APPLICATION FORM –

AGRO POWER □ AGRO LITE □

KISAN MITRA □ KM LITE □
MSME SAMRIDDHI □ MSME SAMRIDDHI LITE □
SWIFT OD □ QUICK GST OD □

For Office use only Application Date (DD/MM/YYYY): _______________________

Proposal No: Application No.
Region Sol Id
Lead Id Financial Year
Name & Emp ID of officer sourcing the proposal

The Branch Manager,

AXIS BANK LTD. ___ ____________ Branch

Dear Sir/Ma’am,
I/We, ____________________________, hereby apply for the above-mentioned facilities aggregating ______________ /-
(Rupees_______________________ _______________________only). I/we furnish below the necessary information.
PART I: GENERAL DETAILS
Name
Existing Customer Yes/No If Yes, Provide Account 1. 2. 3.
of Axis Bank No(s). or CIF ID
Constitution Individual / Proprietorship / Partnership / Private Limited / Public Limited / Others (pl. specify) ___________
Nature of Business Trade / Manufacturing / Service /Others (pl. specify) ___________
Date of
Incorporation (Please mention the year since applicant is in the activity in case of Individuals)
Registration No. CKYC No.
(Company /partnership /MSME reg. no) Yes / No (if yes, share number)
PAN /GIR No.
Udyog Aadhar No
(Wherever
available- Non
Mandatory)
Aadhaar Details Individual Non Individual*

(*Note - Where the client is non-individual, Aadhaar numbers issued to person holding an attorney to transact on its behalf is required to be
submitted. Please fill Aadhaar details - Annexure for multiple people.)
Registered office /
Permanent Address
City: State Distance from Branch: _____Km
PIN Phone / Mobile : Fax:
Email No. of years : Ownership: Self /Owned / Rented or Leased
Correspondence
Address (if
Different from City: State: Distance from Branch: _____Km
above) PIN Phone / Mobile : Fax:
No. of years :
Address of the
Factory/ Unit
Phone / Mobile : Distance from Branch: _____Km
City: State:
PIN No. of years :
Fax Ownership: Self /Owned / Rented or Leased
Details of the About the activity, Years of Experience, etc.
Business activity

City_________________________ District__________________________ and Branch____________________________ where loan is required

.............................. (1) ..............................(2) ..............................(3) ..............................(4) ..............................(5)

Application Form-B2B V1.20 Page 1 of 7
Whether registered under GST: □ Yes □ No (If yes following details are mandatory) GST Exemption □ Yes □ No Exemption reason if Yes_____

GST Registration: □ Single □ Multiple (Please fill GST annexure for multiple GST registration) Special Economic Zone: □ Yes □ No

GSTIN:

Address registered for GSTIN

□ Same as Registered office / Permanent Address □ Same as correspondence Address
□ Same as Factory Address □ As given below
Line 1:

Landmark:

City: State: PIN

Country:

Whether the MSME unit is ZED rated: □ Yes □No. If yes, the gradation obtained by the MSME unit (Tick appropriate one)
□Bronze □Silver □Gold □Platinum
PART II: EXISTING BANKING RELATIONSHIP:

1. Accounts with Other Banks:-

Bank Branch / Address Account Type Account Number

2. Credit Facilities
We declare that, we do not enjoy credit facilities with any bank / we enjoy following credit facilities with other bank(s) as on date DD/MM/YYYY
A. Overdraft & Cash Credit ( in Lacs)
Sr. No Bank & Branch Type of Limit Current Date of Irregularity ROI Security Renewal
with address Facility Outstanding availment offered due on
1
2
3

B. Term loan and other borrowings ( in Lacs)

Sr. Bank & Branch Purpose Limit Current Instalment (Amt) Irregularity ROI Security Tenure Balanced
No with address Outstanding & frequency months
1
2
3
(Pl. Enclose Sanction letter/s for the same)

PART III: Ownership, Management & Personal Guarantee Details

(Individual in case of individual activity/ Proprietor in case of proprietorship firms/ partners in case of Partnership/ Directors in case of company /
Others, if any)

Personal Guarantor: Yes/No Personal Guarantor: Yes/No

Beneficiary Owner: Yes/No Beneficiary Owner: Yes/No

Titl First Name Middle Name Last Name Titl First Name Middle Name Last Name
e e
Name* Name*

Maiden Name Maiden Name

(If Any*) (If Any*)
Father Father
Name* Name*
Mother’s Mother’s
Maiden Name* Maiden Name*

Please put a tick Mark Please put a tick Mark

Occupation Type:□ Service(Private /Public /Government Sector) Occupation Type:□ Service(Private /Public /Government Sector)
□ Others(Professional/Self-Employed/Retired/Housewife/Student) □ Others(Professional/Self-Employed/Retired/Housewife/Student)
□ Business □ Others □ Business □ Others

.............................. (1) ..............................(2) ..............................(3) ..............................(4) ..............................(5)

Application Form-B2B V1.20 Page 2 of 7
 *Aadhaar Details: Individual Non Individual** *Aadhaar Details: Individual Non Individual**

(**Note - Where the client is non-individual, Aadhaar numbers issued to person (**Note - Where the client is non-individual, Aadhaar numbers issued to person
holding an attorney to transact on its behalf is required to be submitted. Please fill holding an attorney to transact on its behalf is required to be submitted. Please fill
Aadhaar details - Annexure for multiple people.) Aadhaar details - Annexure for multiple people.)

Person with Disability: Yes/No Person with Disability: Yes/No

Community: □ Hindu □ Muslim □ Christian □ Sikh □ Buddhist Community: □ Hindu □ Muslim □ Christian □ Sikh □ Buddhist
□ Zoroastrian □ Jain □ Parsi □ Others □ Zoroastrian □ Jain □ Parsi □ Others

Category: □ SC □ ST □ OBC □ Minority □ Woman □ Other/General Category: □ SC □ ST □ OBC □ Minority □ Woman □ Other/General

Age : _____ Years DOB : DD/MM/YYYY Age : _____ Years DOB : DD/MM/YYYY

Gender: □ Male □ Female □ Third Gender Gender: □ Male □ Female □ Third Gender
Nationality: ________________________ Nationality: ________________________
Education: _________________________ Applicant Education: _________________________ Applicant
photograph With photograph With
Residential Address:________________________ Residential Address:________________________
Signature Signature
_________________________________________ _________________________________________
_________________________________________ /Thumb _________________________________________ /Thumb
_________________________________________ impression _________________________________________ impression
Residence Ownership : Own / Rented Residence Ownership : Own / Rented
No of Years in the current residence:_________________ No of Years in the current residence:_________________
Activity experience in years:________________________ Activity experience in years:________________________
Resi. Phone : _____________________________________ Resi. Phone :_____________________________________
Mobile : ___________________________________________________ Mobile : ___________________________________________________
PAN /GIR No(If not having PAN/GIR No. fill Form 60):______________ PAN /GIR No(If not having PAN/GIR No. fill Form 60):______________
Aadhaar Card No.:___________________________________________ Aadhaar Card No.: __________________________________________
DIN : _____________________________________________________ DIN : ______________________________________________________
Pass port/Driving license no ___________________________________ Pass port/Driving license no __________________________________
Net Worth As on ______________ Rs__________________________ Net Worth As on ______________ Rs___________________________
% holding/ Profit Sharing Ratio: _________________ % holding/ Profit Sharing Ratio: _________________

PART IV: Proposal Details

Section 1: *Loan Request Details

S.no Nature of Facility Amount Requested Tenure Purpose Expected Interest Rate
1.
2.
3.
(*In case of fresh term loan, Annexure- TL to be filled and attached)

Details, in case of Take over: ( in Lacs)

Sr. Name of the Bank & Nature of the Sanction Limit Present Irregularity, Existing Details of the collateral
No Branch with Address facility Outstanding if any ROI mortgaged and value
1.
2.

PART V: Security Details

1. Primary Security:
2. Collateral Security (Non Agri Property / Liquid collateral only):
A. Immovable property
Name of Registered Owner Relationship with the Borrower
Property Details
Age of property in yrs Value of the property:

B. Liquid collateral security offered:

2. Corporate Guarantor : (if applicable) Constitution: _______________________

Name of the Corporate: ____________________________________________________ PAN/GIR no: _______________________
Address: __________________________________________________________________________________________________________
City: _______________________ State:___________________________ Pin:____________________ Phone:________________________
CIN No: ____________________ Registration No: ____________________
Net worth: _____________________ as on is Rs _____________________

.............................. (1) ..............................(2) ..............................(3) ..............................(4) ..............................(5)

Application Form-B2B V1.20 Page 3 of 7
 PART VI: Past performance/Future estimates and other details

Amount in lakhs Past year 1 Past year 2 Present year Next year Installed Capacity Utilized
(Actual) (Actual) (Estimate) (Projection) Capacity
Net Sales
Net Profit
Capital (Net worth
in case of
Companies)

Need for proposed expansion/ expenditure:____________________________________________________________________

Implementation Schedule:__________________________ Repayment Schedule:_______________________________________
Associate Concern details
Name of Associate Address of associate Presently banking Nature of association Extent of Interest as a Prop./ Partner/
concerns concerns with Director or Just Investor in Associate
Concern

Part VII – Status regarding Statutory Obligations

Whether complied with (select Yes/No). Select NA in case not applicable

1 Registration under Shops and Establishment ACT Yes / No / NA
2 Registration under MSME (Provisional / Final) Yes / No / NA
3 Latest Sales Tax returns filed Yes / No / NA
4 Latest Income Tax returns filed Yes / No / NA
5 Any other statutory dues remaining outstanding Yes / No / NA

Part VII – Customer Request Details

a) Activate my account for Mobile number updates and alerts: Yes / No - Mobile
This subscribes to all alerts including Value added alerts
b) Activate my account for E –Statements registration: Yes / No - email id: ____________________________________________________
In case E – Statements are activated, physical statements will be disabled
a) New Cheque book request: Number of cheques book/s required

Non Refundable Login Fees – Rs. 5000/- + Applicable taxes. (A Cheque to be issued in favour of
Axis Bank Ltd – COMM - LOGIN FEES-RURAL LENDING – B2B R OR Axis Bank Ltd – COMM - LOGIN FEES-RURAL LENDING – MSME – as applicable)

Details of the chq

Bank Name Branch Name Chq Number Amount Chq Date

I hereby confirm that I have submitted above mentioned cheque towards non-refundable login fees.

I have read, understood and agree to the terms and conditions to various products and services. I accept and agree to be bounded by the terms and
conditions as displayed on www.axisbank.com. I agree that the bank may debit service chargers plus taxes to my account wherever applicable.

Declaration
1. We certify that the information provided by us in this application form is true in all respects and that this shall form the basis of any facility / service that the AXIS Bank (the
Bank) may decide to grant to us at its sole discretion. 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. 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. We will be bound by the terms and conditions of the facility that may be granted to us.
2. We are aware that Bank/ its agents may contact me/us through telecall/SMS/email in connection with my request. I/We authorize Axis Bank to disclose from time to time any
information relating to my/our facility(ies) to any parent/subsidiaries & associate of Axis Bank and to third party(ies) engaged by Axis Bank.
3. We agree that in case of non-payment of dues, in case of any facility availed from the Bank and consequently the account is to be classified as NPA, all other loan accounts of
the Borrower, with the Bank also shall be classified as NPA as per the guidelines issued by RBI and it shall entitle the Bank to recall all such loans/facilities availed by the same
customer from the Bank, irrespective of the regular repayment in such accounts.
4. We understand that as a pre-condition, relating to grant of the facility to us, the Bank requires our consent for the disclosure by the Bank of information and data relating to us,
the credit facility availed of/to be availed of in relation thereto and default, if any, committed by us, in discharge thereof. Accordingly, we hereby agree and give consent for the
disclosure by the Bank of all or any such information and data relating to us, the credit facility availed of/to be availed of in relation thereto and default, if any, committed by us,
in discharge thereof, as the Bank may deem appropriate and necessary, to disclose and furnish to the Credit Information Companies [CIC ] , and any other agency authorised in
this behalf by Reserve Bank of India [“RBI”].
5. We declare that the information and data furnished by us to the Bank are true and correct.

.............................. (1) ..............................(2) ..............................(3) ..............................(4) ..............................(5)

Application Form-B2B V1.20 Page 4 of 7
6. I/We hereby declare that I/We am/are not defaulter(s) to any Bank/Financial Institution.
7. We undertake that CIC and any other agency so authorized may use, process the said information and data disclosed by the Bank in the manner as deemed fit by them; and CIC
and any other agency so authorized may furnish for consideration, the processed information and data disclosed or products thereof prepared by them, to Bank's/ Financial
Institution's and other Credit Grantors or Registered Users, as may be specified by the RBI in this behalf.
8. We confirm that the enclosed copies of financials / Bank Statements/ Title / Legal and other documents etc. are submitted by us against our loan application and are true copies.
9. We understand that charges paid to the Bank towards out of pocket expenses and/or log-in/ processing fees are non-refundable and upon the application being withdrawn by
us or being rejected by the Bank for any reason whatsoever in the pre-sanction or post-sanction stage , we will not be entitled to any refund either in part or in full.
10. We understand that all charges pertaining to the loan including the Processing fees, prepayment penalty, etc. are to be borne by us. We further understand that the relevant
Stamp Duty, Legal Expenses, Valuation Expenses, expenses pertaining to creation of charges with ROC, charges for documentation and any other out of pocket expenses as per
actuals will be borne by us.
11. We understand that disbursement will be subject to production of necessary documents as may be required by the Bank from time to time , satisfactory completion of Bank's
appraisal and documentation process and compliance with Bank's laid down norms /guidelines
12. The proceeds of the facility shall not be used for investment in small savings scheme, capital market, purchase of gold in any form including primary gold, gold bullion,
gold jewelry, gold coins, units of gold ETF and mutual funds. We confirm that we shall utilise the said Credit Facility only for the purposes of Business as mentioned above.
13. Axis Bank will convey its decision (within 2 weeks for credit limit up to Rs. 5 lakh and within 3 weeks for credit limit above Rs. 5 lakh and up to Rs. 25 lakh for Micro & Small
enterprises borrowers) and (within 30 working days for other borrowers) from the date of receipt of the application provided the application is complete in all respects and is
submitted along with all the documents as per 'check list' provided in the application for loan and/or any additional documents as may be required by the bank for proper
appraisal of the application. The computation of timelines shall start from the day on which all documents required for a proper appraisal of the application are provided by
the Customer to bank.
14. From time to time, Axis Bank communicates various new products / special features of existing products / promotional offers which are of significant benefits to its customers.
I hereby provide my consent to receive information / services etc. for marketing purposes through Telephone / Mobile / SMS / E-mails by the Bank / its agents. I understand
that I may opt out by registering in the ‘Provider Customer Preference Register’ as per details provided in the ‘TRAI’ website.
15. I/We undertake that
a) I/We authorize Axis Bank to verify and authenticate my/our Aadhaar number during processing my/our application for legitimate Business purposes.
b) I/We further authorise the Bank to share my Aadhaar related details/information with regulatory / statutory bodies as and when required.
16. Further, we confirm following: No suit is pending in any court of law against the directors/partners.
 I hereby declare that the details furnished above are true and correct to the best of my/our knowledge and belief and I undertake to inform you of any changes therein,
immediately. In case any of the above information is found to be false or untrue or misleading or misrepresenting, I/We am/are aware that I/we may be held liable for it.
 My personal / KYC details may be shared with Central KYC Registry
 I hereby consent to receiving information from Central KYC Registry through SMS/Email on the above registered number/email address
17. Customer declaration in respect of relationship with Director/ Senior Officer of the Bank/any other bank including directors of Scheduled Co-operative Banks, directors of
subsidiaries/trustees of mutual funds/venture capital funds.”

Relationship of the Applicant Yes No

I am a director of Axis Bank or we are a firm in which any director of Axis Bank is interested as a partner/manager/employee/ guarantor
or we are a company in which any of the directors of Axis Bank is interested as a managing agent, manager, employee or as a guarantor
or holds substantial interest.
I am a director of any other bank or we are a firm in which any director of other bank is interested as partner/ guarantor or we are a
company in which any of the directors of other bank holds substantial interest or is interested as a director or as a guarantor.
If yes, mention the name of other bank
I/we am/are a relative of director of Axis Bank/other bank/senior officer of Axis Bank or we are a firm (Partnership / Hindu Undivided
Family) in which any relative of director of Axis Bank / other Bank is interested as a partner/ guarantor or we are a company in which
any relative of the director of Axis Bank / Other Bank hold substantial interest or is interested as a director or guarantor. If yes, mention
the details below.

In the event that the Applicant / Co-applicant are related to any of Director of Axis Bank/ Director of other bank/ Senior officer(s) of Axis Bank:
If the declaration is found to be false then the Bank will be entitled to revoke and/or recall the credit facility.

Sr. No Name of Director(s)/Senior Officer (s) Designation Relationship

1
2

1 2 3
Signature of Applicant
Date & Place
Signature of Guarantor
Date & Place

List of Enclosures
1. KYC Documents: 2. Financial Documents: 3. Bank Statements: 4. Others:

Interest Rate, Processing Fees & Other Charges

I/We understand and agree to the following terms pertaining to the facility/loan:-
1) Rate of Interest: The final applicable interest rate as decided by Axis Bank based on various parameters as per its policies and procedures shall be communicated to the customer
at the time of sanctioned/disbursement of each tranche of the facility/loan. The MCLR prevailing at the time of limit set up shall be applicable for the facility/loan. In case there is
change in the MCLR the margin/spread would appropriately be reset.
2) Processing Fee: A non-refundable processing fees of maximum 0.75% (plus applicable GST) is applicable on the facility/loan sanctioned by the Bank. The applicable processing fee
payable by the customer will be communicated to the customer upon sanction of the facility/loan.
3) Account Service Charge: Account Service charge per account on an annual basis up to a maximum limit of Rs. 4000 (plus applicable GST) would be applicable.
4) Account Maintenance Charges: Account Maintenance Charges for fund based working capital facility will be charged per account annually up to a maximum limit of Rs. 5000 (plus
applicable GST) depending upon the sanctioned amount.
5) Documentation Charges: Documentation charges as applicable will be charge up to a maximum amount Rs. 7500 (plus applicable GST) depending upon the sanctioned amount
6) Penal Interest – In case of overdue account, penal interest will charged as applicable for the product as per the internal policy of the Bank on the entire outstanding amount to
maximum limit of 6% per annum.
7) Other Charges – Other Charges including but not limited to statutory charges, such as stamp duty on documentation etc., as applicable are payable on actual basis and any other
charges as communicated to the customer by the Bank.
All the above charges comprise all the charges applicable for availing the facility.

.............................. (1) ..............................(2) ..............................(3) ..............................(4) ..............................(5)

Application Form-B2B V1.20 Page 5 of 7
Goods and Services tax (GST) will be charged extra as per the applicable rates, on all the charges and fees (wherever GST is applicable).

Acknowledgement of Loan application Bank’s Copy

Application ID:
We acknowledge that we have received an application dated …………………from Mr. /Ms. ………………………………………………………………….. Residence of
…………………………………………………………. for a loan of ……………… under the ……………… product. Axis Bank will convey its decision (within 2 weeks for credit limit up
to Rs. 5 lakh and within 3 weeks for credit limit above Rs.5 lakh and up to Rs.25 lakh for Micro & Small enterprises borrowers) and (within 30 working days for other
borrowers) from the date of receipt of the application provided the application is complete in all respects and is submitted along with all the documents as per 'check
list' provided in the application for loan and/or any additional documents as may be required by the bank for proper appraisal of the application. The computation
of timelines shall starts from the day on which all documents required for a proper appraisal of the application are provided by the Customer to bank.
The applicant is in receipt of the indicative Interest Rate, Processing Fees & Other Charges that would be applicable, if the Bank grants the facility.
For AXIS Bank Ltd. Date: DD/MM/YYYY

(Sign and Stamp) Received the acknowledgment of loan application (Applicant’s Signature)..................................

Documents received: Self-Certified True Copies Notary

Identity Verification Done:
IN PERSON VERIFICATION CARRIED OUT BY

Emp. Name : _____________________________

Emp. Code : _____________________________
Emp. Designation : _____________________________
Emp. Organisation & Code : _____________________________
Emp. Branch : _____________________________ (Employee Signature)
Place : _____________________________

Date D D M M Y Y Y Y

-------------------------------------------------------------------------------CUT HERE-------------------------------------------------------------------

Acknowledgement of Loan application Applicant’s Copy

Application ID:
We acknowledge that we have received an application dated …………………from Mr. /Ms. ………………………………………………………………….. Residence of
…………………………………………………………. for a loan of ₹. ……………… under the ……………… product. Axis Bank will convey its decision (within 2 weeks for credit limit up
to Rs. 5 lakh and within 3 weeks for credit limit above Rs.5 lakh and up to Rs.25 lakh for Micro & Small enterprises borrowers) and (within 30 working days for other
borrowers) from the date of receipt of the application provided the application is complete in all respects and is submitted along with all the documents as per 'check
list' provided in the application for loan and/or any additional documents as may be required by the bank for proper appraisal of the application. The computation of
timelines shall starts from the day on which all documents required for a proper appraisal of the application are provided by the Customer to bank.
The applicant is in receipt of the indicative Interest Rate, Processing Fees & Other Charges that would be applicable, if the Bank grants the facility.
Goods and Services tax (GST) will be charged extra as per the applicable rates, on all the charges and fees (wherever GST is applicable).

We also acknowledge the receipt of Non Refundable Login Fees – Rs. 5000/- + Applicable taxes. (A Cheque to be issued in favour of
Axis Bank Ltd – COMM - LOGIN FEES-RURAL LENDING – B2B R OR Axis Bank Ltd – COMM - LOGIN FEES-RURAL LENDING – MSME – as applicable)

Details of the chq

Bank Name Branch Name Chq Number Amount Chq Date

For AXIS Bank Ltd.

(Sign and Stamp) Date: DD/MM/YYYY
Please Note that:
1. This is only an acknowledgement for having received the application and this should not be constructed as an indication for our acceptance of the proposal, a
decision on which will be taken only after due consideration of the proposal on its merit and / or on fulfillment of conditions if any, that may be stipulated by the
bank.
2. The application will be taken for consideration only after all the particulars / data / documents as may be required are received by the bank
3. In case the proposal is rejected/not considered the reasons for the same will be intimated to the applicant.

Annexure TL
For Term Loan Proposal

.............................. (1) ..............................(2) ..............................(3) ..............................(4) ..............................(5)

Application Form-B2B V1.20 Page 6 of 7
 Type of Machine/Equipment Purpose of Machine/ Equipment Imported / Indigenous Name of Supplier

Estimated Requirement of Funds: Estimated Sources of Funds

Particulars Rs in Lacs Particulars Rs in Lacs
Purchase Price/Project cost Promoters' Share
Incidental Costs Loan Funds
Stamp duty & Registration(if applicable) Subsidy (If any)
Other costs (pl specify _______) Total Estimated Requirements
Total Estimated Requirements Total Estimated Sources

Need for proposed expansion/ expenditure:_____________________________________________________________________

Implementation Schedule:__________________________ Repayment Schedule:_______________________________________

Aadhaar Details – Annexure

1. Aadhaar Number : __________________________

2. Aadhaar Number : __________________________

3. Aadhaar Number : _________________________

4. Aadhaar Number : _________________________

5. Aadhaar Number : __________________________

Customer Declaration:

 I/We authorize Axis Bank to verify and authenticate my/our Aadhaar number during processing my/our application for legitimate Business purposes.
 I/We further authorise the Bank to share my Aadhaar related details/information with regulatory / statutory bodies as and when required.

Signature of Authorized signatory Signature of Authorized signatory

Signature of Authorized signatory Signature of Authorized signatory

.............................. (1) ..............................(2) ..............................(3) ..............................(4) ..............................(5)

Application Form-B2B V1.20 Page 7 of 7