2/28/2023 BAJAJ FINANCE LIMITED ("BFL") - Consumer Finance Application Form

BAJAJ FINANCE LIMITED ("BFL") - Consumer Finance Application Form

Application Form No. : A77143639
CKYC No/KIN :
Deal ID A77143639
Customer ID : 158174293
Date : 28/02/2023

PERSONAL DETAILS

Name of the Applicant : SABINA KHATUN

Father's/ Spouse's name : ABDULLAH SIDDIKI
Mother's Name : NSIMA KHATOON
Date of Birth : 1997-03-24
Gender : Female
Marital Status :
Nationality : Indian
Monthly Income :
PAN or Form 60 (in case PAN is not allotted) : Form 60
Identification Document (POI) : Aadhaar
POI Document Number : 7147
POI Document Expiry Date :
Purpose of Loan : Purchase of Consumer Durable Product

CONTACT DETAILS

Residence Type : Self Owned

Type of Proof Of Address (POA) : Aadhaar
POA Document number : 7147
POA Document Expiry Date :
Is OMC/NFCC Customer : false
Current Address : W/O ABDULLAH SIDDIKI WARD NO 07 GANGULI BENIPATTI MADHUBANI
Area/Locality : BENIPATTI
Landmark : NEAR ME MARKET
City : MADHUBANI
Pin Code : 847223
State : BIHAR
Mobile No. : 6204796339
Alternate Number : 6204796339
Email ID :
Preferred Mailing Address : Residence

EMPLOYMENT/ BUSINESS DETAILS

Employment Type :
Qualification :
Name of the Company/ Business :
Nature of business :
Designation :
Office/Business Address : W/O ABDULLAH SIDDIKI WARD NO 07 GANGULI BENIPATTI MADHUBANI

Consent Details : Accepted IP Address : 2409:4064:4e16:8567:b1f8:8963:7061:354a Language Name : EnglishApplication Number : B179116737
Date & Time: 2023-02-28 15:21:40Mobile Number: 6204796339

Email ID: null

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Area/Locality : BENIPATTI
City : MADHUBANI
Pin Code : 847223 MADHUBANI
State : BIHAR
Office Phone : 8757494745
Official Email ID :

PRODUCT DETAILS

Applied Loan amount : ₹ 18499

MAIN PRODUCT DETAILS

Sr. No. Product Name Premium/ Product Price

1 Y35(8128G) - VIVO-MOBILE Rs18499 ₹ 18499

FORM NO. 60

Income-tax Rules, 1962

FORM NO. 60

[See second proviso to rule 114B]

Form for declaration to be filed by an individual or a person (not being a company or firm) who does not have a permanent account number
and who enters into any transaction specified in rule 114B

1. Name of Individual
Aadhaar
ID - 7147
First Name Expiry:
: SABINA
Aadhaar
ID - 7147
Middle Name Expiry: ##Name_and_address_ITRF_2##
:
Verification
Last Name
: KHATUN I, SABINA KHATUN do hereby declare that what is
stated above is true to the best of my knowledge and

2. Father's/ Spouse's Name (In case of Individual)

belief. I further declare that I do not have a Permanent
Account Number and my/ our estimated total income (including income of spouse, minor
Father's/ Spouse's Name child etc. as per section 64 of Income-tax Act, 1961) computed in accordance with the
: ABDULLAH SIDDIKI provisions of Income-tax Act, 1961 for the financial
year in which the above transaction is held will be
less than maximum amount not chargeable to tax.
3. Date of Birth/ Incorporation of declarant
: 1997-03-24 Verified on 28/02/2023

4. Current Residence Address Place:

Signature of declarant: __________________
: W/O ABDULLAH SIDDIKI

Consent Details : Accepted IP Address : 2409:4064:4e16:8567:b1f8:8963:7061:354a Language Name : EnglishApplication Number : B179116737
Date & Time: 2023-02-28 15:21:40Mobile Number: 6204796339

Email ID: null

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Note:
5. Town/ City
: MADHUBANI 1. Before signing the declaration, the declarant should
satisfy himself that the information furnished in this
form is true, correct and complete in all respects. Any
person making a false statement in the declaration shall be liable to prosecution under
6. Pin Code section 277 of the Income-tax Act, 1961 and on conviction be punishable,
: 847223 (i) in a case where tax sought to be evaded exceeds
twenty-five lakh rupees, with rigorous imprisonment
which shall not be less than six months but which
7. State may extend to seven years and with fine;
(ii) in any other case, with rigorous imprisonment
: BIHAR which shall not be less than three months but which
may extend to two years and with fine.
2. The person accepting the declaration shall not accept
8. Mobile Number the declaration where the amount of income of the nature referred to in item 16 exceeds
the maximum amount which is not chargeable to tax,
: 6204796339 unless PAN is applied for and item 15 is duly filled.

9. Telephone Number (with STD code)

: GENERAL TERMS AND CONDITIONS

10. Amount of transaction (Rs.) I hereby agree and confirm:

: 0 1. That, (i) I am at least 18 years of age, (ii) can
understand, read and write in the English language,
(iii) have read and understood the Application Form,
11. Date of transaction and Master Terms and Condition in relation to the Loan available on Master Terms &
Conditions
: 2023-02-28T09:51:17.205Z
12. Mode of transaction
: (https://www.bajajfinserv.in/master-
Cash Cheque Card Draft/Banker’s Cheque
tncs-applicable-for-cd-loans-and-emi-
Online Transfer Other card.pdf) and (iv) agree to be bound by
the same
2. That I am applying for Finance Facility
from Bajaj Finance Ltd ("BFL") as stated in this Application Form.
13. In case of transaction in joint names, number of persons 3. To submit and execute any/all documents, in such form and manner as may be required
involved in the transaction by BFL in relation to this Application Form and/or related products
4. I shall make payment of the applicable fee and/or
: charges, as specified herein by BFL with respect to
this loan application and as more specifically detailed under Annexure I, below or which
14. Aadhaar Number issued by UIDAI (if available) also can be accessed at https://www.bajajfinserv.in/all-fees-and-charges
:
5. Authentication/Acceptance: The mode of
15. If applied for PAN and it is not yet generated enter date authentication/acceptance may be done by me through any one of the following modes,
of application and acknowledgement number namely:
a. By Physical execution: The documentation will be
: signed by me in person and the same shall be relied
and acted as my explicit written instruction/consent by BFL; OR
16. If PAN not applied, fill estimated total income (including b. By Electronic authentication: By checking the “I Agree” button at the end of the
income of spouse, minor child etc. as per section 64 of Application Form and by submitting the one-time password (“OTP”) sent by BFL, or
Income-tax Act, 1961) for the financial year in which the authentication/execution by any other electronic mode, I confirm my acceptance on the
Application Form, Most Important Terms and Conditions(“MITC”) and Master Terms
above transaction is held (Monthly) and Conditions (“Master Terms”) in relation to the Loan through electronic means and
: the same shall be relied and acted upon by BFL.

17. Details of document being produced in support of 6. CKYC Consent

a. I hereby authorize BFL to verify/ check/ obtain/ download/ upload/ update/ retrieve/
identify
receive my KYC details from/with the Central KYC Registry(CERSAI): (i) by verifying
such details through the CKYC number (i.e. KYC
Identifier Number- KIN) provided by me or (ii) by
18. Details of document being produced in support of obtaining such CKYC number/KIN, through details shared by me for this Application
Form.
address
b. I hereby consent for receiving information from Central KYC Registry through
SMS/Email on the above registered number/email address.

Consent Details : Accepted IP Address : 2409:4064:4e16:8567:b1f8:8963:7061:354a Language Name : EnglishApplication Number : B179116737
Date & Time: 2023-02-28 15:21:40Mobile Number: 6204796339

Email ID: null

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7. Aadhaar No. using e-KYC Authentication facility provided by UIDAI (Aadhaar e-KYC) / Aadhaar paperless Offline e-KYC Verification
Specific (OKYC) consent
a. I voluntarily opt for Aadhaar e-KYC or (OKYC) or Certified Copy of Officially Valid Documents (OVD) or equivalent e-documents of OVD
including documents issued through Digilocker and submit to the BFL my Aadhaar number, Virtual ID, e-Aadhaar, m-Aadhaar, Aadhaar PVC
Card, Aadhaar Letter, XML file or Aadhaar Secure QR code, Masked Aadhaar, Aadhaar details, demographic information, identity
information, Aadhaar registered mobile number, face authentication details and/or biometric information (collectively, “Information”).
b. I am informed by the BFL, that:
i. submission of Aadhaar is not mandatory, and there are alternative options for KYC and establishing identity including by way of
physical KYC with officially valid documents other than Aadhaar. All options were given to me.
ii. For e-KYC/offline verification, BFL will share Aadhaar number and/or biometrics with Central Identities Data Repository (CIDR)/
Unique Identification Authority of India (UIDAI), and CIDR/UIDAI will share with BFL, authentication data, Aadhaar data,
demographic details, registered mobile number, identity information, which shall be used for the informed purposes mentioned in 4(d)
below.
c. In case of OKYC, I shall share the Share Code or confirm on the auto populated shared code, as the case may be for successful XML file
download and upload as contemplated under applicable law to complete my offline KYC process.
d. I authorise and give my consent to the BFL (and its service providers), for following informed purposes:
i. KYC and periodic KYC process as per the PML Act, 2002 and rules thereunder and RBI guidelines, or for establishing my identity,
carrying out my identification, offline verification or e-KYC, or Yes/No Authentication, demographic or other
authentication/verification/identification as may be permitted as per applicable law, for all accounts, facilities, services and
relationships of/through the BFL, existing and future.
ii. collecting, sharing, storing, preserving Information, maintaining records and using the Information and
authentication/verification/identification records:
for the informed purposes above,
as well as for regulatory and legal reporting and filings and/or
where required under applicable law;
iii. producing records and logs of the consent, Information or of authentication, identification, verification etc. for evidentiary purposes
including before a court of law, any authority or in arbitration.

I understand that my Aadhaar number and core biometrics will not be stored/ shared except as per law and for CIDR submission.
8. 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.
9. 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/to any person.

10. I authorize BFL:

a. To use, verify, download, exchange, share or part with all information relating to this application to credit bureaus/credit reference agencies, its
group companies, financial institutions, Credit Information Companies (‘CIC’), NeSL, NSDL, Central KYC Registry (CERSAI) or any
authorized third-party agency as BFL may deem necessary or appropriate for use or processing of the said information and shall not hold BFL
(or any of its group companies or its/ their agents/representatives) liable for use/sharing of the information as stated above.
b. To seek/obtain any other information, relating to me, from any third party.
c. To procure/avail my CIBIL report and provide it to me by deducting applicable charges for the same.
11. That BFL has the absolute discretion, to accept or reject this loan application, as it may be deemed fit by BFL at any time, either before or after
verification.
12. I hereby expressly consent for taking my photo/video along with the invoice and product evidencing the conduct of loan transaction by me and that
such photo/video is unconditionally agreed to be stored and preserved for a period of at least five (5) years or otherwise from the date of closure of
my account and/or as the law/regulations may so mandate, whichever is higher.

13. That this Application Form, its contents and information/details provided by me, from time to time, as part of this application, may be submitted to:
a. BFL, its subsidiaries and affiliates of BFL, any service provider/third party/ legal entity with whom BFL may have business relationship and/or
in reference to rendering services in connection with the product(s) availed by me and/or for promoting/marketing various products and
services.
b. To any Regulator, Court, Law enforcement agency, Quasi-Judicial authority etc. on a need basis.
14. 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. I shall keep BFL updated of any change in the information
provided by me, specifically KYC details, Bank details, etc. and in case any of the above information is found to be false or untrue or misleading or
misrepresenting, I am aware that I shall be held liable for the same and I will not hold BFL liable for any consequences that may arise owing to any
delay/lapse on the my part.

15. Interest Rate Methodology-

Interest rate applicable for consumer durable Loans varies from 0% to 42% basis the BFL’s internal credit and risk policy and as per an algorithmic
multivariate score card which includes following variables (inclusive and not exhaustive):

(i) Interest rate risk (fixed vs floating loan), Credit and default risk in the related business segment (iii) Historical performance of similar
homogeneous clients (iv) Profile of the borrower (v) Industry segment, (vi) Repayment track record of the borrower, (vii), Nature and value of
collateral security, (viii) Secured Vs unsecured loan, (ix) Subvention available, (x) Ticket size of loan, (xi) Bureau Score, (xii), Tenure of Loan,
(xiii) Location delinquency and collection performance and (xiv) Customer Indebtedness (other existing loans)

The aforesaid variables may be revised from time to time.

Consent Details : Accepted IP Address : 2409:4064:4e16:8567:b1f8:8963:7061:354a Language Name : EnglishApplication Number : B179116737
Date & Time: 2023-02-28 15:21:40Mobile Number: 6204796339

Email ID: null

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16. BFL Customer Care Contact details:

For any queries, visit our website https://www.bajajfinserv.in/reach-us. Select the < Email Us > tab and follow the directions to get your query
resolved.

OFFICIALLY VALID DOCUMENTS (OVDS) OR DEEMED TO BE OVDS

OVDs or Deemed to be OVDs (to be taken in case address mentioned on OVDs is not the current address). In cases where Deemed to be OVD is
submitted towards current address, applicant shall submit an OVD updated with current address within a period of three months of submission of
Deemed to be OVD)

List of Officially Valid Documents (OVDs): Passport, Driving License, Aadhaar (First Eight Digits of Aadhaar number to be redacted/masked), Voter's
Identity Card issued by the Election Commission of India, Job Card issued by NREGA duly signed by an officer of the State Government, Letter issued
by the National Population Register containing details of name and address

List of Deemed to be OVDs (DOVDs): Utility bill which is not more than two months old of any service provider (electricity, telephone, post-paid
mobile phone, piped gas, water bill), Property or Municipal tax receipt, Pension or family pension payment orders (PPOs) issued to retired employees by
Government Departments or Public Sector Undertakings, if they contain the address, Letter of allotment of accommodation from employer issued by
State Government or Central Government Departments, statutory or regulatory bodies, public sector undertakings, scheduled commercial banks,
financial institutions and listed companies and leave and licence agreements with such employers allotting official accommodation

ANNEXURE I : FEES & CHARGES LEVIED BY BFL

Processing Fees Mandate Rejection Charges

Upto ₹ 1017 (Inclusive of applicable taxes) collected upfront ₹ 450/- per month from the first instalment due date for mandates rejected
by customers bank until the new mandate is registered
Convenience Fees
Cash Repayment Charges
₹ 117/- (Inclusive of applicable taxes) will be collected along with 01st
instalment Cash Repayment Charges of ₹ 499/- (Inclusive of applicable taxes) are
applicable for Repayment of EMI dues in Cash at BFL Branches
Loan Enhancement Fees
EMI Network Card Fee (If Availed)
₹ 117/- (Inclusive of applicable taxes) for temporary increase in EMI card
limit for the loan transaction. Same will be charged only for increase in ₹ 530/- (Inclusive of applicable taxes)
limit in excess of Rs. 999/- to be collected along with 01st instalment.
Add-on EMI Network Card Fee (If Availed)
CIBIL Transunion Report Fees (If Availed)
₹ 199/- (Inclusive of applicable taxes)
₹ 46/- (Inclusive of applicable taxes) will be collected along with 01st
EMI Network card Annual fee
instalment

Pre-payment Charges ₹ 117/- (Inclusive of applicable taxes) for each card availed

Full Pre-payment : NIL Annual fee will only be charged to the respective Card holders who have
not availed any loan using such Card in the preceding year. The duration of
Part Pre-payment : NIL the preceding year is calculated 12 months from last year’s validity month,
which is printed on the face of your respective Card. For example, If the
Penal Interest
Card is issued in the month of February 2019 (referred to as ‘Member
Since’, on the Card) the date for payment of the annual fee will be March,
Any delay in payment of Monthly Instalment shall attract penal
2020.
interest at the rate of 3.5% per month on the instalment outstanding,
from the respective due date until the date of receipt. Health EMI Network Card Fee (If Availed)

Mandate Registration Charges (If Applicable)

₹ 999/- (Inclusive of applicable taxes)

₹ 118/- (Inclusive of applicable taxes) Please visit NACH/ Cheque Bounce Charges
https://www.bajajfinserv.in/all-fees-and-charges for list of bank on which
mandate registration charges will be applicable.

Consent Details : Accepted IP Address : 2409:4064:4e16:8567:b1f8:8963:7061:354a Language Name : EnglishApplication Number : B179116737
Date & Time: 2023-02-28 15:21:40Mobile Number: 6204796339

Email ID: null

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Note : Not Applicable on successful E-mandate registration ₹ 500/- per bounce in case of default by reason of the repayment
instrument(s) being dishonoured

“Additional cess/ taxes, if any, will be applicable on all charges as per the respective State Laws as may be applicable from time to time.”

The aforementioned charges/fees may be modified by Bajaj Finance Limited from time to time upon prior intimation via Acceptable Modes of
Communication from Bajaj Finance Limited in this regard.

I hereby expressly authorise BFL, its group companies, affiliates and/or business associates and their respective representatives to send me promotional
communications regarding loans, insurance and their respective products and/or services through telephone calls/SMSs/emails/post/bots/bitly, etc. I
understand that I can at any time opt not to receive any telecommunication

By clicking on "I Agree" below, button and/or by entering the one-time password (OTP) sent by BFL and/or by providing physical signature, I hereby
apply for Loan from Bajaj Finance Limited and confirm that all the particulars, information and details mentioned in this Application Form are true and
correct.

SABINA KHATUN

(Name of Applicant) Signature

BFL/CF/Dig/AppF/English/2022/Dec/V1

Consent Details : Accepted IP Address : 2409:4064:4e16:8567:b1f8:8963:7061:354a Language Name : EnglishApplication Number : B179116737
Date & Time: 2023-02-28 15:21:40Mobile Number: 6204796339

Email ID: null

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