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APPLICATION FOR LOAN UNDER APNA OFFICE – 1 / 2 (Individuals) File No. : Agent : HLA/DSA/CRA Code : Please take due care & fill in all the details in CAPITAL LETTERS only. A completed & correctly filled in Form will help us in processing your Application faster. An incomplete / incorrect Application is liable to be rejected. PERSONAL INFORMATION APPLICANT CO-APPLICANT Full Name Surname First Name Middle NameSurname First Name Middle Name Father’s Name Date of Birth, Age, & Sex DD MM YYYY Age: years Male Female DD MM YYYY Age: years Male Female Income Tax PAN [attach Xerox Copy] Place of Birth Marital Status Single Married Others Single Married Others Exact Educational Qualification, Name of Institute / University from which Qualification obtained, & Year of Passing (please specify & attach Proof) Category SC / ST OBC Others SC / ST OBC Others Dependents Please specify Relation of Co-applicant with Applicant: ___________________________________________ No. of Dependents: Children ____________________________ Adults _____________________________.Residence Address _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ Nearest Landmark ___________________________ Dist. _________________ State __________________ PIN STD Code _________ Ph. # _______________ Mob. # __________________ E-mail _____________________________________ No. of years at above Residence __________________ Residence Status: Owned Rented If rented, Rent p.m. _____________________ Permanent Address _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ Nearest Landmark ___________________________ Dist. ________________ State ___________________ PIN STD Code __________ Ph. # _______________________________________ 1 Details of Loans / Cash Credit / Overdraft Facilities availed : [Please attach separate sheet if space is insufficient] Name of Bank / FI Sanc. Date, ROI, Term, & Purpose Details of Security OfferedSanc. Amt. / Limit EMI, if any O/s. Bal. as on Date Have you / your Spouse ever stood as Guarantor ? Yes No If yes, give details : _________________________________________________________________________________________________________ INCOME INFORMATION APPLICANT CO-APPLICANT Present Office Address ___________________________________________ ___________________________________________ Dist. ______________ State ___________________ PIN STD Code __________ Phone No. ______________ FAX _______________ Office Status: Owned Rented If rented, Rent p.m. ___________________________ ___________________________________________ ___________________________________________ Dist. ______________ State ___________________ PIN STD Code __________ Phone No. ______________ FAX _______________ Office Status: Owned Rented If rented, Rent p.m. ___________________________ Nature of Professional Activities & Number of Employees Experience No. of years in current Prof. Practice : _______ years Total Experience: _______________________ years No. of years in current Prof. Practice : _______ years Total Experience: _______________________ years Details of Registration with Statutory Authority Are you regd. with any Statutory Authority? Yes / NoIf yes, Name of Authority: ______________________ ___________________________________________ Registration No. _____________________________ Are you regd. with any Statutory Authority? Yes / NoIf yes, Name of Authority: ______________________ ___________________________________________ Registration No. _____________________________ Gross Annual Income Rs. /- p.a. Rs. /- p.a. Net Annual Income Rs. /- p.a. Rs. /- p.a. Note : (1) Please attach the copies of ITRs, Income Computation Statements, & full set of Financials for the last 3 Assessment Years, along with a Note on the Professional Activities. (2) If Loan is required under Apna Office – 2 , the Detailed Project Report should also be provided. 2 LOAN INFORMATION Loan Required (Rs.): Type of Rate of Interest: Floating / Fixed-10 Term Desired (Max. 10 years): Mode of payment of EMI: ECS / PDC / Escrow Due Date of EMI: Whether to start EMI immediately {required only in case of Construction}? Yes No Purchase of Office / HospitalConstruction of Office / Hospital Extension of Office / Hospital Purpose of Loan: Improvement / Renovation Purchase of Equipments FINANCIAL INFORMATION Particulars Applicant [Rs.] Co-applicant [Rs.] Particulars Applicant [Rs.]Co-applicant [Rs.] Bank Savings / Deposits Life Ins. Policies / PLI Other Properties Shares & Securities Current Balance in PF / PPF Other Assets (Pl. specify) Monthly Expenses : Rs. _____________________/- p.m. Are you a Shareholder of LICHFL? Yes / No Bank A/c. Details [Please attach copies of Bank Statements for at least past 6 Months] Name of the A/c. Holder Name & Address of the Bank Type of Account Account No. PROPERTY INFORMATION [Please attach copies of Title Documents] FULL ADDRESS OF THE PROPERTY ________________________________________________________________________________________ ________________________________________________________________________________________________________________________ Nearest Landmark ____________________________ Dist. ___________________ State _______________________ PIN Area of Land / Undivided Share of Land: __________________ Sq. Ft. Built-up Area: ___________ Sq. Ft. Carpet Area: ___________ Sq. Ft.Name (s) of Owner (s) : ______________________________________ In case of Leasehold Plot : - Name of Lessor: _______________________________________________ Term of Lease: _______________ Dt. of Expiry of Lease : ______________ In case of Purchase of Ready-built / Under Construction Office / Hospital: - Name & Address of Vendor / Builder: ___________________________ _________________________________________________________ Year of Construction (in case of Ready-built): ____________________ % complete: ______________ Exp. Completion Dt.: ______________ Date of Sale Deed: __________ Validity of Sale Deed (days) ________ In case of Construction / Extension of Office / Hospital: - Const. Stage (% completed): _________ Exp. Completion Dt.: ________________ [Note: Please attach the detailed Construction / Extension Estimates] In case of Improvement / Renovation: - Year of Construction of Office / Hospital: ___________________ [Note: Please attach detailed Improvement / Renovation Estimates] Cost / Value of the Property (Rs.) : Cost of Land / Undivided Share of Land (UDL): ____________________ Cost of Office / Hospital (excl. Land / UDL Cost): ______________________ Estimated Cost for Construction / Extension: ______________________ Estimated Cost for Improvement / Renovation: _______________________ Cost of Amenities: ______________________ Total Cost : _________________________ Valuation of Property : __________________________ Cost of Equipments to be Financed, if any (Rs.) : [Please attach separate sheet if space is insufficient] Name of Equipment Price (Rs.) 3 Sources of Funds (Rs.) : Means of Finance Total Requirement Invested so far Promoter’s Contribution Disposal of Investment / Property Loan (s) from LICHFL Others (Pl. Specify) _________________________________________________ Total Funds LIFE INSURANCE POLICY DETAILS [Please attach separate sheet if space is insufficient] Policy No. Name of Insurer & Branch Name of Policyholder Type of Policy & Term Sum Assured (Rs.) Premium Amount (Rs.) Mode of Premium Pmt. [M / Q / H / Y] Dt. of Comm. Present Surrender Value (Rs.) Are you opting for Griha Suraksha (Group Mortgage Redemption Assurance Scheme)? Yes / No. REFERENCES Name: _____________________________________________________ Address: ___________________________________________________ ___________________________________________________________ ______________________________________ Dist. ________________ State ______________________________ PIN STD Code ___________ Ph. # (R) _______________________________ Ph. # (O) ____________________ Mob. # _________________________ E-mail ID: __________________________________________________ Name: _____________________________________________________ Address: ___________________________________________________ ___________________________________________________________ ______________________________________ Dist. ________________ State ______________________________ PIN STD Code ___________ Ph. # (R) _______________________________ Ph. # (O) ____________________ Mob. # _________________________ E-mail ID: __________________________________________________ DECLARATION I / We declare that all the particulars and information given in the Application Form are True, Correct, and Complete, and that they shall form the basis of the Contract for any Loan LICHFL decides to grant to me / us. I / We have no Insolvency Proceedings against me / us nor have I / we ever been adjudicated Insolvent and further confirm that I / we have read the LICHFL Brochure giving details of its Loan Schemes and understood its contents. I / We have understood and selected the Interest Rate Option available. I / We am / are aware that the option on Interest Rate once selected cannot be changed and change (s) may be permitted only at the sole discretion of LICHFL on such Terms and Conditions as decided by LICHFL. I / We agree that LICHFL may take up such references and make enquiries in respect of this Application, as it may deem necessary from my / our Banker (s) or Others. I / We undertake to inform LICHFL regarding any change in my / our Occupation and to provide any further information that LICHFL may require. LICHFL may make available any information contained in this Form and other Documents submitted to LICHFL and information pertaining to the Loan to any Institution or Body. LICHFL may seek / receive information from any source / person to consider this Application. I / We further agree that my / our Loan shall be governed by the Rules of LICHFL which may be in force from time to time. I / We understand that the Upfront Fee is not refundable under any circumstances, and the Loan Sanction or Rejection is at the sole discretion of LICHFL, even after payment of such Fee. I / We am / are aware that the Original Title Deeds (including the Chain of Title) in respect of the Property standing in my / our name will have to be deposited to LICHFL as Security for the Loan. I / We am / are also aware that if the Equipments are also financed, the same will have to be Hypothecated to LICHFL as Security for the Loan. In purchase cases, I / we am / are aware that the Loan Cheque will be given in the favour of the Vendor only and I / we agree to this procedure. Recent Passport-size Photograph of the Applicant with Signature across Recent Passport-size Photograph of the Co-applicant with Signature across Applicant’s Signature : _______________________________________ Co-applicant’s Signature : _______________________________________ Place: ___________________________ Date: ____________________ Mail Correspondence to: Residence Address Office Address Permanent Address 4
