~~,

NF 965/5L(25)O6-2006/Master

{(~ ~U ~/CANARA BANK ~'~I~I'"tJ '"tJ1~1~1'"tJ

lJ~) (\1Kff ~-q:;r~) / (A Govt. of India Undertaking) Photograph Photograph

f,-..:~A' ::0..;""'"
~~~ 5I'.-q:;r.
112, '"'.~. ~I.s,~..,.,\;~-2 / H.O: 112,J.C. Road,Bangalore-2

~
Applicant
~Jt. ApplicanVGuarantor/Co-obligant
~/~/~-31T'I1rf:r
~ 3tia:G;f -~ / LOAN APPLICATION .
(~'«'Ift~\i{, ~~~m~3:hr;;rt:T-~f~m~~it v'" ~~)
(Pleasecompleteall columns,use BLOCKlettersand tick appropriateboxwhereverapplicable)

f1/~ 3:frq"i1
~ij/TO: ~~ ~ ~ ~~
m~/CanaraBank, ~'I~-ilj~l~ ~ ~ ~/{=m9"~
'."."'."'...""""".""""""'.""""""" 5I'?;Ff~I

l/We request you to grant me/us the loans/credit facilities indicated below as per the Bank's Scheme.

ij;'i~IG1I$("1/CANMOBILE0 ~/CANBUDGET 0 ~/CANPENSION 0 ~~/CANMAHILA 0

~rq'("f/CANTRAVEL 0 i ~/CANTECH 0 ij;'i~~("1/CANJEWEL 0 ~~/TEACHERS'LOAN D
3:jlq~(j~~~ ~~~~/The necessary particulars are furnished hereunder:

I. ~ ~ ~~/~/~-~
PARTICULARS APPLICANT JT. APPLICANT/GUARANTOR/CO-OBLIGANT

~/NAME:
fr.rffr / qfff 'CfiT
~ S1jt/1'ftf1{ft/~/Mr/Mrs/Ms S1jt/1'ftf1{ft/~/Mr/Mrs/Ms
,

FATHER'S/HUSBAND'S
NAME: $'jt/Mr. , $'jt/Mr. ::..

.r;J}i'f!f/MALE D I I I I I I I r;J}i'f!f/MALE D
;;r;q-rnfi.rq~ / DATE OF BIRTH & SEX: I I I I I I I ~ D I I I I I I I ~
'1IQ~I/FEMALE '1IQ~1/ FEMALE D

qir/CATEGORY: 3T~/SC D 3T\1f~/ST D 3T~/SC D 3T"f~/ST D

f!t~/BC D ~/OTHERS D f!t~/BC D ~/OTHERS D
:3:j~~~~ct1~/MINORITY COMMUNITY:. :3:j~~~~ct1~/MINORITY COMMUNITY:
~/Christian D ~/Muslim D ~/Christian D ~/Muslim D
~/Parsi D ~/Sikh D ~/Parsi D ~/Sikh D
~ / ZorastrianD ~ / ZorastrianD

3frqf{f ~ / RESIDENTIALSTATUS: ~ / RESIDENT D ~ / RESIDENT D

3T-~/NON-RESIDENT D 3T-~/NON-RESIDENT D

~ ~ / EDN.QUALIFICATIONS: ~ / UNDERGRADUATE D ~ / UNDERGRADUATE D

~/GRADUATE D ~/GRADUATE D
~'<1ct1I~~/
POST-GRADUATE D ~1<1ct1I~~/
POST-GRADUATE D

~/PROFESSIONAL D ~/PROFESSIONAL D
(~~/Specify ) (~~/Specify )

~~/MARITALSTATUS: ~/MARRIED D ~/MARRIED D

~/UNMARRIED D ~/UNMARRIED D

~';f:r'if./No. of DEPENDENTS: ~/CHILDREN D ~/CHILDREN D

~/ADULTS D ~/ADULTS D

=1
 ciI"Zt.~i\""ifirt{{.jVOTERIDCARDNO
q;r~./PAN No.: I [
~1~~lt{{./PASSPORTNO .
I I
~ ~ m 'fir/ Owned D m 'fir/Owned D
PRESENT ACCOMMODATION ~ iTU ~ / Company provided D ~ iTU ~ / Company provided D

qft"qJ\/Family D qfto;:m:/Family D

~~/Rented D ~~/Aented D

~ ~/Aent Paid (As ) ~ ~/Aerit Paid {As }

~/Others D ~/Others D

Aesidential
~q"(fT' Address q<fffr;r/Present: """""""'.""""'.""""'."""'" q<fffr;r/Present:

.fq';fjPIN I I
'..'.'..".'."'.".""'.".".""'."'..'.' I I I I I fq';f/PIN
..'..".'..'..'..."..'.'...' I I ' I ' I' I I I

~it~rfffqr/
~ {{ {{.
.jTelephone
/ Mobile No.
No. '.' ' ""."""".".."."

Since how long at this address qrf !Vears qrf /Vears

~/Permanent: fq';f/PIN I I I I I I I , ~/Permanent: fq';f/PIN I 1 II I I I

:sTq;'-qm~~~~%j
f-~ ~ i\" / E-MaiIID: ~/Aesidence D ~/Aesidence
'.'...'...' ' '.'."""""..".."...".' D

Communication to be mailed to : ~ q"(fT/ Permanent Address D ~ q"(fT/ Permanent Address D

~ / Office D ~ / Office D

II. ~(1-1~I"1 ~~~~1~(1'/~~1'q' ~ II. ~(1-1~I"1 ~~~~I~(1'/~' ~

SALARIED' SELF EMPLOYED./BUSINESS. MISCELLANEOUS SALARIED' SELF EMPLOYED./BUSINESS. MISCELLANEOUS

'i~GI~~11~ ';f; 0 ~~ful~{1f D ~~ D 'i~i1~~11~ ';f; D ~~ful~{1f D ~~ D

Multinational Co Manufacturing Retired Multinational Co Manufacturing Retired
~fR.';f;. D ~I~~I~ D ~ D ~fR.';f;. D ~I~~I~I D ~
Public Ltd Co Trading Housewife Public Ltd Co Trading Housewife D

~~/~ D ~ 0 ~D ~~/~D ~ D ~D
~~/Govt DeptiPSU Services Student ~~/Govt DepfIPSU Services Student

~fR.';f;. D ~ D ;j:p:f D ~fR.';f;. D ~ D ;j:p:f D

Pvt Ltd, Co Agriculture Others.. Pvt Ltd. Co Agriculture Others..

~/~, D ...~"fi't ~/~. D ...~"fi't

*Prop./
~/~~;rTr{
Partnership Specify *Prop./
~/~~;rTr{
Partnership Specify

'Name of Organisation/Concern : '.'..".' "Name of Organisation/Concern,.,., "..., , ".".,.,

~/Length
~ /Designation of Service
: """"""""'..""""'..""""", ".,.. qrf/Vrs. ~/Length
~ / Designation: of Service
"", ...""""""""'
".,., qrf/Vrs.

~~
~ ~ / Office
q"(fT fufu/Date
Addressof retirement
: : ""'.."'..""""""."""""...".""'."'" ; ~ClIF;j~~ q"(fT
~ ~ / Office
fufu/Date
Addressof retirement
: :,.".,.".,."...",."""...""".."
; : ,."

~/Tele : ..",.,...,.,...,.."..., -
2 ~/Tele : :
 ~ /Oepartment """"""""""""""""""""""""""" , ~ /Oepartment 'If

~ {";r.{";r /./Employee
EPF No No ~MTtt {";r.
{";r. / / Employee
EPF No No , ,.

{";rrro;rifctJq"4I~~1
~{";r. {";rrro;rifctJq"4I~I~1
~~.
No.
~/qrf{fq;~/Monthly/Annuallncome:
of employees in the organisation No.
~/qrf{fq;~/Monthly/Annuallncome:
of employees in the organisation

"fi./As
qf<f/q(:;fT~~/('f\"~/IS m<r/Source
Spouse working: 6T/~ YES/NO. qf<f/q(:;fT~~/('f\"~/IS
"fi./As.., m<r/Source
Spo~e working: ~/~ YES/NO.

~~,
~m«.
~1t\ctJ~i J1rf{1'!f)
/ Issued /3"W:f"fi./lfYes.
Credit
by : "..".."'."""""""""""""""""""""
Card No.monthly """""""""""""""""
income As ~~,
~m«.
~1t\ctJ~i ~3"W:f"fi./lf
/ Issued / Credit
by : CardYes, No.'nonthly
""""""""""""""""""""""""""
income As

~/ Limit: ~ / Limit:

3W:f~ (~.)/INCOME DETAILS(As.) ~~ (~.)I.INCOME DETAILS(As.)

~~/~ ~~q;1-~/ ~~/~ ~~q;1-~/

SALARIED PERSONS I PENSIONERS OTHER THAN SALARIED PERSONS SALARIED PERSONSI PENSIONERS OTHER THAN SALARIED PERSONS

~~~/~ ~~3W:r ~~~/~ ~~3W:r

Monthly Gross Salary/Pension : Annual Gross Income: Monthly Gross Salary/Pension Annual Gross Income:

~~~/~ ~~3W:r ~~~/~ ~~3W:r

Monthly NetRalary/Pensiorl: Annual Net Income: Monthly NetSaiary/Pension: Annual Netlncome:

~3W:r(~'fi'f:) 3W:r~~,~i:Iilf ~3W:r(~'fi'f:) 3W:r~~,~i:Iilf

Other Income (specify): Income Tax paid, if any: Other Income (specify): Income Tax paid, if any:

q-ifijR"if~m~~~~ q-ifijR"if~m~~~~

~19T(IT~ BANKING WITH:

PRESENTLY ~19T(IT~ BANKING WITH:
PRESENTLY

DEPOSIT A/c DETAILS: DEPOSIT A/c DETAILS:

~,~i:Iilf ~,~i:Iilf
Liabilities, if any: Liabilities, if any:

III. ~ q ~3it c))~ / DETAILSOFASSETS& LIABILITIES:

(~.if/ln As.)

~
"" ~
~~q;-/.
~/~-31J'1rft ~ ~
~~/
~/~-31J'1rft

ASSETS APPLICANT JT. APPLICANT/ LIABILITIES APPLICANT JT. APPLICANT/

GUARANTOR/CO-OBLIGANT GUARANTOR/CO-OBLIGANT

~~ ~/~~/

IMMOVABLE BANK/S/FINANCIAL

PROPERTY INSTITUTION/S

-~ ~/EMPLOYEA"

INVESTMENTS

~if-.rq"(f ~/OTHEAS

SAVINGS WITH BANK/S (~ "fit/Specify)

~/OTHERS

(~~/Specify)
~/TOTAL ~/TOTAL J
IV". "Cfi") ~~/~~/~-~/W611K~~~/~/:a:r;<r~~611K~~fif;{fr~H~

a) ~ I ~ir,
WHETHER mm*
APPLICANT/JT. ~ APPLICANT/GUARANTOR
~ IS RELATED TO CHAIRMAN/DIRECTORS OF OUR BANK/ANY OTHER BANK, ANY EMPLOYEES OF

OUR BANK? IF YES, DETAILS OF RELATIONSHIP :

*~ q;r3riti 3"ftfo
~ ~ ~qffr-q(';ft"
, fqm,tmIT
(~ q'f~) ~ (~ ~ ~), ~;f;'t q(';ft",
:a:tt(~:a:tt), :a:ttq;rqffr,11Tt
(~11Tt), 11Tt;f;'t':f;:;ft,
~ (~~), ~q;rqffr, qffr-q(';ft"q;r11Tt
(~11Tt~), qffr-':f;:;ft;f;'t~ (~~)
.Aelationship means and includes spouse, father, mother (including step'mother/ son (including step-son), son's wife, daughter (including

step-daughter), daughter's husband, brother (including step-brother), brothers wife, sister (including step-sister), sister's husband,

brother (including step-brother) of the spouse, sister (including step-sister) of the spouse.

~) ~~~/~~~~&f/~~/~~I~~,i:iT~~"fit:

b) WHETHER APPLICANT IS THE CHAIRMAN / MANAGING DIRECTOR / DIRECTOR(S) OF OUR / OTHER BANK. YES / NO. IF YES, FURNISH DETAILS:

3
 I' 'I ~~~~

V.~ 'CtiT
~ / PURPOSEOF LOAN:

...~/~~/ ~~/~ I iift::j!q,~/~ ~~~

'Cfi) ~-t~ICSlI~~~~it ~qn ~ "ifif1T):fqqdf I ~(~.) ~(~.)
A. IN RESPECT
OFCANMOBILE Descriptionof Article/ Name& Addressof InvoiceValue/ Loanappliedfor
Vehicle. Make/Model Supplier/Dealer PurchasePrice (Rs.) (Rs.)

-fit~/PURCHASE OF:
~/~:~
Car/Jeep:New
D ~~~~ Used O .

GT~/TwoWheeler 0

~~~
Cons.DurableArticle 0 .

~/Computer 0

~. ~~it- ~'CtiT~ ~~~~~ufu(Q.)

B. IN RESPECTOF .PURPOSE OF THE LOAN AMOUNTOF LOANAPPLIEDFOR(Rs.)

~/CANBUDGET
~ / CANPENSION
~-t~~~1 / CANMAHILA
~~/TEACHERS' LOAN
~-t~I~~ / CANTRAVEL
~ / CANTECH
~/CANJEWEL

~~~it~~~/Details of Journey in case of CANTRAVEL:

~ ~ ~ ~ / ifr q;r / ~ 1T):f yqTIT~ "ifif~~ I~ (\ ~ ~~ ffiTT(!"

/ Estimatedcost
Nameof the person/sundertakingjourney Placesproposedto Ofi;:r "ifif~ '!'ff / TOTAL
be visited ~ / Journey .
Lodging

~ 1JTN~ -fit rnfu / Date of commencement

of Journey: I I I I I I I I I

~/TRAVEL: \'{f{(f/I~lndiaO fum/Abroad 0 ~~it/Through: ~/AirO ~/waterO ~/RoadO

~ ~ / PersonallyarrangedTrip0 ~ ~ ~ ~ ~ ~ ~ / Throughconductedtour 0

VI. ~'CtiT3";f'{rrRfR/REPAYMENT OFLOAN:

~TT(fT;:r3:fqfu/REPAYMENTPERIOD: 00 ~/Months

3~"ifif (f(I"f;T/MODE OF REPAYMENT:

~mwm/~~f~«. ij~'i!f?r~'f;@~~~~~/~~~~~ctJ~~1
0 ~~~~OOI
By registering
withyou. irrevocablemandatewith the Sa)arypayingauthority/Employer
to credit salary to my/ourS8 A/c No

~mwm/m"4f.~. 'f9m~. ij~~/~q;)-~~~~~~~!~~

mw~~ctJ~'~~~~OOI .
0 By registeringirrevocablemandate with the salary paying authority/Employerto remit loan instalments/lnterest to my/our
S8 A/c No , with you.

4 .
 I

D ~~Gt/m"Gf.~. "{gT"(fT~ i;t~~/~~~~~3l~~~1 ~I

Irrevocable Mandate for deduction of loan instalment/interest from my/our S8 A/c No with you.

~
D /~ 1ft;t\'~/Post
~"-t~~(1 Dated
~ Cheques
~ ~ ~ ~ ~ / I/WE HAVE ATTACHED
D ~~(m~)/
THE COPIES OF
AnyTHE
otherFOllOWING
(specify) DOCUMENTS:

~ /q;l- ~ T1lffi/~-~ /U ~ ~ ~ ~ ~IGI~I~ ~ Gl' mam

D 2 copies of Passport size Photographs of the Applicant/s and Guarantor/s / Co-obligant

D mw~/q;l-/Proforma Invoice/s

~~~~~mii'31IGI'iI",I~~ ~~~ftqli (~~mm) .

D Valuation Report of Automobile Engineer in respect of Used Vehicles (if applicable).

~~~~, ~1oo1tt-~(1 ~~~/In addition to the above documents, following are to be submitted by

~~-tlff~"[r{r ~q~lftlCf)I3ffi~m-~~-tlff (~oi~ff;MI/CANMAHllA)

Salaried persons CJTf"[r{r/Professionals and other Cf)1~~lo,I1~I~"[r{r m-~I~Cf)lo,I1~1 f:rftRr[I"{T
Non-salaried class Working women Non-working women

~ ~ ~ qI11f ~. 16 3nt it' ifr w !:frq-fft ~ ~ ~ ~ ~ ~ /~ 3rP:f "q'i\ ~ qfff / fi:rffr / 3':f 'fiT ~
.Salary certificate and ~ Gl' qq1 ~ 3rP:f"q'i\ ~q~fOl~i ~/3nt it'~ ifr ~ ~/~ 3rP:f"q'i\
Form No. 16 Income Tax Returns for the past two Salary Slip and/or IT ~ / 3nt it' ~ ifr

years acknowledged by ITQ Returns/ITAQ Salary Slip and/or IT

Returns/ITAQ of her
husband/father/son

tiT'quJT
/ DECLARATION
1. ~/~~~~~~~~~it~~a-q;-m~~~~~~~~V~ ~I
l/We hereby apply for a loan from Canara Bank to the extent indicated in the Loan Request column of this application form.

2. ~/~~~V~~~~~~it~~~~~~, ~3ft\1iUf~qm~~~q)T3Tf':m:
~~~m~~~~~~~~~1
l/We declare that the foregoing particulars and information furnished in this application form are true, accurate and complete
and that they shall form the basis of any loan Canara Bank may decide to sanction me.

3. ~/~~~V~~~~5rfu~f?;q,ft;l~1 ~~~, ;rmf?;qlft;l~Iq)T~~~1Tl:rT~1

l/We confirm that I have/had no insolvency proceedings against me, nor have I been adjudicated insolvent.

4. ~/~~~V~~~ 31rq'{TJf~"r:f;t5rfu5rm'~~3ft\~~~~~~~1
l/We confirm having received a copy of Fair Practice Code and confirm having read the same.

5. ~/~;srri'r~~V~~~~JffifT~~~3ft\~~~-~~~~1
l/We further confirm that I have read the terms and conditions and understood the contents therein.

6. ~/~~~V~~~~~it5rGR'~~~it~~~~~1
l/We confirm that no litigation is pending in the matter of property offered as security.

7. ~/~~~V~~m~, 31fi:r~~~I~~I~,
~~~mit~~~~~1
l/We hereby agree that Canara Bank may, at its discretion, conduct discreet enquiry in respect of this application.

.8. ~/~q"'q-;r~V~~~~~/~, ,'3:jlql~~I~q"(ITitf/:f;{{t~~~"r:f;t~{rIT/ ~3ft\~~~

~ ~ /'i:fiUTi!r
~ ~ ~ ,'3:j
Iq~~~dI~ I
l/We undertake to inform as to any change in my occupation/employment, residential address and provide any further information
that the Bank may require.

9. m~<:til-~~,'3:jlq~~~m~~~"r:f;t~~, ~~itu/"6lmJ~~m~rrcl(fr:wrr";jfr-af~1
Canara Bank will be at liberty to take such action as it may deem necessary, if my/our above statements are found to be
untrue.

10. ~/~~V~~~~~~~~~~~/~um~~~q)Tm~~~friif~~1
l/We agree that Canara Bank shali have the sole discretion to reject this application/reduce the loan amount without assigning
any reason therefor.

11. ~/~;srri'r~V~~itu~~-~m~~~~~mrrr~~~-~q"{~~\%1TT1
l/We further agree that my loan transactions shall be governed by the rules of Canara Bank which may be in force from time
to time.

~'qjT~ ~~/~'qjT~
Signature of the Applicant Signature of the Jt-Applicant / Guarantor/Co-obligant

~/PLACE: ~/PLACE:

~/DATE: ~/DATE:
5

rI""""C
 l"-'~.' C'~- ,

~1<-li~<-I3~/FOR OFFICE USE

~ ftq)i :{f. / CAED1TAEFORTNo. R:~ I DATE: ~ 3rIt:tt I CUSTOMERID :

-
AJ:=J~ ~ ~ ~ '1Jffi~ ~ ~ ~ ~ ~ IThe followinalimitis sanctionedon the termsand conditionsdetailedbelow:

~~ fcf(j
ct.rm:it"ifir~
~rt't~ ufu("fi.) m;r ~G\* ':!~~ Cfi@~~~~/
Natureof Limit Amount(As.) Margin Rate of Interest' RepaymentConditions Detailsof Security
.including Personal
Guarantee

* ~q"{~OO~lT1:!;~uT~':!~I~ ~~~/*Subjectto changeas decidedby the Bankfrom time to time

~ ~ / Other terms & conditions:

1) ~~"ifir3fi:ra"~~~~~q"{~~'t1Trij-~f{?f~~~/ii"Gq;{~~1 ~~"'fir~~rt't~
« 6~ 1:ftoa\
~ 3'OrnT
~, ~, ~ ~ 31rt1
~ rt't~ I
The Bank may revoke in part or in full or withdraw/stopfinancialassistanceat any stage by giving reasonablenoticeto the borrower.
Credit facilities sanctionedare to be availed within 6 months from the date of this letter, failing which, the limits will automatically
stand cancelied.

2)

3)

4)

~/~~/~~
MANAGER/SENIOR
MANAGER/CHIEF
MANAGER

~rt't~'1Jffi"ifir~~~
Acceptedall the termsand conditionsof sanction.

~/BORROWER