Home Loans - Additional Co-Applicant FormPlease fill information in capital letters and black ink

House type Owned Leased Rented

Preferred Address for Communication

PAN Number

Marital Status Single Married Widow Divorcee Separated

Religion Hindu Muslim Sikh Christian Zoroastrian Buddhist Jain Other

Category SC ST OBC General Others

UID No. Date of Issue

VID No. Date of Issue

Mobile No

Pin code

Nature of Employment Self Employed Salaried Wage worker Contract worker Farming

Permanent Address

Landmark

District

City

State

House number

Street/Area

Same as applicant

Highesh Academic Qualification

Personal Details (Individual)

Name

Gender Male Female Third Gender

Father's Name

Mother's Name

Spouse's Name

Date of Birth D D M M Y Y Y Y

Pincode

Mobile No

House type Owned Leased Rented Years of stay

State

District

City

Street/Area

Present Address

House number

Same as applicant

Relationship with Applicant

Person with Disability

Date of ExpiryPassport No.

Date of ExpiryDriving licence.

Co

-Ap

pli

ca

nt’

s P

ho

to

Signature

Date

Name

(Paste photo here and signacross such that your

signature is on the photoas well as on the form)

Declaration

“I/We, ____________________________________________________________________________________________________________________, hereby declare that

the particulars furnished above are true and correct to the best of my/our knowledge and that no information has been withheld/suppressed. I/we understand that the

sanction of the loan is at the sole discretion of Ujjivan Small Finance Bank upon fulfilment of the other terms and conditions as required by Ujjivan .Small Finance Bank

I/we agree that Ujjivan shall be entitled to reject my application without giving any reason therefore. I/we confirm that the loan shall be used for the stated purpose and

will not be used for any speculative or anti-social purpose. I/we declare that I/we will not take loan from any other bank for the purpose as stated in the application form without permission from Ujjivan Small Finance Bank. I/we authorize Ujjivan Small Finance Bank to conduct such credit checks, references and make enquires in respect

of the application as it may consider necessary in its sole discretion and also authorize Ujjivan Small Finance Bank without any notice to me/us to share and disclose the

information relating to the loan to any credit bureau, financial institution or any other authority for proper verification and other administrative services. I/we undertake

to inform Ujjivan Small Finance Bank regarding any change in my/our occupation/postal address/telephone number and to provide any further information that may be

I/we confirm that Ujjivan Small Finance Bank may call for additional documents other than those already submitted along with the application form. I/we confirm that I/we have read the terms and conditions applicable to this loan and/or they have been read to me/us

in_____________________________________ (vernacular language) by ______________________________________________________________________Mr./Ms.

son/daughter of _____________________________ and I/we understand, accept and acknowledge the contents herein, and hereby accept the terms and conditions herein.

I/we agree that these terms and conditions may be changed by Ujjivan at any time. Small Finance Bank Ujjivan Small Finance Bank reserves the right to retain the photograph and the documents submitted with the application and may not return the same to the applicant. I/we acknowledge that information given in the loan

application shall form the basis of any loan Ujjivan may decide to grant to me/us.Small Finance Bank Ujjivan Small Finance Bank may use the services of agents in

sales/marketing/service etc. and the promotional/service/transactional calls/messages may be sent by such agents on behalf of Ujjivan Small Finance Bank.”

Yes No

required. I/we hereby give my consent to Ujjivan Small Finance Bank Ltd to carry out my/our Aadhar EKYC authentication and to fetch EKYC data from Aadhar data base.

Emp. ID UJJ

Emp. ID UJJ

Emp. ID UJJ

Loan Officer

Credit Officer

Cluster/Program Manager

Signature D D M M Y Y

D D M M Y YSignature

Signature D D M M Y Y

Note: This form is an addendum to the Home Loan Application Form