companies/affiliates to send me communications regarding loans, insurance and other products from BFL, its group companies and/or
third parties (collectively "Other Products") through telephone calls/SMSes/emails/post/bitly/bots/ in person communication etc.
including but not limited to promotional communications, irrespective of rejection of my Loan application.
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.
Place : DELHI
Date : 16/5/2024
SECTION 3
Health Declaration
Confirmation of Good Health - for enrolment into Complimentary Group Life Insurance Cover
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Yes
No
I have never had/ currently have any disorder of heart/ circulatory system/ blood pressure/ stroke/ asthma/ lung/ cancer/
tumour/ HIV positive/ brain/ nervous system/ diabetes/ hepatitis/ liver/ digestive tract/urinary/ kidney/depression /mental
/psychiatric /epilepsy /blood /musculoskeletal/any disability. I have never had symptoms persisting more than 7days nor been
absent from work for any illness/ injury/ disabilities for more than 10days in last 3years. This health confirmation shall form the
basis of your enrolment. Any known misstatement, misrepresentation and /or omission of material importance may void the
coverage under this policy.
Currently or in the last 3 months, I or my family members have not been tested positive for Covid-19/have not been self-isolated
with symptoms on medical advice/advised to undergo, repeat or awaiting Covid-19 test/currently or past 1 month I do not have
symptoms like persistent cough, breathlessness, fever, raised temperature or flu like symptoms/ have not been in contact with
an individual suspected or quarantined or confirmed to have Covid-19 or Sars cov-2/ or doesn’t mine or immediate family
members occupation require me/them to come in close contact with Covid-19 patients or with coronavirus contaminated
material.
Complimentary Group Credit Life insurance cover
In addition to the above mentioned CPP LivAssist membership, I am aware and hereby consent to avail the complimentary
Group Credit Life insurance cover provided by Life Insurer in order to protect the loan availed by me from Bajaj Finance Ltd. The
cover will be issued upto 75% of the disbursed loan amount for a period of maximum upto 3 years.
In the event of any eventuality giving rise to a claim under the group insurance scheme and/or any surrenders and/or
cancelations, the proceedings should be paid to the MPH (Bajaj Finance Ltd.) against the outstanding loan by the Life Insurer and
balance if any to my nominee/beneficiary/legal heir, as the case may be.
I authorise the Life Insurer to send certiﬁcate of insurance through SMS - Bitly Link instead of a hard copy. The same would be
sent to my mobile phone number and/or email mentioned in this application form.
Note: Complementary Insurance cover is being offered at BFL’s sole discretion and may be discontinued in the future.
Insurance Product - HEALTH PLUS
Sum Insured : 400000.0
Tenure in Months : 24.0
Premium (Inclusive of applicable taxes) : 4015.0
Plan Option : NA
Sum Assured Type : NA
Authorization - I do hereby authorize and instruct Niva Bupa Health Insurance Co. Ltd. (formerly known as Max Bupa Health
Insurance Co. Ltd.) to refund, the premium (in full or prorated as the case may be) to the Master Policyholder, in event of
cancellation/withdrawal of the insurance cover to me/us under the group policy of the Master Policyholder. In event Niva Bupa
Health Insurance Company limited refunds the premium amount as per instruction above, it shall be considered full and
complete discharge of any liability by Niva Bupa Health Insurance Company limited towards me and I shall not have any
objection to such refund subsequent to payment as per above instructions.
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# Conditions Apply. Please refer to the 'Insurance Disclaimer and Customer Declaration' section below before concluding a Sale.
Product Name: Niva Bupa Health Plus | UIN: NBHHLGP22157V032122
Date : 2024-05-16
Place : DELHI Borrower Signature
Insurance Product - BAJAJ ALLIANZ LIFE GROUP SAMPOORNA JEEVAN SURAKSHA
Sum Insured : 130143.87
Tenure in Months : 48.0
Premium : ₹ 5699.0
Premium Payment Option : Single
Plan Option : Base
Sum Assured Type : Level
Premium Payment Frequency : Single
Cover Type : Single Life
DECLARATION OF GOOD HEALTH: - I am in sound state of health / I have never undergone, or expect to undergo any surgical
procedure for any illness, ailment, disease or disability / I have never suffered from, or not suffering from any disease/ailment
requiring any form of medication for more than 7 consecutive days, nor been absent from work for more than 7 days / I do not
engage or intend to engage in any business, sport or occupation of a hazardous nature and I do not have any history of conviction
under any criminal proceedings in India or abroad / My any proposal for insurance, or revival of policy on my life to this company
or any other insurance company never been postponed/declined/accepted on terms other than proposed / For Female Lives only -
I am not pregnant / I have never suffered from any disease of the breast, uterus, cervix, ovaries or any other part of the
reproductive system
 Yes
No
Assignment - I have received/applied a loan from M/s Bajaj Finance Ltd. In order to secure the said loan, I hereby assign all the
rights and interest in the life insurance policy issued pursuant to the abovementioned application to the Assignee (Bajaj Finance
Limited) and submission of this request shall be treated as adequate notice of assignment to Bajaj Allianz Life Insurance
Company Ltd. (“Company”). In the event of my death during the term of the policy, the benefits, as per the policy terms and
conditions, will be paid to the Assignee to the extent of the liability against me that exists with the Assignee, and balance
amount, if any, shall be paid to my nominee. I hereby indemnify and keep indemnified the Company and its directors,
employees and successors and hold them harmless from all the liabilities or claims that may arise in future pursuant to such
assignment..
# Conditions Apply. Please refer to the 'Insurance Disclaimer and Customer Declaration' section below before concluding a Sale.
Product Name: Bajaj Allianz Life Group Sampoorna Jeevan Suraksha | UIN: 116N166V01
Date : 2024-05-16
Place : DELHI Applicant's Signature
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Insurance Nominee Details - HEALTH PLUS
Nominee Name : NA
Nominee Gender : NA
Nominee Date of Birth : NA
Nominee Mobile No. : NA
Nominee Email ID : NA
Nominee's Relationship with Applicant : NA
Appointee Name (in case Nominee(s) is a Minor) : NA
Appointee Gender : NA
Appointee Date of Birth : NA
Appointee Mobile No. : NA
Appointee Email ID : NA
Appointee's Relationship with Nominee : NA
Insurance Nominee Details - BAJAJ ALLIANZ LIFE GROUP SAMPOORNA JEEVAN SURAKSHA
Nominee Name : NA
Nominee Gender : NA
Nominee Date of Birth : NA
Nominee Mobile No. : NA
Nominee Email ID : NA
Nominee's Relationship with Applicant : NA
Appointee Name (in case Nominee(s) is a Minor) : NA
Appointee Gender : NA
Appointee Date of Birth : NA
Appointee Mobile No. : NA
Appointee Email ID : NA
Guardian's Relationship with Nominee : NA
Health Details of Insured
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Health details of Proposed Insured (Please use in boxes to indicate choice)
1. Have you ever suffered or are currently suffering from: (a) Chest Pain or heart attack or any other heart Yes  No
disease (b) Cancer, tumor, growth or cyst of any kind (c) Stroke, paralysis, epilepsy, any psychiatric /
mental disorder, disorder of the brain/nervous system or any kind of physical disabilities (d)Asthma,
Tuberculosis or any other lung disorder (e) Diseases or disorder of muscles, bones, joints, arthritis or
blood disorder(anemia) or any endocrine disorder (f) Diseases of the kidney, digestive system(stomach,
pancreas, gall bladder, intestine), liver, Hepatitis B or C or HIV/AIDS infection (g) Diabetes, high blood
pressure?
2. During the last 5 years have you undergone any major surgery or been hospitalized for more than one Yes  No
week?
3. Do you take part in any adventurous sports or hobbies? (like paragliding, mountaineering, deep sea Yes  No
diving, motor racing, bungee jumping, etc.)
4. Do you smoke more than 10 cigarettes a day? Yes  No
5. Has more than one of your parents and siblings died before the age of 60 years as a result of heart Yes  No
attack, stroke, cancer, diabetes, HIV?
6. Are you taking any medication or has a doctor ever attended to you for any conditions, diseases or Yes  No
impairment not mentioned above (except for cough or cold)?
7. For females: (a) Are you presently pregnant? (b) Do you have a history in the past of an abortion, Yes  No
miscarriage or caesarean section due to complications during pregnancy or due to any other cause? (c)
Have you given birth to a child with any congenital disorder such as Down syndrome, congenital heart
disease etc.? (d) Have you ever had any disease of breast, uterus, cervix, ovaries or any other part of the
reproductive system?
8. Have you ever been declined, deferred, and accepted at special terms, had cover reduced or had Yes  No
exclusion imposed for any life, health or accident insurance cover?
9. Do you have any history of conviction under any criminal proceedings in India or abroad? Yes  No
Insurance Disclaimer & Customer Declaration
Customer/Proposer/Life Assured's Declaration
(1) I/We provide my/our consent voluntarily for enrolling as a member of group insurance offered to me by the above
insurer under the master policy of Bajaj Finance Limited.
(2) I/We understand, agree and confirm that these statements and this declaration are basis of the contract between the
insurer and the policyholder. Subject to Section 45 of the Insurance Act 1938 as amended from time to time, if any
untrue statements are contained herein or there has been any non-disclosure of any material fact, the policy to be
issued by the insurer in the name of the policyholder may be treated as void as far as I/We am/are concerned.
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(3) I/We confirm that I/We have read and understood, the rules and any additional rules of the plan, the standard policy
provisions and any additional provisions that govern the policy to be issued by insurer in the name of the policyholder
and on my/our life, and I/We agree and confirm that the same shall be binding on me/us. I/We authorize the
policyholder to disclose to the insurer such particulars as they may require including the details given above and any
changes to the same, pay the premium payable on my/our behalf /collected from me/us to the insurer. I/We
understand that any statutory levy or charges including any indirect tax may be charged to me/us either now or in
future by the insurer and I/We agree to pay the same
(4) I/We further agree that if after the date of submission of the proposal but before the issuance of Policy
i. there is an adverse change in my/our occupation, financial condition, health condition, which will affect the
decision of the Insurer in underwriting risk or
ii. if the proposal for assurance or an application for revival of the policy made to any insurer on my/our life or the
Life to be assured is withdrawn or dropped, deferred, declined or accepted on terms other than as proposed,
I/We shall forthwith intimate the same to the insurer in writing and failure to do so shall lead to a decision as
per the applicable terms and conditions of the policy.
(5) I/We understand that insurer has the right to reject a proposal without giving reasons thereto and confirm to give an
undertaking that I/We shall not raise any claims thereof. I/We understand the significance of the contract and that the
contract will be governed by the provisions of the Insurance Act 1938 as amended from time to time and that the same
will not commence until written acceptance of this application issued by the insurer on its normal terms and conditions
is received.
(6) I/We hereby declare that the content of the form and document has been fully explained and given by me/us and
I/We have fully understood the significance of the proposed contract
(7) I hereby declare that the above statements and/or particulars given by me are true and complete in all respects to the
best of my knowledge
(8) I understand that the information provided by me will form the basis of insurance policy, is subject to Board approved
underwriting policy of the insurance company and that the policy will come into force only after full receipt of premium
chargeable.
(9) I further declare that I will notify in writing any change occurring in the occupation or general health after the proposal
has been submitted but before communication of the risk acceptance by the Company
(10) I declare and further consent to the Company seeking medical information from any doctor or hospital who/which at
any time has attended me or from any past or present employer concerning anything which affects my physical or
mental health and seeking information from any insurer to whom an application for insurance has been made for the
purpose of underwriting the proposal and/or claim settlement.
(11) I authorize the Company to share information pertaining to my proposal including the medical records for the sole
purpose of underwriting the proposal and/or claim settlement and with any Governmental and/or Regulatory Authority
(12) I hereby provide my consent and authorize the Company to make welcome calls, service calls or any other commercial
communication (electronic or otherwise and/or including but not limited to SMS/WhatsApp) with respect to the
proposed or existing policy of Company from time to time. I hereby expressly authorize BFL to send me
communications regarding loans, insurance and other products from BFL, its group companies and/or third parties
through telephone calls / SMSs / emails/ post etc. including but not limited to promotional communications. I confirm
that I shall not challenge receipt of such communications by me as unsolicited communication, defined under TRAI
Regulations on Unsolicited Commercial Communications. I understand that I can at any time opt not to receive any
telecommunication by registering under the Do Not Call Registry
(13) I agree that this declaration shall be the basis of the decision by insurer to cover or not cover me under insurance.
(14) I hereby authorize BFL to verify/check/obtain/download/ my KYC details available with CERSAI/UIDAI/CKYC registry. I
agree that the details/documents provided by me may be shared by BFL with the insurer(s) and may be
downloaded/verified by insurer(s) for processing of this application. In the event if I am found to be existing customer
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of BFL, I confirm that there is no change in my existing KYC details and authorize BFL to use my existing KYC for this
application.
(15) I understand and agree that in case any error, omission, incorrect information, blank forms, etc. are detected at the
claim stage because of lapses on the part of the scheme member, such claims shall be treated as invalid by the insurer
and the claim payout shall not be processed.
(16) I understand that any If any of the requirement/s raised by the insurer including further requirements pertaining to
medical tests/reports/investigations are not completed within three months from the date when the member
enrolment details were shared by the Master Policy Holder (MPH) with the insurer, the received premium amount for
the said enrolment, would be refunded and the respective member's enrolment shall be deemed as withdrawn.
Cancellation/ Termination
Once the Insured ceases to be a member or the policy is cancelled by the Master policyholder or the insurer for any
reason whatsoever, the cover will automatically stand cancelled. However, the Insured under this policy can port to a
similar approved retail health policy available with the company as per 'Portability Guidelines', subject to the
Company's medical underwriting criteria.
Statutory Warning (Prohibition of Rebates) - Section 41 of Insurance Act 1938
(i) 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 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 maybe allowed in accordance
with the published prospectus or tables of the insurer.
(ii) Any person making any default in complying with the provisions of this section shall be punishable with fine which
may extend to Ten Lakh Rupees.
Fraud, misrepresentation and forfeiture: Fraud, misrepresentation and forfeiture would be dealt with in accordance with
provisions of Section 41 of the Insurance Act 1938 as amended from time to time.
Disclaimer - Conditions apply - These products are offered under the Group Insurance scheme wherein Bajaj Finance
Limited is the Master policyholder. The insurance coverage is provided by our partner Insurance Company , Bajaj
Finance Limited does not underwrite the risk. IRDAI Corporate Agency Registration Number CA0101. BFL does NOT hold
any responsibility for the issuance, quality, serviceability, maintenance and any claims post sale. Please refer insurer's
website for Policy Wordings. Purchase of these product are purely voluntary in nature. BFL does not compel any of its
customers to mandatorily purchase any third party products.
I hereby consent and authorize Bajaj Finance Limited to share this application and all information and details as
provided by me under this application with insurer for the purpose of customer verification and claim settlement and I
shall not hold Bajaj Finance Limited liable for the use/sharing of my application/information as stated above.
Date : 2024-05-16
Place : DELHI Applicant's Signature
SECTION 4
Officially Valid Documents (OVDs) or Deemed to be OVDs
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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) :
1. Passport
2. Driving License
3. Aadhaar (First Eight Digits of Aadhaar number to be redacted/masked)
4. Voter's Identity Card issued by the Election Commission of India
5. Job Card issued by NREGA duly signed by an officer of the State Government
6. Letter issued by the National Population Register containing details of name and address
List of Deemed to be OVDs (DOVDs) :
1. Utility bill which is not more than two months old of any service provider (electricity, telephone, post-paid mobile
phone, piped gas, water bill)
2. Property or Municipal tax receipt
3. Pension or family pension payment orders (PPOs) issued to retired employees by Government Departments or Public
Sector Undertakings, if they contain the address
4. 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 Levied by BFL
Processing Fees
upto 3.93% (Inclusive of applicable taxes) applicable on gross loan amount.
Stamp Duty (as per respective state)
Payable as per state laws on Gross Loan Amount and deducted upfront from the Gross Loan Amount
Pre-payment Charges
Full pre-payment (foreclosure) Charges

Foreclosure can be processed post clearance of first EMIs
Term Loan: 4.72%(Inclusive of applicable taxes) on the outstanding loan amount as on the date of Full Pre-payment.
Part pre-payment
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Term Loan: 4.72% (Inclusive of applicable taxes) of the principal amount of Loan prepaid on the date of such Part Pre-
Payment
Foreclosure or Part-payment charges are not applicable for Micro Finance Personal Loan.
Broken period interest / Pre monthly instalment -Interest
"Broken Period Interest/Pre monthly instalment Interest" shall mean the amount of interest on Loan for the number of day(s)
which is (are):
Scenario 1: Over and above the period of 30 (thirty) days from the date of disbursement of the Loan
Method of recovery of Broken Period Interest/Pre Monthly Instalment-Interest:
Deduct from disbursement
Scenario 2: Less than period of 30 (thirty) days from the date of disbursement of the Loan, Interest on first instalment will be
charged for actual number of days
Penal Charge
Delay in payment of instalment(s) shall attract Penal Charge of ₹ 8 per day per instalment from the respective due date
until the date of receipt of the full instalment(s) amount.
PG Facility Charges
₹ 11 (Inclusive of Applicable taxes) will be charged for utilizing the payment gateway to make part or full payments
towards the loan through digital properties
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EMI Network Card Fee/Health EMI Network Card (If availed)
₹ 530/- (Inclusive of applicable taxes)
Add-on EMI Network Card Fee (If availed)
₹ 199/- (Inclusive of applicable taxes)
EMI Network card Annual fee
₹ 117/- (Inclusive of applicable taxes) for each card availed

Annual fee will only be charged to the respective Card holders who have not availed any loan using such Card in the
preceding year. The duration of the preceding year is calculated 12 months from last year’s validity month, 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
Since’, on the Card) the date for payment of the annual fee will be March, 2020.
Bounce Charges
₹ 700 per bounce.“Bounce charges” shall mean charges for non-payment of instalment (s) on their respective due dates
due to dishonour of payment mandate or non-registration of the payment mandate or any other reason
Cash Collection handling Charges
₹ 177 (inclusive of applicable taxes) will be charged if customer opts to make payment in cash when the collection is done
by the collection agents. This fee is charged only once per month, regardless of the number of payments made against
multiple LANs
Cash Deposit Charges
Customers will incur a cash deposition charge of ₹ 50 (Inclusive of Applicable taxes) when making cash payments at our
branch offices
“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.
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I hereby confirm that I have read the entire text, features, disclosures, exclusions, etc. and voluntarily applying for CPP Liv
Assist
 I hereby confirm that I have read the entire text, features, disclosures, exclusions, etc and voluntarily applying for Bajaj
Allianz Life Group Sampoorna Jeevan Suraksha
 I hereby confirm that I have read the entire text, features, disclosures, exclusions, etc and voluntarily applying for Niva
Bupa Health Plus
 I hereby confirm and accept the following: a) General Terms and conditions b) Communication Terms c) Detailed terms and
Conditions accessed by me at Website (https://www.bajajfinserv.in/forms-centre)
 I have read and understood the BFL-WhatsApp Terms and Conditions available at https://bfin.in/?RMMKSYQXSI
(https://bfin.in/?RMMKSYQXSI) and I hereby consent to receive important updates related to my relationships with Bajaj
Finance Limited on WhatsApp.
Note*: Loan Application will be processed within 12 days from the date of receipt of all the documents to the satisfaction
of BFL
 By clicking on "I Agree" below, 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. Further I acknowledge that Bajaj Finance
Limited at its sole discretion may reject or approve this application. I hereby acknowledge that I have not paid any amount
or given anything in kind to Bajaj Finance Limited by way of fees/commission apart from the charges that may be
indicated in the loan agreement/documentation. I further understand and agree that unless otherwise specified by Bajaj
Finance Limited in writing, all fees/charges paid by me to Bajaj Finance Limited for availing the Loan shall be non-
refundable, irrespective of cancellation.
 I hereby expressly consent for taking my photo to evidence the conduct of loan transaction by me and I further hereby
consent that such photo for storage and preservation of the same for a period of at least five (5) years or otherwise from
the date of closure of the loan and/or as the law/regulations may so mandate, whichever is higher.
By checking with tick mark in the box, I, hereby, signify my consent for availing the aforementioned products/ services
ARCHNA DIXIT
(Name of Applicant) Applicant Signature
Date : 2024-05-16 Place : DELHI
PLCS/Dig/AppF/Eng/Apr24/V1
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Bajaj Finance Limited ("BFL") - Personal Loan Application Form

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5/16/24, 4:25 PM Personal Loan - Application Form

Bajaj Finance Limited ("BFL") - Personal Loan Application Form

Required Loan amount : ₹ 126000.0

Required Loan Tenure (In Months) : 39.0

Product Type : Personal Loan

Purpose of Loan : Personal Use

Type of Loan : NEW

Loan Variant : Term Loan

Customer ID (For existing Customers) : 69064804

Name of the Applicant : ARCHNA DIXIT

Father's name : ARCHNA DIXIT

Mother's name : DIXIT

Spouse's name(if applicable) : NA

Date of birth : 15/3/1975

Gender : Male  Female Transgender

Marital status :  Married Unmarried Others

Alternate mobile number :

Residence type : Owned by Self/Spouse

Residing duration (in : NA

Address proof : OVD-Aadhar/ Enrollment

CKYCR Number/ KIN (KYC : NA

Documents :  PAN + 1 OVD

Form 60 (in case PAN is not allotted) + 1 OVD

Officially Valid Document : NA

Preferred Language : ENGLISH

Employment/Business Details - Applicant

Employment Type : Salaried with PF deductible

Name of Company / Business : SHRINGAR BEAUTY PARLOUR

Years in current employment : NA

Total Work Experience : NA

Gross Annual Income : NA

Nature of Work : Other Professions

Office / Business address : SHRINGAR BEAUTY PARLOUR KRISHNA NAGAR

Residence cum Office : No

Permanent Residential Address - Applicant

Same as Current Residence

Contact Person Name : ARCHNA DIXIT

Relationship with Applicant : Self

Bank Account Details

Account Type : Savings

Bank Name : STATE BANK OF INDIA

Bank Account No. : 30851955834

Bank IFSC : SBIN0001573

Branch & Address : KRISHNA NAGAR,

Interest Rate Methodology

a. Interest rate risk (fixed vs floating loan)

b. Credit and default risk in the related business segment

c. Historical performance of similar homogeneous clients

d. Profile of the Borrower(s)

f. Repayment track record of the Borrower(s)

g. Secured Vs Unsecured loan

h. Nature and Value of collateral Security,

j. Ticket size of loan

m. Location delinquency and collection performance

n. Customer Indebtedness (other existing loans)

General Terms and Conditions

I hereby agree, confirm and authorize:

3. I hereby acknowledge that:

6. Consent for additional details