Annexure A

ARYAVART BANK
(A Joint Undertaking of Govt. of India, U.P. Govt. & Bank of India)
Head Office: Gomti Nagar, Lucknow 226010

FOR OFFICE USE ONLY

File No. Loan A/C No.

Sanctioning Authority Sanctioned Amt. Rs ……………… ……….
Sanction Date Processing Fees Rs ……………… ……….

To,
The Manager
Aryavart Bank
Branch

ANNAPURNA LOAN APPLICATION- INDIVIDUALS

Loan requested for Rs. …………………
1200000 Period of Loan 7
………………….. years
Type of Loan OD facility Rs. ……….. Term Loan Rs. ………… Total Loan Rs. …………………
Purpose of Advance : …………………………………………………………………………………………………………

In case of repayment of personal loans of other banks

Name of the Bank : …………………………. …….. Account No. ……………………
Amount Outstanding Rs. …………………………. as on …………………………..

PERSONAL INFORMATION OF APPLICANT/S

Full Name Gender Male / Female / Other

(in Capital Letters only) RAJKUMAR
Father’s Name Mother’s Name
Date of Birth Qualification
Aadhar No. PAN No .
Religion / Cast Category Gen / OBC / SC / ST
Mobile No. Marital Status Married / Unmarried
Permanent Address Correspondence
Address

EMPLOYMENT INFORMATION :
Type of Employment Salaried Employed in Govt./PSUs/Company/Others
Employers Name Designation
Office Phone No. Contact Person
Date of Joining Date of confirmation
Office Address
 INCOME DETAIL :
Applicant :
APPLICANT
1. Monthly Gross Income
2. Other Income(Specify)
A Total ( 1+2)
3. Outgoing
(a) Income Tax/Profession Tax
(b) PF /NPS Contribution
(c) Insurance Premium
(d) House Rent
(e) House Loan Instalment
(f) Vehicle Loan Instalment
(g) O/D Limit/over head interest
(h) Loan Instalment
(i) Children Education
(j) Other (Specify)

B.Total Outgoings
4. Net Income (A-B)
FINANCIAL STATEMENT

Please give details of all assets and liabilities of applicant like immovable property,
bank savings, PF/NPS, Shares etc, separately in following format on separate sheet (As
per CBD -23)
Assets Liabilities
Particulars Value (A) Particulars Value (B)
1.
2.
3.
4.
5.
Net worth : (A) – (B) : Rs……………………
SECURITIES / COLLATERAL

Particulars Value in Rs.

1. Main Security
2. Collateral Security
a. ...………………. ...……………….
b. …………………. ………………….
c. …………………. …………………
………………………. ………………….
TOTAL
 DETAILS OF BANK ACCOUNTS

Applicant
Bank
Branch
Type of A/c
A/C Opened on
Present Bal.
DETAIL OF CREDIT CARD HELD

Issuing organization Applicant

Card No. Credit
Limit
Date of obtained
EMPLOYMENT HISTORY (LAST 10 YEARS) OF APPLICANT/CO-APPLICANT

Employer Designation Contact Person Phone No. No. of Year

1.
2.
3.
4.
I/We confirm that I/We have/had not any insolvency proceedings against me/us nor
have I/We ever been adjudicated insolvent I/We further confirm that I/We have read bank's
brochure and understood the contents. I/We agree that Bank may take up such references and
make such enquiries in respect of the application as it may deem necessary. I/We undertake to
inform the bank regarding any change in information provided above and to provide any
information/ documents that bank may require. I/We further agree to execute the document/
declaration/ undertaking that the bank may ask to do and agree to be bound by such
document/declaration/under taking and be governed by the rules of the bank which may be
informed from time to time. I/We further state that:

1. I undertake that I do not have any advance facility from any other Bank other than declared
above and I shall not seek any advance facility from any other Bank without your prior
written consent so long as I continue to be indebted to you. You will be full entitled to
withdraw the advance facility/ies granted to me in the event of my committing of this
undertaking.
2. I have given the irrevocable letter/s of authority to my employer/s authorizing the
realization of monthly installments as aforesaid from my salary as well as monthly interest
and or other dues that may be payable to me and the event of my resignation/ retirement /
death/ termination from services for any reasons whatsoever and for making payment
thereof you directly. A copy thereof duly acknowledged is enclosed.
3. I undertake to provide further information as bank may ask from me from time to time.
4. I undertake to execute necessary documents for the loan at my costs and to create
adequate security for the loan as desired by the Bank prior to disbursement of the loan.
5. The information given herein above is true to the best of my knowledge and belief.
6. The finance required beyond the bank loan, shall be met by me/us as is stated herein above.
7. The above information provided by me/us is true and correct. I/We undertake that if based
on the information provided by me/us our guarantor/s, Bank sanctions loan/s to me/us and in
case at any point of time hereinafter it transpires that any information provided by
me/us/our guarantors is found to be incorrect/false or that the loan availed of by me/us is
not used for the purpose mentioned above the bank shall be at liberty to recall the advance
forthwith, irrespective of the contracted terms of the loan and charge me penal/additional
interest as deemed fit. I/we would repay forthwith the entire loan outstanding together
with interest/penal additional interest and other charges.
8. I authorize the Bank to take my Credit Information Report from the CICs and debit my
account to pay the applicable charge for it.

PHOTO Signature of Applicant

APPLICANT Date:

Place:
 PERSONAL INFORMATION OF GUARANTORS
Particular Guarantor – 1 Guarantor – 2
Full Name (Capital Letter)
Father's Name
Occupation
Age (in Completed Years)
Address
Phone
Employment Details
Type of Employment
Designation
Employers Name
Employed in

DETAILS OF BANK ACCOUNT

GUARANTOR - I GUARANTOR-2
Bank
Branch
Type of A/c
Present Bal.
DETAILS OF CREDIT CARD
GUARANTOR - I GUARANTOR-2
Issuing organisation
Card No./A/c No.
Credit Limit
Date obtained
I/We hereby declare that the particulars furnished by me hereinabove are
true to the best of my knowledge and believe. I/we authorize the Bank to take my/our
Credit Information Report from the CICs and debit my account to pay the applicable charge
for it.

Signature of Signature of
GUARANTOR - I GUARANTOR-2

Date :
PHOTO PHOTO
Place :
Guarantor-1 Guarantor-2
 ARYAVART BANK
HEAD OFFICE: A-2/46,
A 2/46, VIJAY KHAND, GOMTI NAGAR, LUCKNOW

(FOR OFFICE USE ONLY)

BRANCH :

PROPOSAL NO. …………….. DATE : ………..

PURPOSE OF ADVANCE : …………………………………………………………………………………………………………

In case of repayment of personal loans of other banks

Name of the Bank : …………………………. …….. Account No. ……………………
Amount Outstanding Rs. …………………………. as on …………………………..

TENOR OF LOAN : ……………. Years / months LOAN AMOUNT : Rs. …………

A. DETAILS OF APPLICANT/S :

1. Name / Father’s / Husband’s Name

2. Net Worth (As per CBD-23

23 Dated: ……………… enclosed) Rs. …………….

3. Constitution

4. Date of Birth & Age

5. Date of Joining

6. Date of Confirmation

7. Remaining Length of Service

8. PAN

9. Aadhar

10. Mobile

11. E-mail

12. Profession/ Emp ID

13. CIBIL Score

14. Permanent Address

15. Present Address

16. Monthly Income Rs. …………………..

Annual Income Rs. …………………..
(As
As per …………………………. for month / year)
year
 D. GUARANTOR’S DETAIL

GUARANTOR’S Guarantor – 1 Guarantor – 2

Name
Address
Age
Net Worth
CIBIL Score
Existing Loan 1. Name : …………………………………. 1. Name : ………………………………….
A/c details of
2. Purpose : ……………………… 2. Purpose : ………………………
guarantors
3. Sanction Amount : ……………………. 3. Sanction Amount : …………………….

4. Outstanding : …………………………… 4. Outstanding : ……………………………

5. EMI : ……………………………………….. 5. EMI : ………………………………………..

6. Overdue : …………………………………… 6. Overdue : ……………………………………

E. ELIGIBILITY CRITERIA (As per extant circular no. …………………. Dated:…………………)

1 Monthly income of proponents(s) Rs…………………………

Monthly net Income Rs…………………………
Eligible Amount Rs. …………………………
(20 times of monthly net income)
2 Amount Applied Rs. …………………………
3 The deduction of proponent(s) should be
below 65% of monthly salary/income Monthly Income of the proponent (s) Rs .…….……
as per salary slip/ITR of ……… 20…….
Monthly deduction as per salary slip/ Rs ……………
ITR ……………… 20 ……..
Existing all Loan A/C deductions of Rs ……………
the applicant(s)
Proposed deduction on loan amt. of Rs ……………
Rs. ………………… for ……………. EMI
Proposed deduction for RD. of Rs ……………
Rs. …………… …… monthly
Total proposed deductions Rs ……………
Proposed deduction % ………. %

4 Loan Amount Recommended for Sanction Total Rs. …………………….

(1 or 2 whichever is lower) Out of which OD Rs. ………………….
and Term Loan of Rs. …………………

F. SECURITY PROPOSED :

Details of the proposed RD Monthly Installment – Rs. ………… Tenor ………….. Maturity Rs ………………..
(in case of OD)
Others if any
Rate of Interest CIBIL Score : ………………………
As per circular no. … …….. dated …………. Interest Rate : ……………………

Repayment Repayment of OD On Demand

Repayment of Term Loan

Total repayment period : ……………… months
Number of EMI : ……………….
Amount of EMI : Rs. ……………………….
EMI commencing from : ……………………………..
Documentation 1. DP Note (L-434) 7. Deed of Guarantee (OD-194)
(indicative) 2. Bearer Letter (L-435) (Stamped)
3. Debit Authority Letter 8. Irrevocable Authority Letter
4. Installment Letter (L-440) 9. Salary certificate of proponent
5. Authority Letter (AG-15) and guarantors
6. L-516 (Stamped) 10. Debit Authority Letter for
monthly deduction of RD.
Delegation Power As per extant circular no……………… dated ……………..….. of the bank the delegation
to sanction this proposal lies with ………………………………………

Other Terms & ………………………………………… ………… …………… ………………….. …………………………………… ………………

Conditions ……… ……… ……………..
………………………………………… ………… …………… ………………….. …………………………………… ………………
……… ……… ……………..

Comments & Recommendations :

………………………………………… ………… …………… ………………….. …………………………………… ……………… ……… ………

……………..

………………………………………… ………… …………… ………………….. …………………………………… ……………… ……… ………

We have scrutinised the application cum proposal and observe that the same is as
per the scheme of the bank. We recommend for sanction of loan
Rs. ............................ to Shri ........................................................................ under
Aryavart Annapurna Scheme of the Bank as detailed above.

MANAGER / SENIOR MANAGER / CHIEF

MANAGER

SANCTIONED Rs..............................

Date :

BRANCH MANAGER / REGIONAL MANAGER / GENERAL MANAGER