Bitly Transaction

TRANSACTION DETAILS
Product Type Loan Downpayment (Rs.) EMI Amount (Rs.)

Amount/Premium
(Rs.)
Len 30699.00 1000.00 4386.00

S3(92IN/10i3/8/1/MS/W11/15/FHD
LSM (Max Bupa 1199 171.29

Health Insurance)
Total Downpayment
___ 1000.00 ___
(Rs.)
Total EMI (Rs.) ___ ___ 4557.29
Bajaj Finance Limited T and C apply

Consumer Finance Customer ID: A24925034
Date : 14/09/2022
Application Form
CKYC No/ FI Reference No.:
Personal Details
* SIMANCHAL SAHU
* SAHEB SAHU
* SAROJINI SAHU
* 23/09/1989
Marital Status* Married Gender* Male
Monthly Income* Rs 15000-25000
Identification Document Aadhaar
Corresponding ID Number* 9894
ID Expiry Date*
Contact Details
Residence Type* Self Owned
Type of POA* Aadhaar
POA document number* 9894
POA Expiry Date*
Residence Address* S/O SAHEB SAHU JAGAMOHAN null ASKA
Area/Locality* S/O SAHEB SAHU City*
Landmark* NR LAXMI NRUSHIHA TEMPLE Pin Code* 761114
State* ORISSA Mobile No* 9556515157
Alternate Number* 9337373624
Email ID*
Preferred Mailing Address* Residence
Employment / Business Details

Employment Type* Self Employed
Qualification* 12th Standard & below
Name of the Company/Business*
Nature of business* Workshop
Designation*
Office/Business Address* JAGAMOHAN ASKA GANJAM
Area/Locality* S/O SAHEB SAHU City*
State* ORISSA Pin Code* 761,114
Office Phone* 9337373624
Product Details
Applied Loan Amount * 16000.00
Undertaking/Declaration
1. I hereby apply for a finance facility from Bajaj Finance Limited ("BFL") as stated in this Application Form.
2. I declare that all the particulars, information and details provided in this Application Form and the documents submitted by
me are true, correct, complete and up-to-date in all respects and that I have not withheld any material information.
3.I request BFL to procure my CIBIL report and provide it to me. Also, I hereby expressly consent for deducting applicable
charges (Rs. 25 + GST) for the same.
4. I confirm that no insolvency proceedings or suits for recovery of outstanding dues, monies or property (ies) and/or any
criminal proceedings have been initiated and/or are pending against me.
5. I declare that I have not received any request for or made any payment in cash, bearers cheques or of any other kind in
connection with this Application Form from/toany person.
6. I hereby authorize BFL to exchange or share information and details relating to my application to its group companies or
any third party, as may be required or deemed fit, for the purpose of processing this loan application and/or related offerings
or other products/ services that I may apply for from time to time.
7. I hereby consent to and authorize BFL to increase or decrease the credit limit assigned to me basis BFL's internal credit
policy and criteria at its sole discretion from time to time. I will not raise any objection or dispute with regard to the same at
any point of time.
8. Iunderstand that my BFL account login credentials including login and transaction password issued by BFL from time to
time, constitutes confidential information and I agree to keep the same secure and confidential to prevent any unauthorized
use.
9. By submitting this application, I hereby expressly authorize BFL to send me communications regarding loans, insurance
and other products from BFL, its group companies and/or third parties through telephone calls / SMSs / emails/ post etc.
including but not limited to promotional communications. I confirm that I shall not challenge receipt of such communications
by me as unsolicited communication, defined under TRAI Regulations on Unsolicited Commercial Communications. I
understand that I can at any time opt not to receive any telecommunication by registering under the Do Not Call Registry.
10. I understand and acknowledge that BFL has the absolute discretion, without assigning any reasons to reject my
application and that BFL is not answerable/ liable to me, in any manner whatsoever, for rejecting my application.
11. I hereby confirm having read and understood the Master Terms and Conditions Applicable to Loans for Consumer
Durable, Digital, Lifestyle Products and EMI Cards and unequivocally accept the same.
AADHAAR DECLARATION
(1) I/We hereby confirm that I/we have no objection in authenticating myself/ourselves with Aadhaar based authentication
system. I/We consent to provide and authenticate my/our Aadhaar number through the available mode of Aadhaar based
authentication, as permitted under the prevailing law/regulation, for the purposes of availing this product/service and for
availing such other third-party products/ service from BFL under this Application form.
(2) I/We understand that the Aadhaar based authentication shall be used only for authenticating my identity with Central
Identities Data Repository for the aforementioned specific purpose(s).
(3) I/We hereby authorize BFL to store my/our KYC data/documents provided under this Application including my/our
Aadhaar number, proof of identity and address obtained from UIDAI.
Place :
Date : 14/09/2022
DNC false
Note: BFL shall be entitled at its sole and absolute Signature of the Applicant
discretion to reject / approve
www.bajajfinservlending.in
Application Form Submitted by the applicant/s.

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TRANSACTION DETAILS

Product Type Loan Downpayment (Rs.) EMI Amount (Rs.)

Len 30699.00 1000.00 4386.00

LSM (Max Bupa 1199 171.29

Total EMI (Rs.) _ _ 4557.29

Bajaj Finance Limited T and C apply

CKYC No/ FI Reference No.:

Employment / Business Details

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