indus kisan application form 28.08.2020€¦ · application form indus kisan liability application...

APPLICATION FORMINDUS KISAN

Liability Application No.: _________________________

Name of Primary Applicant: _______________________ 1 4 0 2 9 8 0 4 3 5

ADDITIONAL DOCUMENTS/DeefleefjJeÌle omleeJes�e

E.g. Indemnity, Project Report etc., please specify:/pewmes #eefleHete|le, Heefj³eespevee efjHeesì& Deeefo, Je=ÀHe³ee Gu}sKe JeÀjW:

FROM THE BORROWER/$eÝCeer mes

Photograph of the Borrower(s)/$eÝCeer/$eÝCeer³eeW JeÀe/JesÀ HeÀesìes

Application form duly filled & signed/efJeefOeJele Yeje Deewj nmlee#eefjle DeeJesove He$e

Copy of Identity Proof and Address Proof (PAN Card/Election Card/Driving License/ Ration Card/Passport/Aadhaar, Utility Bill, etc.)/Hen®eeve JesÀ ÒeceeCe Deewj Heles JesÀ ÒeceeCe JeÀer Òeefle (Hewve JeÀe[&/celeoelee JeÀe[&/[^eFeEJeie }eFmeWme/jeµeve JeÀe[&/HeemeHeesì&/DeeOeej, ³etefìef}ìer efye}, Deeefo)

Copies of land records confirming ownership & crop pattern, recently dated and not older than 30 daysfrom date of field inspection/mJeeefcelJe Deewj HeÀme} He×efle JeÀer Hegefä JeÀjves Jee}s Yetefce efjJeÀe@[& JeÀer Òeefle³eeb, ne} ner ceW efoveebefJeÀleDeewj #es$e efvejer#eCe JeÀer leejerKe mes 30 efoveesb mes DeefOeJeÀ Hegjeveer ve nes

In case of non agri property, copy of title deeds obtained and cross checked with original before affixingOSV stamp/iewj Je=Àef<e mebHeefÊe JesÀ ceece}s ceW, Òeehle JeÀer ieF& nJeÀ efJe}sKe JeÀer Òeefleef}efHe Deewj DeesSmeJeer mìecHe ef®eHeJeÀeves mes Hen}s cet} mes ogyeeje peeb®e JeÀer ieF&

Attested photocopy of the prevailing land rates record from Sub-Registrar/GHe-Hebpeer³eJeÀ mes Òe®eef}le Yetefce ojesb JesÀ efjJeÀe@[& JeÀer HeÀesìesJeÀe@Heer

Field visit report along with photograph of house and field/ceJeÀeve Deewj #es$e JesÀ HeÀesìes meefnle #es$e oewjs JeÀer efjHeesì&

Valuation report of the non-agri property offered as collateral (if applicable)/mebHeeefée&JeÀ JesÀ ªHe ceW oer ieF& iewj Je=Àef<e mebHeefÊe JeÀer cetu³eebJeÀve efjHeesì& (³eefo }eiet nes)Copy of lease land records, if applicable (affidavit and 7/12 extract of the lease land)/HeÆs JeÀer Yetefce JesÀ DeefYe}sKeesb JeÀer Òeefle, ³eefo }eiet nes (µeHeLe He$e Deewj HeÆe Yetefce JeÀe 7/12 meejebMe)

No dues certificate from Bank(s), local financial institution(s) (if applicable)/yeQJeÀ/yeQJeÀebs, mLeeveer³e efJeÊeer³e mebmLeeve/mebmLeeveesb mes JeÀesF& yeJeÀe³ee veneR JeÀe ÒeceeCe He$e (³eefo }eiet nes)Income proof by submitting Income declared in any of the last 2 FY IT returns or J-form/Mandi tax etc.in case of non-farm income/efJeÀmeer Yeer efHeí}s 2 efJeÊeer³e Je<e& JeÀer Dee³e JeÀj efJeJejCeer ceW Ieesef<ele Dee³e pecee JeÀjJesÀ Dee³e ÒeceeCe³ee iewj-Je=Àef<e Dee³e JesÀ ceece}s ceW pes-HeÀe@ce&/ceb[er ìwJeÌme Deeefo

Legal heirs declaration form (in case the primary applicant is more than 70 years of age)/JeÀevetveer GÊejeefOeJeÀejer Iees<eCee He$e (³eefo ÒeeLeefceJeÀ DeeJesoJeÀ 70Je<e& mes DeefOeJeÀ Gce´ JeÀe nes)

Fl report of Urban collateral, if applicable/µenjer mebHeeefée&JeÀ JeÀer S]HeÀS} efjHeesì&, ³eefo }eiet nes

Whether name of any applicant/guarantor appears in any RBI default/negative list/JeÌ³ee efJeÀmeer DeeJesoJeÀ/ieejbìerJeÀlee& JeÀe veece Yeejleer³e efjpeJe& yeQJeÀ JesÀ ®etJeÀJeÀlee&/veJeÀejelceJeÀ met®eer ceW Dee³ee nw?

Application form duly filled & signed along with photographs/efJeefOeJele Yeje Deewj nmlee#eefjle DeeJesove He$e HeÀesìes meefnle

Proof of agri activity, employment or business or relationship proof of applicant(s)/Je=Àef<e JeÀe³e&JeÀ}eHe, jespeieej ³ee J³eJemee³e ÒeceeCe ³ee DeeJesoJeÀ/DeeJesoJeÀebs mes mebyebOe JeÀe ÒeceeCe

IN CASE OF TAKEOVER OF LIMITS/meercee Hetjer nesves JesÀ ceece}s ceW

Latest sanction letter from existing Bank, if available/ceewpetoe yeQJeÀ mes veJeervelece cebpetjer He$e, ³eefo GHe}yOe nes

Complete TL statement, last 2 years CC statement, last 6 months statement in case of non agri loan and last 6 months Savings Account statement, whichever available (please specify under remarks)/Hetje ìerS} mìsìceWì, efHeí}s 2 mee} JeÀe meermeer mìsìceWì, iewj-Je=Àef<e $eÝCe JesÀ ceece}s ceW efHeí}s 6 ceen JeÀe efJeJejCe Deewj efHeí}s 6 cenerves JeÀe ye®ele KeeLee efJeJejCe, pees Yeer GHe}yOe nes (Je=ÀHe³ee efìHHeCeer JesÀ lenle Gu}sKe JeÀjW)

Particulars/efJeJejCeSr. No./Je´ÀceebJeÀ

Remarks/efìHHeefCe³eeb

Yes/No/NA/neb/veneR/GHe}yOe veneR

FROM THE GUARANTOR/ieejbìerJeÀlee& mes

Copy of Identity Proof and Address Proof (PAN Card/Election Card/Driving License/ Ration Card/Passport/Aadhaar, Utility Bill, etc.)/Hen®eeve JesÀ ÒeceeCe Deewj Heles JesÀ ÒeceeCe JeÀer Òeefle (Hewve JeÀe[&/celeoelee JeÀe[&/[^eFeEJeie }eFmeWme/jeµeve JeÀe[&/HeemeHeesì&/DeeOeej, ³etefìef}ìer efye}, Deeefo)

Copy of title deeds, in case non-agri property has been mortgaged along with a copy of legal opinion onthe title of the property from existing bank. In case of takeover from PACs, whether records were personally verified by visiting society?/³eefo iewj-Je=Àef<e mebHeefÊe JeÀes ceewpetoe yeQJeÀ mes nJeÀ efJe}sKe Hej JeÀevetveer je³e JeÀer Òeefle JesÀ meeLe efiejJeer jKee ie³ee nw lees nJeÀ efJe}sKe JeÀer Òeefleef}efHe~ HeerSmeer mes DeefOeûenCe JesÀ ceece}s ceW, JeÌ³ee meesmee³eìer JeÀe oweje JeÀjJesÀ efjJeÀe@[&JeÀe J³eeqJeÌleiele ªHe mes mel³eeHeve efJeÀ³ee ie³ee Lee?

INDUS KISAN: PRE-SANCTION CHECKLIST/Fb[me efJeÀmeeve: cebpetjer-hetJe& peeb®e-met®eer

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I/We, the farmer(s) named below, hereby individually/jointly apply for the under mentioned facilities aggregating ______________________________________/- (Rupees _____________________________________________________________________________________) I/We furnish below the necessary information.

cewQ /nce efvecveefueefKele efkeÀmeeve SleodÜeje J³eeqkeÌleiele ©He mes /meb³egkeÌle ©He mes veer®es GefuueefKele kegÀue ______________________________________/-(ªHe³es _______________________________________________________) keÀer megefJeOeeDeesb keÀs efueS DeeJesove keÀjlee nbt/keÀjles nwQ~ ceQ /nce DeeJeM³ekeÀ peevekeÀejer veer®es Òemlegle keÀjlee ntb/keÀjles nQ~

INDUS KISANAPPLICATION FORM FOR LOAN FACILITY(IES)/$eÝ=Ce megefJeOee/megefJeDeesW keÀs efueS DeeJesove He$e

FOR BANK USE ONLY/kesÀJeue yeQkeÀ GHe³eesie kesÀ efueS Sourcing RM & Branch Details/ eef Dee S Deew MeeKee e efJeJejCeme s me¥ie j ce j keÀ

Agri RM Name & ECN/Sûeer Dee S e Deew F& erSj ce ve ce j me ve:Login Branch Name/ue efieve keÀ ve cee@ MeeKee e e :Login Branch Code/ue efieve keÀ s[e@ MeeKee e :

Lead Details/ e efJeJejCeueer[ keÀ Lead provided by/ueer[ kesÀ efceueFme Üeje erëTalisma Ref. No./leefuemce oYe&e meb mebK³eeëReferral Emp. Name and ECN/js jue keÀce&®e jer keÀ ve ce j me veHeÀ e e e Deew F& erS ë

Direct/Òel³e#e

CFD/meerSHeÀ[er

Branch/µeeKee

DETAILS OF APPLICANTS/ DeeJesokeÀeW kesÀ efJeJejCe

I-Works No. keÌme& vebyej: /Dee³e-Je

PRIMARY APPLICANT/ÒeeLeefcekeÀ DeeJesokeÀ

Cust ID/ûeenkeÀ DeeF&[er CKYC ID/ Jee DeeF&[er:meerkeÀs ³emeer

Salutation/Jebove*: Date of Birth/pevce efleefLe*:Mr./Þeer. Mrs./Þeerceleer Ms./keÀg. Others/Dev³e D D M M Y Y Y Y

First Name/Henuee veece*:

Middle Name/ceO³e veece:

Last Name/Debeflece veece*:Mother’s Maiden Nameceelee keÀe efJeJeen-HetJe& Debeflece veece*:Father/Husband Name/efHelee/Heefle keÀe veece:

1PAN/Hewve :

NREGA/vejsieeOthers/Dev³eVoter ID/celeoeve Hen®eeve He$e

Other ID proof/Dev³e Hen®eeve keÀeÒeceeCe:

Driving Licence/[eFeJf eib e ueeFmemW eAadhaar/DeeOeejPassport/HeemeHeesì&

ID Proof No./Hen®eeve ÒeceeCe mebK³ee: Expiry/meceeefHle: M M Y Y

Gender/efuebie*: Male/Heg©<e Female/ceefnuee Others/Dev³e

Marital Status/JewJeeefnkeÀ efmLeefle*: Married/efJeJeeefnle Single/DeefJeJeeefnle Others/Dev³e

Mobile No./ceesyeeFue vebyej#: Ph. No./HeÀesve vebyej: S T D -

Email/F&cesue:

st1 Applicant Name/

st1 Applicant Signature/ÒeeLeefcekeÀ DeeJesokeÀ kesÀ

nmlee#ej

yeQkeÀ keÀer ceesnj kesÀ meeLejbieerve HeÀesìes ueieeveer nw ~

Colour Photographto be affixed

with Bank Seal

1 # 1 #* Mandatory field. If PAN is not available, please attach Form 60. The number provided will be used for sending loan details./*DeefveJee³e& Keeves, Hewve GHeueyOe veneR nes, lees ke=ÀHe³ee HeÀece& 60 mebueive keÀjW~ GHeueyOe keÀjeF& ieF& vebyej $eÝCe efJeJejCe Yespeves kesÀ efueS Fmlesceeue keÀer peeSieer~Total number of applicants: ____________________. If more than three applicants, then please attach the applicant details separately to this application form./DeeJesokeÀeW keÀer kegÀue mebK³eeë ____________________³eefo leerve mes DeefOekeÀ DeeJesokeÀ nes, lees ke=ÀHe³ee Fme DeeJesove He$e keÀs meeLe DeeJesokeÀ keÀs efJeJejCe Deueie mes mebueive keÀjW~

Education Qualification/ Mew#eefCekeÀ ³eesi³elee:

IIIiterate/efvej#ej Primary/ÒeeLeefcekeÀ th12 Pass/12JeeR Heeme

Gratuate and above other than agri-tech/ke=Àef<e lekeÀveerkeÀ kesÀ DeefleefjkeÌle Dev³e efJe<e³e ceW mveelekeÀ leLee DeefOekeÀ

Gratuate and above in agri-tech/ke=Àef<e lekeÀveerkeÀ ceW mveelekeÀ leLee DeefOekeÀ

(Tick any one)/(ef er s)keÀme SkeÀ keÀes ®egve

(For Existing Customer/ceew e ûeenkeÀ ):peto keÀs efueS

ÒeeLeefcekeÀ DeeJesokeÀ keÀe veece

Address proof submitted/Heles keÀe ÒeceeCe efkeÀ³ee:Òemlegle Address proof Numbers/Heles kesÀ ÒeHeÀ keÀe Je´ÀceebJeÀ:t Communication Address/He$e J³eJenej keÀe Helee*:

M M Y Y

Passport/HeemeHeesì& Aadhaar/DeeOeej Driving Licence/[eFeJf eib e ueeFmemW e Voter ID/celeoeve Hen®eeve He$e

Others/Dev³e NREGA/vejsiee

Residence/efveJeeme Office/keÀe³ee&ue³e

Nearest Land Mark/vepeoerkeÀer ueQ[ceeke&À:

State/jep³e: Pin/efHeve:

City/Menj: District/efpeuee :

Expiry/meceeefHle:


M M Y Y







Expiry/meceeefHle:

Sr. No./¬eÀ.meb. Type of Facility/megefJeOee keÀ ÒekeÀej Purpose/Òe³eespeve Amount in `/jeefMe ©He³es ceW

Total/³eesie

DETAILS OF LOAN FACILITIES REQUESTED/DevegjesOe keÀer ieF& $eÝ=Ce megefJeOeeDeeW keÀe efJeJejCe

Total/³eesie

Non-agri Property (ies)/iewj ke=Àef<e mebHeefÊe (mebHeefÊe³eeb)

Agri Land/ke=Àef<e Yetefce

Farm shed/godown/HeÀece& Mes[/ieesoece

Any Other immovable assets/keÀesF& Dev³e De®eue Deeefmle³eeb

Cattles/HeMegOeve

Farm machinery/Kesleer keÀer ceMeerveW

2/4 wheelers/2/4 Heefn³ee Jeenve

Other movable assets/Dev³e ®eue Deeefmle

Asset/Deeefmle Nos./meKb³ee Approx Value/Devegceeefvele cetu³e Approx Value/Devegceeefvele cetu³e Asset/Deeefmle Nos./meKb³ee

ASSET DETAILS (OF ALL THE APPLICANTS) (IN `LAKHS)/Deeefmle efJeJejCe (meYeer DeeJesokeÀeW keÀe) (ueeKe ©. ceW)

INCOME DETAILS (OF ALL THE APPLICANTS)/Dee³e efJeJejCe (meYeer DeeJesokeÀeW keÀer)I. Income from Agriculture/ke=Àef<e mes Dee³e:

Crop Name/HeÀmeue keÀe veece

Yield per acre in Qtls./eqkeÌJebìue ceW Òeefle SkeÀæ[ GHepeCurrent Year*/®eeuet Je<e&

MSP/Qtl./SceSmeHeer/eqkeÌJebìue Scale of Finance/acre/efJeÊe/SkeÀæ[ keÀe ceeveCurrent Year*/®eeuet Je<e& Current Year*/®eeuet Je<e&

a) Dairy/[s³ejer:

Current Year*/®eeuet Je<e& Animal Type/ HeMeg keÀe ÒekeÀej

No. of animals/ HeMegDeeW keÀer mebK³ee Avg. cost of rearing per cattle/day/

Òeefle HeMeg/efove Heeueve keÀer Deewmele ueeieleAvg. Price of milk/Lt./ Deewmele otOe/ueer. keÀer keÀercele

Avg. Milk per cattle/day/ Deewmele Òeefle HeMeg otOe/efove

Remark/efìHHeCeer

ii. Income from Agri Allied activities/ke=Àef<e mes mebyeb× keÀe³e&keÀueeHeeW mes Dee³e:

Name of Family Member/heefjJeej kesÀ meom³e keÀe veece

Age/Dee³eg

RELATIONSHIP DETAILS/mebyebOe keÀe efJeJejCe

Gender/efuebie

Relationship with Primary Applicant/ÒeeLeefcekeÀ DeeJesokeÀ kesÀ meeLe mebyebOe

Occupation/J³eJemee³e

Address/Helee

Mobile No./ceesyeeFue veb.

Type of Income/Expense Dee³e/J³e³e keÀe ÒekeÀej

#Frequency /#yeejbyeejlee

Amount as per frequency Current Year*/

®eeuet Je<e& DeeJe=efÊe keÀs Devegmeej jeefMe*

*Proposed/*ÒemleeefJele, #Monthly, Quarterly, Half Yearly or Yearly/#ceeefmekeÀ, efleceener, íceener ³ee Jeeef<e&keÀ

I. Particulars of Land Holdings (in acres) Only cultivable land proposed for availing finance is to be mentioned

Yet-peesle keÀe efJeJejCe (SkeÀæ[ ceW) kesÀJeue efJeÊe keÀe ueeYe Gþeves kesÀ efueS ÒemleeefJele kesÀJeue ke=Àef<e ³eesi³e Yetefce keÀe GuuesKe keÀjvee nw ~

Particulars/efJeJejCe Main Applicant/

cegK³e DeeJesokeÀCo-applicant(s)/

men DeeJesokeÀ Total/ ³eesie

Address/Helee

Remark/efìHHeCeer

iii. Other Income/Dev³e Dee³e:

PARTICULARS OF LAND HOLDING AND CROPS/Yet-peesle Deewj HeÀmeueeW keÀe efJeJejCe

mJeeefcelJe Jeeueer Yetefce (S)Owned land (A)/

HeÆs Jeeueer Yetefce (ceewefKekeÀ)(yeer)Leased land (Oral)(B) /

Leased land (Registered)(C)/ HeÆs Jeeueer Yetefce (Hebpeerke=Àle)(meer)

kegÀue Yetefce (S+[er) Total land (A+D)

HeÆs Jeeueer kegÀue Yetefce ([e=r yee+r meer) Total leased land (D=B+C)/

ii. Crop details and marketing arrangement (Proposed for Current year)/HeÀmeue keÀe efJeJejCe Deewj efJeHeCeve J³eJemLee (®eeuet Je<e& kesÀ efueS ÒemleeefJele)

*Direct sale to market, Tie-up with Commission Agent, Co-operative Societies, Govt. Agencies or Private Corporates./ *yeepeej ceW Òel³e#e efye¬eÀer, Deeæ{efle³ee (keÀceerMeve SpeWì), menkeÀejer meefceefle³eesb, menkeÀejer Spesbefme³eesb ³ee efvepeer keÀbHeefve³eesb keÀs meeLe ieþpees][ ~

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Sr.No/ ¬eÀ.meb.

Crop Name/ HeÀmeue keÀe veece

Area covered (in acres)/ Meeefceue #es$e (SkeÀæ[ ceW)

Marketing Arrangement*/ efJeHeCeve J³eJemLee*

Source/method of irrigation#/ efmeb®eeF& keÀe mees$e/efJeefOe #

Month of Sowing/yegkeeF& keÀe cenervee HeÀmeue keÀe cenervee

Month of Harvest/

#Dry farming, Well/Canal, Sprinkler or drip. #metKeer Kesleer, kegÀDeeb/venj, efmHe´kebÀuej ³ee ef[^He~

Activity Type/keÀe³e&keÀueeHe keÀe ÒekeÀej No. of units/FkeÀeF³eesW keÀer mebK³ee Current Year Net Income*/®eeuet Je<e& keÀer efveJeue Dee³e Remark/efìHHeCeer

b) Others (poultry, bee-keeping, fisheries, etc.)/Dev³e (cegieer& Heeueve, ceOegcekeÌKeer Heeueve, celm³e Heeueve, Deeefo):

*Only Government value is to be considered./*kesÀJeue mejkeÀejer cetu³e ceevee peeSiee.

yeQkeÀ, [ekeÀIej ³ee menkeÀejer meefceefle keÀe veece

Name of the Bank, Post Office or Co-operative Society/

Approx. balance. (in Rs.)/ ueieYeie Mes<e (©. ceW)DeeJesokeÀ keÀe veece

Name of applicant/

Keelee mebK³ee (³eefo Keelee Fb[meFb[ yeQkeÀ ceW yeveeS jKee ie³ee nw lees DeefveJee³e&)

Account Number (Mandatory if account is maintained with IndusInd Bank) /

pecee keÀe ÒekeÀej (ye®ele, ceer³eeoer pecee jeefMe, jeä^er³e ye®ele

ÒeceeCehe$e, Deeefo)

Deposit Type(Savings, FD, NSC, etc.)/

FD Number/ ceer³eeoer pecee mebK³ee

FD Date/ ceer³eeoer pecee keÀer efleefLe

FD in the Name of/ ceer³eeoer pecee efkeÀmekesÀ veece hej nw

FD Maturity Date /ceer³eeoer pecee keÀer HeefjHekeÌJelee efleefLe

FD Rate/ ceer³eeoer pecee keÀe oj

Initial Deposit (in Rs.)/ÒeejbefYekeÀ pecee (©. ceW)

Survey No./meJe#x eCe meKb ³ee

Village/ieebJe

Tehsil/lenmeerue

District/efpeuee

State/jep³e

Land Owner Name/Yetefce mJeeceer keÀe veece

Area (in Acres)/#es$eHeÀue (SkeÀæ[)

Value (in Rs.)*/ cetu³e (©. ceW)*

Encumbrance if any (Y/N)/$eÝCeYeej ³eefo keÀesF& nes (neb/venerb)

SECURITY DETAILS/ÒeefleYetefle (peceevele) efJeJejCeParticulars of properties to be mortgaged /Charged to our Bank/nceejs yeQkeÀ kesÀ Heeme yebOekeÀ jKeves/ÒeYeeefjle keÀjves Jeeueer mebHeefÊe³eeW keÀe efJeJejCe a) Agricultural Property:/ S) ke=Àef<e mebHeefÊeë

b) Non-agricultural Property details:/ye) iewj ke=Àef<e mebHeefÊe keÀe efJeJejCe ë

Security Type/ ÒeefleYetefle keÀe ÒekeÀej

Address/Helee

Encumbrance if any (Y/N)/$eÝCeYeej ³eefo keÀesF& nes (neb/venerb)

Area (Sq Mts)/#es$eHeÀue (Jeie& ceerìj)

Value (in Rs.)*/ cetu³e (©. ceW)*

*Only through empaneled valuer (min. of two valuations will be taken by bank through independent valuers)./

*kesÀJeue meg®eeryeà cetu³eebkeÀkeÀeW Üeje (mJeleb$e cetu³eebkeÀkeÀeW kesÀ ceeO³ece mes yeQkeÀ Üeje v³etvelece oes cetu³eebkeÀkeÀ efueS peeSbies)~

c) Liquid Security details (only FD with us):/(keÀ) ®eueefveefOe (vekeÀoer) ÒeefleYetefle efJeJejCe (nceejs Heeme keÀer ieF& ceer³eeoer pecee)ë

BANKING DETAILS/yewefkebÀie efJeJejCe

I. Financial history (other than to existing liabilities)/efJeÊeer³e Fefleneme (ceewpetoe osveoeefj³eeW keÀes íesæ[keÀj)ë

Cheque bounced history in past 1 year: No. of Cheques Lodged _______________________. No. of Cheques Bounced _______________________/

efHeíues 1 Je<e& ceW ®ewkeÀ Jeeheme nesves keÀe Fefleneme: ope& ®eskeÀeW keÀer mebK³ee_______________________. Jeeheme ngS ®eskeÀeW keÀer mebK³ee_______________________

Name of theInstitution/ mebmLee keÀe veece

InstalmentFrequency/

efkeÀmle keÀer yeejbyeejlee

Loan Amount(in Rs.)/

$eÝCe keÀer jeefMe (©. ceW.)

Present O/S(in Rs.)/

Jele&ceeve yekeÀe³ee(©. ceW.)

Max Overduedays in past */

efJeiele ceW DeefOekeÀleceDeefleos³e efove*

Are these overdue in recent months?#/ keÌ³ee ³es Deefleos³e neue kesÀ

cenervees ceW nQ?#

Remaining Tenor (in Months)/

Mes<e DeJeefOe(cenerveeW ceW)

osveoejer keÀe ÒekeÀej Deewj GÎsM³e (HeÀmeue /Jeenve/DeeJeeme

$eÝCe Deeefo)

Liability type and purpose(Crop/Auto/home loan etc.)/

ROI % y³eepe oj…

ii. Particulars of existing liabilities (if any) / Banking Declaration (all Applicants)/ceewpetoe osveoeefj³eeW (³eefo keÀesF& neW) keÀe efJeJejCe /yeQefkeÀbie Iees<eCee (meYeer DeeJesokeÀ)

Sanctioned amount (in Rs.)/ cebpetj jeefMe (©. ceW)

Present O/s (in Rs.)/

Jele&ceeve yekeÀe³ee (©. ceW)yeQkeÀ Deewj MeeKee keÀe veeceName of the Bank & branch/

megefJeOee keÀe ÒekeÀejFacility Type/

$eÝCe keÀe GÎsM³ePurpose of Loan/

#*2 years statement for agri and 6 months for non agri, 6 months for agri and 3 months for non agri I/ we hereby declare that I/we am/are not having any accounts#with other banks / FI other than the details mentioned above. / *ke=Àef<e kesÀ efueS 2 Je<e& Deewj iewj-ke=Àef<e kesÀ efueS 6 cenerves, ke=Àef<e kesÀ efueS, 6 cenerves Deewj iewj ke=Àef<e kesÀ efue³es 3 cenerves keÀe

efJeJejCe~ ceQ/nce SleÎJeeje ³en Iees<eCee keÀjlee ntb /keÀjles nQ efkeÀ Thej GefuueefKele efJeJejCe kesÀ DeefleefjkeÌle cesje/nceeje Dev³e efkeÀmeer yeQkeÀ/efJeÊeer³e mebmLee ceW keÀesF& Keelee veneR nw~

iii. Whether loan is to be taken over ? Yes/No. If yes, please provide the details./keÌ³ee efkeÀmeer Dev³e yeQkeÀ/efJeÊeer³e mebmLee kesÀ $eÝCe keÀe YeejûenCe efkeÀ³ee pee jne nw? neb/veneR. ³eefo neB, lees ke=ÀHe³ee efJeJejCe oW ~

Other Facilities required/Dehesef#ele Dev³e megefJeOeeSb

Disability/ efJekeÀueebielee

ADDITIONAL DETAILS/DeefleefjkeÌle efJeJejCe

Muslim/cegeqmueceHindu/ efnbot

Zoroastrian/ �eesjeefmì^³eve

Christian/F&meeF&

Jain/pewve

Sikh/ efmeKe

Parsi/Heejmeer

Buddhist/yeewOo

Others/Dev³e_____________

Declaration/Iees<eCeeë1. I / We certify that the information given above and in the enclosures is true in all respects and this shall form the basis of any facility / service that IndusInd

Bank (the Bank) may decide to grant to us at its sole discretion. I am / We are fully aware that if the above information is found to be incorrect, the loans sanctioned subject to above information would become repayable immediately. /1. ceQ/nce ÒeceeefCele keÀjlee nbt /keÀjles nQ efkeÀ Thej Deewj mebueivekeÀeW ceW oer ieF& peevekeÀejer meYeer HenuegDeeW mes mel³e nw Deewj ³en efkeÀmeer Yeer megefJeOee /mesJee keÀe DeeOeej yevesieer pees Fb[mebFb[ yeQkeÀ (yeQkeÀ) SkeÀcee$e DeHeves efJeJeskeÀeOeerve nceW Òeoeve keÀjves keÀe efveCe&³e keÀj mekeÀlee nw ~ cewb/nce Fme yeele mes HetCe&leë DeJeiele ntb / nQ efkeÀ ³eefo ieuele peevekeÀejer ieuele HeeF& peeleer nw lees Ghe³e&gkeÌle peevekeÀejer kesÀ DeeOeej Hej mJeerke=Àle $eÝ=Ce lelkeÀeue Òeefleos³e (®egkeÀewleer ³eesi³e) nes peeSiee ~

2. I/ We also understand that the Bank reserves the right to seek any information from any source or to give any information and /or assign any work to any third party at its sole discretion. I / We further agree that the facility that may be provided to us shall be governed by the rules of the Bank that may be in force from time to time. I/ We will be bound by the terms and conditions of the facility that may be granted to us./2. ceQ/nce ³en Yeer mecePelee ntb /mecePeles nQ efkeÀ yeQkeÀ SkeÀcee$e DeHeves efJeJeskeÀeOeerve efkeÀmeer Yeer ñeesle mes keÀesF& Yeer peevekeÀejer ceebieves ³ee keÀesF& Yeer peevekeÀejer osves Deewj/³ee efkeÀmeer leermejs He#e keÀes keÀesF& keÀe³e& mecevegosefMele keÀjves keÀe DeefOekeÀej DeHeves Heeme megjef#ele jKelee nw ~ ceQ / nce Deeies Fme yeele Hej mencele ntb / nQ efkeÀ nceW Òeoeve keÀer pee mekeÀves Jeeueer megefJeOee yeQkeÀ mes mece³e-mece³e Hej ÒeYeeJeer nes mekeÀves Jeeues efve³eceeW Üeje Meeefmele nesieer ~ ceQ / nce Gme megefJeOee kesÀ efveyebOeveeW SJeb MeleeX mes yeeO³e neWies pees nceW Òeoeve keÀer pee mekeÀleer nQ~

Farmer Category (Based onland holding)/efkeÀmeeve ÞesCeer (Yet-peesle kesÀ DeeOeej Hej)

Small Farmer (2.5-5Acre)/ íesìs efkeÀmeeve (2.5-5 SkeÀ›)Tenant Farmer/keÀeMlekeÀej Marginal Farmer (0-2.5Acre)/meerceeble efkeÀmeeve

(0-2.5 SkeÀ›)Distress Farmer/ mebkeÀìûemle efkeÀmeeveOral Lessee/ceewefKekeÀ HeÆsoej Landless Labourers/Yetefcenerve ÞeefcekeÀ

Share Cropper/yebìeF&oej Others (> 5 Acre)/Dev³e (> 5 SkeÀ›)

Name to be embossed onRuPay Kisan Card/©Hes efkeÀmeeve keÀe[& Hej DebefkeÀle efkeÀ³ee peeves Jeeuee veece

Community/ mecegoe³e

Caste/ peeefle General/meeceev³e OBC/De.efHe.Je. SC/De.pee. ST/De.pe.pee.

Yes/ ne@B No/ venerb

SMS Alert/SmeSceSme Deueì& Cheque Book/®eskeÀ yegkeÀ

Customer met in person declaration by sourcing executive./ûeenJeÀ J³eeqJeÌleiele ªHe mes efce}e meese\meie JeÀe³e&heeueJeÀ Üeje Iees<eCee

I confirm having met the customer in person at the

and I hereby confirm that I have verified the copies with the original documents and the AOF has been filled up in my presence.

I confirm that All documents of KYC complete & matches details provided in AOF. I hereby certify that the above information is true. Later if it is found

to be incorrect and bank suffers any loss due to fraud or otherwise, I may be held accountable and shall be liable for any loss suffered by the Bank.

3. I/we certify that all information furnished by me/us is true. l/We hereby authorise and give consent to the Bank to disclose, without notice to me/us, information furnished by me/us in application form(s)/related documents executed in relation to the facilities availed from the Bank, our finance details and repayment information to the Bank's other branches/subsidiaries/affiliates Credit Bureaus/Rating Agencies, Service Providers, banks/financial institution, governmental/regulatory authorities/ Law enforcement authority or third parties for KYC information verification, credit risk analysis, or for other related purposes that the Bank may deem fit, at any time. I also authorise the Bank to disclose the information relating to Bank Guarantee/Letter of Credit facility if any availed by me/us. l/We waive the privilege of privacy & privity of contract./ 3. ceQ/nce ³en ÒeceeefCele keÀjlee/leer ntB efkeÀ cesjs/nceejs Üeje oer ieF& mecemle peevekeÀejer mel³e nw ~ ceQ/nce SleodÜeje yeQkeÀ keÀes cegPes/nceW Deefûece met®evee efoS efyevee, yeQkeÀ mes ÒeeHle megefJeOeeDeeW kesÀ mebyebOe ceW efve<Heeefole DeeJesove ÒeeHe$e($eeW)/mebyebefOele omleeJes]peeW ceW cesjs/nceejs Üeje ÒeoÊe peevekeÀejer, cesjs/nceejs efJeÊeer³e efJeJejCeeW Deewj ®egkeÀewleer keÀer peevekeÀejer keÀe yeQkeÀ keÀer Dev³e MeeKeeDeeW/Deveg<ebieer mebmLeeDeeW/menyeàeW/¬esÀef[ì y³etjes/jsefìbie SpeWefme³eeW/mesJee ÒeoeleeDeeW/yeQkeÀeW/efJeÊeer³e mebmLeeveeW/mejkeÀejer ³ee efve³eecekeÀ ÒeeefOekeÀjCeeW/efJeefOe ÒeJele&ve ÒeeefOekeÀjCeeW ³ee leermejs He#eeW kesÀ mece#e kesÀJee³emeer peevekeÀejer kesÀ mel³eeHeve, $eÝCe pees]efKece efJeÍues<eCe, ³ee yeQkeÀ Üeje Gef®ele mecePes ieS Dev³e mebyebefOele Òe³eespeveeW meW efkeÀmeer Yeer mece³e ÒekeÀìve keÀjves kesÀ efueS DeefOeke=Àle keÀjlee/leer ntB/keÀjles nQ SJeb Devegceefle oslee/leer ntB/osles nQ ~ ceQ/nce yeQkeÀ keÀes yeQkeÀ ieejbìer/$eÝCe megefJeOee He$e mes mebyebefOele peevekeÀejer keÀe ÒekeÀìve keÀjves kesÀ efueS Yeer DeefOeke=Àle keÀjlee/leer ntB/keÀjles nQ yeMelex ceQves/nceves Ssmeer keÀesF& megefJeOee ueer nes ~ ceQ/nce DevegyebOe keÀer efvepelee SJeb ieesHeveer³elee kesÀ efJeMes<eeefOekeÀej keÀe l³eeie keÀjlee/leer ntB/keÀjles nQ ~

4. We confirm that I/we shall utilize the said Credit Facility only for the purposes as mentioned above./ 4. ceQ/nce Hegefä keÀjlee ntb/keÀjles nQ efkeÀ ceQ/nce Gme $eÝ=Ce megefJeOee keÀe Ghe³eesie kesÀJeue Ghe³e&gkeÌle Òe³eespeveeW kesÀ efueS ner keÀ©biee/keÀjWies ~

5. I/We hereby declare that I/We am/are not a director or specified near relation of a director of a banking company./ 5. ceQ/nce SleÜeje ³en Iees<eCee keÀjlee ntb/keÀjles nQ efkeÀ ceQ/nce efkeÀmeer Yeer yeQkeÀ keÀe/kesÀ efveosMekeÀ Je efvekeÀì mebyebOeer veneR ntb/nQ ~

6. I/We hereby declare that I/We am/are not defaulter(s) to any Bank/Financial Institution./ 6. ceQ/nce SleodÜeje ³en Iees<eCee keÀjlee ntb/keÀjles nQ efkeÀ ceQ/nce efkeÀmeer Yeer yewQkeÀ /efJeÊeer³e mebmLee keÀe/kesÀ ®etkeÀkeÀlee& veneR ntb/nQ ~

7. All documentation charges including stamp duty, legal opinion charges, valuation charges and other incidental expenses will be borne by me/us at the actual and to be paid in advance./ 7. mìe@He MegukeÀ, keÀevetveer je³e ÒeYeej, cetu³eebkeÀve ÒeYeej Deewj Dev³e DeekeÀeqmcekeÀ J³e³e meefnle meYeer ÒeuesKeve MegukeÀ JeemleefJekeÀ ©He mes cesjs/nceejs Üeje Jenve efkeÀ³ee pee³esiee Deewj GmekeÀe Yegieleeve Deefûece ceW efkeÀ³ee peevee nesiee~

MODE OF OPERATION (Please select one)/ b eueve efJeefOe me®e keÀer (efkeÀmeer SkeÀ keÀes ®egves)

Single/SJeÀue

All jointly/meb³egJeÌle ªHe mes

Either or Survivor/oesveeW cesb mes JeÀesF& SJeÀ ³ee GÊejpeerJeer

Former or Survivor/HetJe&Jeleea ³ee GÊejpeerJeer J³eeqkeÌle

Anyone or Survivor/JeÀesF& SJeÀ ³ee GÊejpeerJeer

Later or Survivor/}sìj ³ee GÊejpeerJeer

Signature/nmlee#ej

Place/mLeeve: Date/efleefLe: D D M M Y Y Y Y

FOR BANK USE ONLY/kesÀJeue yeQkeÀ GHe³eesie kesÀ efueS

Residence Office Address Permanent Address

I also confirm that applicant(s)/Guarantors have signed in my presence only/ce Q ³en Yee r Heeg äf JeÀjlee n/bt JeÀjlee r n Bt eJf eÀ DeeJeos JeÀ/DeeJeos JeÀe/bs ieejìb eJr eÀleeD& ee bs ve s JeÀs Je} cejs e r GHeemq Leelf e ce Wnmlee#ej eJf eÀS n~Q

Name/veece:

ECN/F&meerSve:

Main Applicant Name/cegK³e DeeJesove JeÀe veece:

Co-Applicant 1 Name/men-DeeJesoJeÀ ‰ JeÀe veece:

Co-Applicant 2 Name/men-DeeJesoJeÀ Š JeÀe veece:

Co-Applicant 3 Name/men-DeeJesoJeÀ ‹ JeÀe veece:

ceQ Hegefä JeÀjlee/JeÀjleer ntB efJeÀ ceQ ûeenJeÀ mes efveJeeme JeÀe³ee&}³e JesÀ Heles mLee³eer Heles Hej efce}e Deewj ceQ FmeJesÀ Üeje Fme yeele JeÀer Hegefä JeÀjlee ntb efJeÀ ceQves cet} omleeJespeeW JesÀ meeLe Òeefle³eeW JeÀes mel³eeefHele efJeÀ³ee nw Deewj Keelee Kees}ves JeÀe HeÀe@ce& cesjer GHeeqmLeefle ceW Yeje ie³ee nQ~ ceQ Hegefä JeÀjlee/JeÀjleer ntB efJeÀ JesÀJeeF&meer JesÀ meYeer omleeJespe Hetjs nQ Deewj SDeesS]HeÀ ceW GHe}yOe JeÀjeF& ieF& peeveJeÀejer mes ces} Keeles nQ. ceQ Sleo Üeje ÒeceeefCele JeÀjlee ntb efJeÀ Ghe³e&gkeÌle peeveJeÀejer mel³e nw~ yeeo ceW ³eeor ³en ie}le Hee³eer peeleer nw Deewj yeQJeÀ JeÀes efJeÀmeer Yeer OeesKeeOe›er ³ee Dev³eLee JesÀ JeÀejCe JeÀesF& neefve nesleer nw, lees cegPes peJeeyeosn "nje³ee pee meJeÀlee nw Deewj yeQJeÀ Üeje G"e³es peeves Jee}s efJeÀmeer Yeer vegJeÀmeeve JesÀ ef}S ceQ GÊejoe³eer jntbiee~

Signature/nmlee#ej

Signature/nmlee#ej

Signature/nmlee#ej

Signature/nmlee#ej

(Please fill separate form for each co-applicant/Òel³eskeÀ men DeeJesokeÀ kesÀ efueS Deueie HeÀece& YejW)

DETAILS OF APPLICANTS/DeeJesokeÀeW kesÀ efJeJejCeRELATIONSHIP WITH PRIMARY APPLICANT/ÒeeLeefcekeÀ DeeJesokeÀ kesÀ meeLe mebyebOe

STINDUS KISAN 1 CO-APPLICANT DETAILS/Fb[me efkeÀmeeve Henues men-DeeJesokeÀ keÀe efJeJejCe

1 # 1 #* Mandatory field. If PAN is not available, please attach Form 60. The number provided will be used for sending loan details./*DeefveJee³e& Keeves, Hewve GHeueyOe ve nes lees ke=ÀHe³ee HeÀece& 60 mebueive keÀjW~ GHeueyOe keÀjeF& ieF& mebK³ee $eÝCe efJeJejCe Yespeves kesÀ efueS Fmlesceeue keÀer peeSieer~I certify that the information given above and in the enclosures are true in all respects and that this shall form the basis of loan application./cewb ÒeceeefCele keÀjlee ntb efkeÀ Thej leLee mebueivekeÀeW ceW oer ieF& peevekeÀejer meYeer HenuegDeeW mes mel³e nw Deewj ³en efkeÀ ³en $eÝCe DeeJesove keÀe DeeOeej yevesiee ~

Name of the Primary Applicant/ÒeeLeefcekeÀ DeeJesokeÀ keÀe veece:

Application Date/DeeJesove efleefLe:

Application Number/DeeJesove mebK³ee:

Loan amount Requested (In Rs.)/DevegjesOe keÀer ieF& $eÝCe jeefMe (©HeS ceW):

I, the farmer named below, hereby jointly apply for the afore mentioned loan application as a co-applicant. I furnish below the necessary information./cewQ, efvecveefueefKele efkeÀmeeve, Sleod Üeje Ghe³e&gkeÌle $eÝCe DeeJesove kesÀ ef}S meb³egkeÌle ©He mes men-DeeJesokeÀ kesÀ ©He ceW DeeJesove keÀjlee ntb ~ ceQ DeeJeµ³ekeÀ peevekeÀejer veer®es Òemlegle keÀjlee ntb ~

D D M M Y Y Y Y





Last Name/Debeflece veece*:Mother’s Maiden Name/ceelee keÀe efJeJeen-HetJe& Debeflece veece*:Father/Husband Name/efHelee/Heefle keÀe veece:PAN/Hewve:










with Bank Seal st1 Co-Applicant Name/

st1 Co-Applicant Signature/ÒeeLeefcekeÀ

men-DeeJesokeÀ kesÀ nmlee#ej

ÒeeLeefcekeÀ men-DeeJesokeÀ keÀe veece

Email/F&cesue:

Education Qualification/Mew#eefCekeÀ ³eesi³elee:



M M Y Y







Expiry/meceeefHle:


M M Y Y







Expiry/meceeefHle:


Name and Signature/thumb impression of the Co-applicant/men DeeJesokeÀ keÀe veece Deewj nmlee#ej/Debietþs keÀe efveMeeveëSignature/nmlee#ej

(Please fill separate form for each co-applicant/Òel³eskeÀ men DeeJesokeÀ kesÀ efueS Deueie HeÀece& YejW)

DETAILS OF APPLICANTS/DeeJesokeÀeW kesÀ efJeJejCeRELATIONSHIP WITH PRIMARY APPLICANT/ÒeeLeefcekeÀ DeeJesokeÀ kesÀ meeLe mebyebOe

NDINDUS KISAN 2 CO-APPLICANT DETAILS/Fb[me efkeÀmeeve otmejs men-DeeJesokeÀ keÀe efJeJejCe

1 # 1 #* Mandatory field. If PAN is not available, please attach Form 60. The number provided will be used for sending loan details./*DeefveJee³e& Keeves, Hewve GHeueyOe ve nes lees ke=ÀHe³ee HeÀece& 60 mebueive keÀjW~ GHeueyOe keÀjeF& ieF& mebK³ee $eÝCe efJeJejCe Yespeves kesÀ efueS Fmlesceeue keÀer peeSieer~I certify that the information given above and in the enclosures are true in all respects and that this shall form the basis of loan application./cewb ÒeceeefCele keÀjlee ntb efkeÀ Thej leLee mebueivekeÀeW ceW oer ieF& peevekeÀejer meYeer HenuegDeeW mes mel³e nw Deewj ³en efkeÀ ³en $eÝCe DeeJesove keÀe DeeOeej yevesiee ~

Name of the Primary Applicant/ÒeeLeefcekeÀ DeeJesokeÀ keÀe veece:

Application Date/DeeJesove efleefLe:

Application Number/DeeJesove mebK³ee:

Loan amount Requested (In Rs.)/DevegjesOe keÀer ieF& $eÝCe jeefMe (©HeS ceW):

I, the farmer named below, hereby jointly apply for the afore mentioned loan application as a co-applicant. I furnish below the necessary information./cewQ, efvecveefueefKele efkeÀmeeve, Sleod Üeje Ghe³e&gkeÌle $eÝCe DeeJesove kesÀ ef}S meb³egkeÌle ©He mes men-DeeJesokeÀ kesÀ ©He ceW DeeJesove keÀjlee ntb ~ ceQ DeeJeµ³ekeÀ peevekeÀejer veer®es Òemlegle keÀjlee ntb ~

D D M M Y Y Y Y

Email/F&cesue:















with Bank Seal



nd2 Co-Applicant Name/

nd2 Co-Applicant Signature/otmejs

men-DeeJesokeÀ kesÀ nmlee#ej

otmejs men-DeeJesokeÀ keÀe veece


M M Y Y







Expiry/meceeefHle:


M M Y Y







Expiry/meceeefHle:

1*Mandatory field. If PAN is not available, please attach Form 60. # The number provided will be used for sending loan details./Deevf eJee³e& Keeve,s Hevw e GHeueyOe ve nes lees keÀ= He³ee HeÀece& 60 meub eive keÀj.W # GHeueyOe keÀjeF& ieF& meKb ³ee $eÝCe eJf eJejCe Yeps eves keÀs euf eS Fmlecs eeue keÀer peeSiee.rI enclose extracts of land record/salary certificate/tax returns / assessment order copies. I certify that the information given above and in the enclosures are true in all respects and correct./ceQ Yeet cf e DeeYf eueKs e keÀe meej/Jels eve ÒeceeCe He$e/keÀj eJf eJejCee/r evf eOeej& Ce DeeoMs e keÀer Òeelf e³eeb meub eive keÀjlee n.bt ceQ ÒeceeeCf ele keÀjlee nbt ekf eÀ Thej leLee meub eivekeÀeW ceW oer ieF& peevekeÀejer meYeer HenueDg eeW mes mel³e nw Deejw mener n~w

ceQ Þeer/kegÀ._______________________________keÀes DeeJesove mebK³eeë_______________________efoveebefkeÀleë______________kesÀ ceeO³ece mes Òeoeve keÀer ieF&/Òeoeve keÀer

peeves Jeeuee ©. ________________________ keÀer ____________________$eÝCe megefJeOee kesÀ efueS ieejbìerkeÀlee& yeveves keÀe ÒemleeJe keÀjlee ntB Deewj veer®es efJeJejCe Òemlegle keÀjlee nBt ~

I offer to stand as guarantor for the________________________________Loan facility extended /to be extended to Mr/Ms._______________________________of `__________________________vide Application Number: _________________________________Dated: ____________and furnish the particulars here below.

INDUS KISAN GUARANTOR FORM/Fb[me efkeÀmeeve ieejbìerkeÀlee& HeÀece&

DETAILS OF GUARANTOR/ieejbìerkeÀlee& keÀe efJeJejCeRELATIONSHIP WITH PRIMARY APPLICANT/ÒeeLeefcekeÀ DeeJesokeÀ kesÀ meeLe mebyeOe

Communication Address/He$e J³eJenej keÀe Helee*: Residence/efveJeeme Office/keÀe³ee&ue³e



City/Menj: District/efpeuee:

Assets/mebHeefÊe³eeb Value/cetu³e Liabilities/os³eleeSb

Vehicle/Jeenve

Immovable propertyt e.g. land, house, etc./De®eue mebHeefÊe Goe. Yetceer, cekeÀeve, Deeefo

Other Address/Dev³e Helee Residence/efveJeeme Office/keÀe³ee&ue³e


*Net Annual Income (in `)/*efveJeue Jeeef<e&keÀ Dee³e (©.)

*Present Bank/ *Jele&ceeve yeQkeÀ *Account Number/*Keelee mebK³ee

ASSETS AND LIABILTIES AS ON DATE (In `Lakhs) /Deepe keÀer efleefLe Hej Deeefmle³eeb Deewj os³eleeSb (ueeKe ©He³es ceW)

Value/cetu³e

Networth (A-B)/efveJeue ceeefue³ele (S-yeer)

LIC (Surrender Value)/SueDeeF&meer (DeY³eHe&Ce cetu³e)

Bank Balance/FD/yeQkeÀ Mes<e/ceer³eeoer pecee Shares/Mutual Funds/Mes³ej/c³et®egDeue HebÀ[

Other (Specify)/Dev³e (GuuesKe keÀjW)Total (A)/³eesie (S)


Name and Signature/thumb impression of the Co-applicant/men DeeJesokeÀ keÀe veece Deewj nmlee#ej /Debietþs keÀe efveMeeve ëSignature/nmlee#ej

Loan form Induslnd Bank/Fb[meFb[ yeQkeÀ mes $eÝCe

Loan form Other Bank /FI/Dev³e yekQ eÀ/eJf eÊee³r e memb Lee me s $eÝCe

Other Liabilities (Specify)/Dev³e ovs eoeejf ³ee b (GuueKs e keÀj)W

Total (B)/³eesie (yeer)


City/Menj: District/efpeuee:















with Bank Seal



Guarantor’s Name/

Guarantor’s Signature/ieejbìerkeÀlee& kesÀ nmlee#ej

ieejbìerkeÀlee& keÀe veece

KEY FACT STATEMENT INDUS KISAN/cegK³e leL³e mìsìceWì Fb[me efJeÀmeeve

1. Loan amount/$e+Ce jeefµe

2. Loan term/$e+Ce JeÀer DeJeefOe

3.Interest Type (Floating or fixed)y³eepe JeÀe ÒeJeÀej (DeefmLej ³ee efmLej)

4.

(a) Interest chargeable(In case of Floating Rate Loans)/(S) ÒeYee³e& y³eepe (DeefmLej oj kee}s $e+CeeW JesÀ ceece}s ceW)

(b) Interest chargeable(In case of Fixed Rate Loans)/(yeer) ÒeYee³e& y³eepe (efmLej oj kee}s $e+CeeW JesÀ ceece}s ceW)

5. Date of Reset of interest/y³eepe Hevg eevf eO& eej& Ce JeÀe r leejeKr e

6.Mode of communication of changes/yeo}eJeeW y³eepe JesÀ yeejs ceW mebHeJe&À JeÀe meeOeve

Display of information on Branch’s Notice board and Bank’s Website/µeeKee JesÀ met®evee HeÆ Deewj yeQJeÀ JeÀer JesyemeeFì Hej met®evee JeÀe Òeoµe&ve

D D M M Y Y Y Y

Fee payable/os³e µeguJeÀ

Processing fee/ÒemebmJeÀjCe µeguJeÀ:

AMC/SScemeer:

Plus applicable service tax/meeLe ner }eiet mesJee JeÀj:Plus applicable service tax/meeLe ner }eiet mesJee JeÀj:

7.

Loan 1/$e+Ce 1:

Loan 2/$e+Ce 2:

Loan 3/$e+Ce 3:

Loan 4/$e+Ce 4:

Loan 1/$e+Ce 1:

Loan 2/$e+Ce 2:

Loan 3/$e+Ce 3:

Loan 4/$e+Ce 4:

Loan 1/$e+Ce 1:

Loan 2/$e+Ce 2:

Loan 3/$e+Ce 3:

Loan 4/$e+Ce 4:

Loan 1/$e+Ce 1:

Loan 2/$e+Ce 2:

Loan 3/$e+Ce 3:

Loan 4/$e+Ce 4:

Loan 1/$e+Ce 1:

Loan 2/$e+Ce 2:

Loan 3/$e+Ce 3:

Loan 4/$e+Ce 4:

a

On application(Pl individually specify all type of fee)/DeeJesove Hej (Je=ÀHe³ee meYeer ÒeJeÀej JesÀ µeguJeÀJ³eeqJeÌleiele ªHe mes GuuesKe JeÀjW)

bProduction Loan (CC) Annual Maintenance charge to be deductedannually in the Month of October/GlHeeove $e+Ce (meermeer) Jeee|<eJeÀ jKejKeeJe µeguJeÀ DeJeÌletyej cenerves ceW Jeee|<eJeÀ ©He mes JeÀeìe peeSiee

Nilµetv³e

c

dFee refundable if loan not sanctioned/disbursed/ ³eefo $e+Ce cebpetj/efJeleefjle veneR efJeÀ³eeie³ee lees JeeHemeer ³eesi³e µeguJeÀ

Nil/µetv³e

e Not applicable/}eiet veneR

fPenalty for delayed payments/efJe}befyele Yegieleeve JesÀ ef}S ob[ 18% p.a. on overdue amount/Deefleos³e jJeÀce Hej 18… Òeeler ke<e&

8.EMI payable/os³e meceerJe=Àle ceeefmeJeÀ efJeÀmle (F&SceDeeF&)

9.Details of security/collateral obtained/}er ieF& ÒeefleYetefle/mebHeeefée&JeÀ JeÀe efJeJejCe

10. Quarterly along with saving account statement/ye®ele Keelee efJeJejCe JesÀ meeLe $ewceeefmeJeÀ

Loan 1/$e+Ce 1:

Loan 2/$e+Ce 2:

Loan 3/$e+Ce 3:

Loan 4/$e+Ce 4:

Loan 1/$e+Ce 1:

Loan 2/$e+Ce 2:

Loan 3/$e+Ce 3:

Loan 4/$e+Ce 4:

During the term of the loan(Pl individually specify all type of fee)/$e+Ce JeÀer DeJeefOe JesÀ oewjeve (Je=ÀHe³ee meYeer ÒeJeÀej JesÀµeguJeÀ J³eeqJeÌleiele ªHe mes GuuesKe JeÀjW)

On foreclosure(Pl individually specify all type of fee)mece³eHetJe& yebo JeÀjves Hej (Je=ÀHe³ee meYeer ÒeJeÀej JesÀµeguJeÀ J³eeqJeÌleiele ªHe mes GuuesKe JeÀjW)

st% on entire sanction limit if closed before 3 years from 1 disbursement date/Hen}s mebefJelejCe JeÀer leejerKe mes 3 Je<e& mes Hen}s yebo nesves Hej mebHetCe& cebpetj meercee Hej …

Conversion charges for switching from floating to fixed interest and vice-versa/DeefmLej mes efmLej y³eepe Deewj FmeJesÀ efJeHejerleeqmJeeE®eie JesÀ ef}S HeejrJele&ve µeguJeÀ

Date on which annual outstandingbalance statement will be issued/Jen leejerKe efpeme Hej Jeee|<eJeÀ yeJeÀe³ee µes<e efJeJejCepeejer efJeÀ³ee peeSiee

Disclaimer/DemJeerkeÀjCe:

This letter is being issued as a part of acknowledgment of the loan application received. Induslnd Bank shall be entitled, at its sole discretion to accept or decline application./ ³en He$e ÒeeHle $eÝCe DeeJesove keÀer DeefYemJeerke=Àefle kesÀ SkeÀ Yeeie kesÀ ©He ceW peejer efkeÀ³ee pee jne nw. Fb[meFb[ yeQkeÀ DeeJesove keÀes SkeÀcee$e DeHeves efJeJeskeÀeOeerve mJeerkeÀej ³ee DemJeerkeÀej keÀjves keÀe DeefOekeÀejer nesiee.

INDUS KISAN: ACKNOWLEDGEMENT OF LOAN APPLICATION/Fb[me efkeÀmeeveë $eÝCe DeeJesove keÀer DeefYemJeerke=Àefle

Date of Acknowledgment/DeefYemJeerke=Àle keÀer efleefLeë D D M M Y Y Y Y

Application Receipt No./DeeJesove jmeero mebK³eeë

To/Òeefle,Name of Applicant/DeeJesokeÀ keÀe veeceë

Address of Applicant/DeeJesokeÀ keÀe Heleeë

PIN :/efHeve

Contact-Phone No.: / mebHe&keÀ-HeÀesve vebyej: S T D - Mobile/ceesyeeFue:

Kind Attn: Mr. / Mrs. /Miss/O³eeveeLe&: Þeer/Þeerceleer/kegÀceejer

We acknowledge that we have received an application dated ________________________ from ____________________________________________________

(Name of the applicant (s) for a loan under the Indus Kisan product.

nce mJeerkeÀej keÀjles nQ efkeÀ nceW ____________________________________________________ (DeeJesokeÀ (keÀeW)/kesÀ veece) mes Fb[me efkeÀmeeve GlHeeo kesÀ lenle $eÝCe kesÀefueS SkeÀ DeeJesove efoveebefkeÀle __________________ÒeeHle ngDee nw~

For IndusInd Bank Ltd./ke=Àles Fb[meFb[ yeQkeÀ efueefceìs[

Authorized Signatory/DeefOeke=Àle nmlee#ejkeÀlee&

Documents Received/ÒeeHle omleeJespeë Documents to be provided/Òeoeve efkeÀS peeves Jeeues omleeJespeë

Employee Name/keÀce&®eejer keÀe veeceë

Branch contact No./MeeKee mebHeke&À veb.ë S T D -

1.

2.

3.

4.

5.

6.

1.

2.

3.

4.

5.

6.

Crop/HeÀme} LandT ype(Owned /Lease)/

Yetefce JeÀe ÒeJeÀej(mJeeefcelJe/ heÆe)

Acreage/jJeÀyee

Season(Rabi/

Kharif )/ceewmece

(jyeer/KejerHeÀ)

Village/ieebJe Tehsil/lenmeer} District/efpe}e State/jep³e

UNDERTAKING/Je ve®e

As per Pradhan Mantri Fasal Bima Yojana (PMFBY), I wish to notify aforesaid cropping pattern for the current season. I/We hereby declare that there will be no changes in particulars submitted by me for the current season and I will be submitting aforesaid details in start of each cropping season in case of any change in cropping pattern./ ÒeOeeve ceb$eer HeÀme} yeercee ³eespevee (HeerSceSHeÀyeerJeeF&) JesÀ Devegmeej, ceQ ®ee}t ceewmece JesÀ ef}S GHe³e&gJeÌle HeÀme} He×efle DeeOermetef®ele JeÀjvee ®eenlee ntb~ ceQ/nce Fme yeele JeÀer Iees<eCee JeÀjlee ntb/JeÀjles nQ efJeÀ cesjs Üeje Jele&ceeve ceewmece JesÀ ef}S cesjs Üeje Òemlegle efJeÀS ieS efJeJejCe ceW JeÀesP& Heefjkele&ve veneR nWseies Deewj ceQ HeÀme} He×efle ceW Heefjkele&ve JesÀ ceece}s ceW He´l³esJeÀ HeÀme} ceewmece JesÀ He´ejbYe ceW GHe³e&gJeÌle efJeJejCe He´mlegle JeÀ ªbiee~

CROP INSURANCE DETAILS/HeÀme} yeercee efJeJejCe

(Signature/Thumb impressionof Borrower)

(JeÀpe&oej JesÀ nmlee#ej/Debiet"s JeÀe efveµeeve)

Place/mLeeve:

Date/leejerKe: D D M M Y Y Y Y

I hereby, declare that I would like to take benefit of coverage under PMFBY/RWBCIS from Kharif/Rabi (Year) ___________________ season by choice. Therefore, requesting for enrolment under the scheme as per the scheme provisions.

APPLICATION FORM FOR OPT IN PMFBY SCHEME/HeeSr ceSHeÀyeeJr ee³e ³eeps evee ce W µeeecf e} nevs e s JeÀs e}f S DeeJeos ve He$eINDUS KISAN/Fb[me efkeÀmeeve “Opt In” form for Revamped PMFBY/RWBCIS/HegvejeslLeeve HeerSceS]HeÀyeerJee³e/Deej[yu³etyeermeerDeeF&Sme ceW µeeefce} nesves keÀe DeeJesove He$e

Date/efoveebJeÀ: D D M M Y Y Y Y

APPLICATION DETAILS/DeeJesove efJeJejCe1. Name of the account holder as per updated Aadhaar1. KeeleeOeejJeÀ JeÀe veece DeÐeleve DeeOeej JesÀ Devegmeej:

3. KCC Loan Account No/JesÀmeermeer $e+Ce Keelee mebK³ee:

4. Aadhaar No/DeeOeej mebK³ee:

5. Mobile/Telephone No/ceesyeeF}/ìs}erHeÀesve vebyej:

FARMER ACKNOWLEDGEMENT/efJeÀmeeve HeeJeleer

“Opt In” form for Revamped PMFBY/RWBCIS/Hegvees&lLeeve HeerSceSHeÀyeerJeeF&/Deej[yu³etyeermeerDeeF&Sme JesÀ ef}S Dee@Hì Fve HeÀe@ce& D D M M Y Y Y Y

APPLICATION DETAILS/DeeJesove efJeJejCe

6. Opting in season Kharif/Rabi(Year) /6. KejerHeÀ/jyeer (Je<e&) ceewmece ceW DeeeÅHìie Fve:

Bank Branch Name:yeQJeÀ µeeKee JeÀe veece:

Branch Code No:µeeKee JeÀes[ mebK³ee:

2. Name of the account holder as per bank pass book2. KeeleeOeejJeÀ JeÀe veece yeQJeÀ Heeme yegJeÀ JesÀ Devegmeej:

ceQ Sleod Üeje Iees<eCee JeÀjlee ntb efJeÀ ceQ KejerHeÀ/jyeer (Je<e&)____________________ceewmece mes HeerSceS]HeÀyeerJee³e/Deej[yu³etyeermeerDeeF&Sme JesÀ lenle JeÀJejspe JeÀe }eYe }svee ®eentbiee~ Fmeef}S, ³eespevee JesÀ ÒeeJeOeeveesb JesÀ Devegmeej ³eespevee JesÀ ÒeeJeOeeveesb JesÀ DeOeerve veeceebJeÀve JesÀ ef}S DevegjesOe JeÀj jne ntb~

Signature of Account holderKeeleeOeejJeÀ JeÀe nmlee#ej:

For Office Use: The Above declaration is recorded in the bank documents for appropriate action on date.

JeÀe³ee&}³e GHe³eesie JesÀ ef}S: GHe³e&gJeÌle Iees<eCee Gme efoveebJeÀ Hej Gef®ele JeÀej&JeeF& JesÀ ef}S yeQJeÀ omleeJespeesb ceW ope& JeÀer ieF& nw~

Bank Official (signature) with dateyeQJeÀ DeefOeJeÀejer JesÀ (nmlee#ej) leejerKe JesÀ meeLe

Date/efoveebJeÀ:



1. Name of the account holder as per updated Aadhaar1. KeeleeOeejJeÀ JeÀe veece DeÐeleve DeeOeej JesÀ Devegmeej:

3. KCC Loan Account No/JesÀmeermeer $e+Ce Keelee mebK³ee:

4. Aadhaar No/DeeOeej mebK³ee:


2. Name of the account holder as per bank pass book2. KeeleeOeejJeÀ JeÀe veece yeQJeÀ Heeme yegJeÀ JesÀ Devegmeej:

For Office Use: The Above declaration is recorded in the bank documents for appropriate action on date.



Disclaimer: In case, if the farmer wish to Partial Opt In for some of the corps under the scheme he/she needs to get himself/herself enrol under the scheme through other channels of enrolment like Common Service Centre, Agents of Insurance Companies, Online facility on PMFBY Portal or android based Crop Insurance App./

“Opt Out” form for Revamped PMFBY/RWBCIS/HegvejeslLeeve HeerSceS]HeÀyeerJee³e/Deej[yu³etyeermeerDeeF&Sme mes yeenj efvekeÀ}ves keÀe DeeJesove He$e

D D M M Y Y Y Y


1. Name of the KCC Holder/JeÀs meemr ee r OeejJeÀ JeÀe veece:

2. KCC Loan Account No/JeÀs meemr ee r $e+Ce Keelee meKb ³ee:

3. Mobile/Telephone No./ceesyeeF}/ìs}erHeÀesve vebyej:

I am aware of the scheme provisions and benefits of PMFBY/RWBCIS. I hereby, declare that I would like to continue with KCC loan scheme, however, I am opting out of

PMFBY/RWBCIS from Kharif/Rabi (Year)_________________________________season by choice. Therefore, requesting for non-enrolment under the scheme./

DemJeerkeÀjCe: ³eefo efJeÀmeeve ³eespevee JesÀ lenle JegÀí HeÀme}esb JesÀ ef}S DeebefµeJeÀ ªHe mes µeeefce} nesvee ®eenlee nw, lees Gmes Dev³e ®ewve}esb pewmes JeÀe@ceve mee|Jeme meWìj, yeercee JebÀHeefve³eesb JesÀ SpeWìesb, HeerSceS]HeÀyeerJee³e Heesì&} ³ee Sb[je@³e[ DeeOeeefjle HeÀme} yeercee SsHe Hej Dee@ve}eFve megefJeOee JesÀ ceeO³ece mes mJe³eb JeÀes ³eespevee JesÀ DeOeerve veeceebJeÀve JeÀjJeevee nesiee~

DemJeerkeÀjCe: ³eefo efJeÀmeeve ³eespevee JesÀ lenle JegÀí HeÀme}esb JesÀ ef}S DeebefµeJeÀ ªHe mes µeeefce} nesvee ®eenlee nw, lees Gmes Dev³e ®ewve}esb pewmes JeÀe@ceve mee|Jeme meWìj, yeercee JebÀHeefve³eesb JesÀ SpeWìesb, HeerSceS]HeÀyeerJee³e Heesì&} ³ee Sb[je@³e[ DeeOeeefjle HeÀme} yeercee SsHe Hej Dee@ve}eFve megefJeOee JesÀ ceeO³ece mes mJe³eb JeÀes ³eespevee JesÀ DeOeerve veeceebJeÀve JeÀjJeevee nesiee~

FARMER ACKNOWLEDGEMENT/efJeÀmeeve HeeJeleer

D D M M Y Y Y Y


4. Opting Out for season: Kharif/Rabi (Year)/ceewmece JesÀ ef}S yeenj efveJeÀ}vee: KejerHeÀ/jyeer (Je<e&):

Disclaimer: In case, if the farmer wish to Partial Opt In for some of the corps under the scheme he/she needs to get himself/herself enrol under the scheme through other channels of enrolment like Common Service Centre, Agents of Insurance Companies, Online facility on PMFBY Portal or android based Crop Insurance App./

ceQ HeerSceSHeÀyeerJee³e/Deej[yu³etyeermeerDeeF&Sme JesÀ ³eespevee ÒeeJeOeeveesb Deewj }eYeesb mes DeJeiele ntb~ ceQ Sleod Üeje Iees<eCee JeÀjlee ntb efJeÀ ceQ JesÀmeermeer $e+Ce ³eespevee peejer jKevee ®eenlee ntb, ne}ebefJeÀ, ceQ KejerHeÀ/jyeer (Je<e&)_________________________________ceewmece mes HeerSceSHeÀyeerJee³e/Deej[yu³etyeermeerDeeF&Sme mes yeenj efveJeÀ} jne ntb~ Fmeef}S, ³eespevee JesÀ lenle iewj-veeceebJeÀve JeÀe DevegjesOe JeÀj jne ntb~

Signature of Account holderKeeleeOeejJeÀ JeÀe nmlee#ej:


For Office Use: The Above declaration is recorded in the bank documents for appropriate action on date./


1. Name of the KCC Holder/JeÀs meemr ee r OeejJeÀ JeÀe veece/:

2. KCC Loan Account No/JeÀs meemr ee r $e+Ce Keelee meKb ³ee:


For Office Use: The Above declaration is recorded in the bank documents for appropriate action on date./


APPLICATION FORM FOR OPT OUT FROM PMFBY SCHEME/HeeSr ceSHeÀyeeJr ee³e ³eeps evee me s yeenj efvekeÀ}ves JesÀ ef}S DeeJeos ve He$e/INDUS KISAN/Fb[me efkeÀmeeve



Date/efoveebJeÀ:



Date/efoveebJeÀ:“Opt Out” form for Revamped PMFBY/RWBCIS/HegvejeslLeeve HeerSceS]HeÀyeerJee³e/Deej[yu³etyeermeerDeeF&Sme JesÀ ef}S DeeJesove He$e


For more details, call our Phone Banking Numbers: 1860 267 7777 / 1800 209 0061 / +91 22 4406 6666

Visit us at www.indusind.com

IndusInd Bank Ltd. 3rd Floor, Building Number 10, Tower - B, DLF Cyber City, Gurgaon - 122002.

IndusInd Bank Ltd. 2401, Gen. Thimmayya Road, Pune - 411001.