Contacted By _________________

Contact No __________________

SUBSCRIBER INFORMATION CUM APPLICATION FORM

PERSONAL INFORMATION

Name of the subscriber

Father / Husband Name

Telephone Numbers

E-mail

Permanent Address (PI. provide proof of address)

Mailing Address (PI. provide proof of address)

Name of Spouse

Names of Children

No of Dependents

Nature of Business

Your Vehicle

Your House

Name Address

Partners / Directors / Employer

Incase of Partnership Firm & Company

PAN number (P). provide copy of PAN Card

Mr./Mrs.Dr

D

D

1

3

6

2

5

7

DateAnniversary

OWNCAR :

TWO WHEELER :

FINANCED COMPANY PROVIDED

COMPANY PROVIDED

COMPANY PROVIDED

FINANCED

FINANCED

OWN

OWN

D

MR

O

O

B

B

D

D

M

M

M

M

Y

Y

Y

Y

Y

Y

Y

Y

INFORMATION

Nominee Details

If nominee is a minor then provide Name & address of guardian

Name Relationship Date Of Birth Percentage

PROFESSIONAL DETAILS

You are (Pl. tick the appropriate)

If self employed (Pl. tick the appropriate)

Your Profession (PI. indicate the nature of activity if others is ticked) BUSINESS DETAILS

FINANCIAL DETAILS

Date of Establishment

No. of employees

Name and Address of the Firm/Company

PAN/TAN Number

Annual Turnover

Monthly Income

Immovable Properties (PI. furnish details of the properties) Location & Address

Pl. provide copy of latest financial statement

If salaried - employed in(Pl. tick the appropriate group)

1

1

3

2

2

4

5

SALARIED

GOVT

PROPRIETOR

CHARTERED ACCOUNTANT

BANKER BULIDER OTHERS

(Pl. indicate the nature of activity if others is ticked)

PUBLIC - SECTOR

PARTNER

DOCTOR ENGINEER LAWYER

DIRECTOR OTHERS

PUBLIC - LTD - CO

SELF - EMPLOYED RETIRED PENSIONER

PVT LTD MNC

Are You Member of any chits group in Our Company?

Are You Member of any Other Chits Company?

Name Of Company

DECLARATION

Place :

Date : Signature of Introducer Signature of Subscriber

Of the above encumbered properties,if any (Pl. indicate the serial number from the above list and inform to whom it is encumbered)

Refrence

1

1

3

3

2

2

4

4

5

5

YES

YES

NO

NO

IF YES GROUP ID

IF YES GROUP ID

IF YES GROUP ID

IF YES GROUP ID

MONTHLY SUBSCRIPTION AMOUNT

MONTHLY SUBSCRIPTION AMOUNT

VALUE OF CHIT

VALUE OF CHIT

TERMINATION DATE

TERMINATION DATE

1.I/We hereby confirm and declare that the above mentioned particulars are correct.

2.Rules and regulations relating to the chit has been read/translated and I/We have understood the same. I/We agree to be bound and abide by the terms and conditions of Mahathej Chit Funds PVT LTD I wish to join the proposed Chit group as subscriber.

3.I/We understand that I/We have to give security to the extent of future liabilities (installments) when I/ We bid the chit. I/We here by agree to give security acceptable to the company to the extent of up to 150% of the future liability in the form of moveable or immovable properties.

4.Please allot me a chit of value Rs----------------- with a monthly subscription of Rs------------------------- I am remitting Rs--------------------(Rupees --------------------------------------------------------------------only) By cash/cheque/DD/NEFT/RTGS No-------------------- date ------------- Drawn on --------------- being the payment of first installment

1. In case of partnership firm the authorized signatory/signatories as per the partnership deed should sign the form2. In the case of Companies and Trusts, a resolution to join the chit is to be attached.

OFFICE USE ONLY

INSTRUCTIONS OF FILLING THE FORM

Receipt Number

Customer ID

Introducer / Name

Verified By / Name

Group Details

Branch Name

Group Details

Authorised / Signature

Signature

Admitted / Not AdmittedSignature

1. Please fill in all the columns in capital letters.2. Ensure entering only one alphabet in each block wherever the columns are divided into blocks.3. Wherever indicated please provide copies of the necessary documents as proof.4. Acceptable documents --- both original and copy to be produced. Original will be returned after verification.

Passport Passport

Driving License Driving License

Voter’s ID Card Voter’s ID Card

Latest Telephone Bills

Employer’s Certificate

Rental Agreement

Aadhar Card

ID Card issued by Government authorities

ID Card issued by Employer Acceptable to us

Proof of Identity Proof of Address

5.If space is not sufficient please use attachment s and provide the column reference in the attachment.(Example: if space is not sufficient for address of various properties, then provide the same in a separate sheet and write “Immovable Properties” on the sheet and Pl. see the attachment list in the column).

6.Wherever “Yes” is retained and “No” is scored off, Pl. furnish the required details.

OFFICE ADDRESS

#65, 2nd floor, 1st Block, 3rd Cross, 3rd Phase, BSK 3rd Stage Bangalore,Karnataka, India - 560085

mahathejharichits@gmail.cominfo@mahathejharipvtltd.com

+91 93 4215 5275