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INDIAN OVERSEAS BANK Affix Passport size photo of applicant Affix Passport size photo of coapplicant Affix Passport

size photo of Guarantor

To The Manager Indian Overseas Bank .. Branch

Application for Sanjeevini Loan scheme Amount of Loan... Personal Details


Name First

Applicant
Middle Last First

Co-applicant
Middle Last First

Guarantor
Middle Last

Name of father / husband Residential address : House number, Street name Locality City /Town State and Pin code

Residence is Do you own a vehicle Permanent address: House number, Street name Locality City /Town State and Pin code Phone Number (residence) Phone Number (office) Mobile Number E-mail ID (personal) E-mail ID (official) Date of Birth Sex Marital Status Number of dependents Income Tax PAN / GIR No. Passport Number Voters ID No. Qualification

Owned Rented Official Two-wheeler Car

Owned Rented Official Two-wheeler Car

Owned Rented Official Two-wheeler Car

Day

Month

Year

Day

Month

Year

Day

Month

Year

Male Female Married Unmarried Children Others.

Male Female Married Unmarried Children Others.

Male Female Married Unmarried Children Others.

Graduate Post Graduate service consultant

Graduate Post Graduate Service consultant

Graduate Post Graduate Service consultant

Occupation

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If in service, designation Name of the employer Address of employer

Number of years in employment/ profession Total work experience

Income Details
Income from salary / Occupation/profession Net income as per salary certificate/I.T return

Income / month (Applicant)

Income / month (co-applicant)

Guarantor

Other income Rent Income of spouse others - specify . Expenses: Rent Installment for other loans Family maintenance expenses

Bank accounts
Name of Bank, Branch

Applicant

Co-applicant

Guarantor

Savings / Current A/c Number Term deposits Deposit amount 1 2 Due on Deposit amount Due on

Property owned
Land and building Location Value Any other property . .

Applicant

Co-applicant

Guarantor

Liabilities
Loan against property Any other borrowing Other guarantees

Applicant

Co-applicant

Guarantor

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For construction/repair/renovation of clinic/hospital


Details of property in which the activity is to take place Location

Built in area / plinth area in the case of construction/renovation In the case of old house, age of the building Whether approval of appropriate authority obtained Whether the property is free of encumbrance Total cost of construction/repair Less: Loan required Margin: (how the margin is to be met)

Loan for purchase of vehicle/ambulance


Make and model of vehicle to be purchased Name of the dealer In case of used vehicle, year of manufacture and age Cost of vehicle Loan amount required Repayment period required

Loan for purchase of equipment


Items to be purchased Name of the dealer from whom purchased

Cost of the articles to be purchased .. .. .. Loan amount required Repayment period required Names of two references with address

1.

2.

Security offered
Nature and type of security If Immovable property location of property / in case of other security, the details thereof:

Value of the security In whose name the security is held Is the security fee of any encumbrance
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Declaration
I/we hereby confirm having read the terms and conditions for the above scheme and agree to abide by the same. I/we confirm that the particulars given above are true and correct and I/we have not withheld any information that may be vital for sanction of the loan applied for by me/us. I/we confirm that the loan amount will be utilised for the purpose stated and not for any speculative or anti social purpose. I/we confirm that I/we have not been declared insolvent or any insolvency proceedings are initiated against me/us. I/we agree that the Bank may make any references and enquiries in respect of this loan application, as may be deemed necessary. I/we agree that sanction of the loan is at the sole discretion of the Bank and shall be governed by the rules of the Bank in force. I/we will execute necessary security documents as per Bank requirement before availing the loan. I/we also understand that the Bank has the right to recall the loan if they are not used for the stated purpose.

CIBIL Disclosure Requirement


I/we hereby agree and give consent for the disclosure by Indian Overseas Bank of all or any such information and data relating to me/us, the information and data relating to my/our obligation in any credit facility granted/to be granted, by the Bank and guaranteed to me/us as a guarantor and default if any, committed by me/us in discharge of my/our obligation, as the Bank may deem appropriate and necessary, to disclose and furnish to Credit Information Bureau (India) Ltd and any other agency authorised in this behalf by Reserve Bank of India. I/we declare that the information and data furnished by me/us to Indian Overseas Bank are true and correct. I/we undertake that the Credit Information Bureau (India) Ltd. and any other agency so authorised may use, process the said information and data disclosed by the Bank in any manner as deemed fit by them; and the Credit Information Bureau (India) Ltd and any other agency so authorised may furnish for consideration, the processed information and data or products thereof prepared by them, to banks/financial institutions and other credit grantors or registered uses as may be specified by the Reserve Bank of India in this behalf.

Signature of Applicant Date:

Signature of Co-applicant

Signature of Guarantor

-----------------------------------------------------------------------------------------------------------------------------------------For Office Use Date of receipt of application: Reason for rejection: Whether all columns have been filled up: Processing charges: Date of sanction/rejection

Whether all documentary proof submitted:

Signature of Manager
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