WORKING CAPITAL LOAN APPLICATION FORM

Application No.:

Date of Application :

Customer ID
(For existing customers)

Account No.

1. TELL US ABOUT YOUR BUSINESS

*Primary applicant-
Entity Name

*Entity Type

Individual Sole Proprietorship Partnership

Private Limited Company Limited Liability Partnership (LLP) Public Limited Company

Industry Type Manufacturing Trading Service Others ( )

(Self Employed)
Annual Turnover Below 50 Lakhs 50 Lakhs to 1Cr. 1 Cr. to 5 Cr. 5 Cr. to 10 Cr. 10 Cr. to 25 Cr.
(As Per Latest Audited Above 50 Cr.
25 Cr. to 50 Cr.
Financials)
*No. of Employees 0 to 20 21 to 50 51 to 100 above 100
*Expected Monthly Remittance 1 lac 1 lac - 5 lac 5 lac - 15 lac 15 lac - 25 lac >=25 lac
*Expected Monthly Withdrawls 1 lac 1 lac - 5 lac 5 lac - 15 lac 15 lac - 25 lac >=25 lac
*Purpose of Opening Business Collection of Instrument Others
*Entity Existence (Years): *Company Listed Y N
*Total No. of Branches / Regional Offices: *Presence in other cities:
*PAN *Date of Incorporation D D M M Y Y Y Y

*Nature of Industry (Refer to Annexure)

Website Address

2. ENTITY PROOF

*Entity Proof Name of Document

ID Number (If applicable) Expiry Date (If applicable) D D M M Y Y Y Y

*Address Proof Name of Document

ID Number (If applicable) Expiry Date (If applicable) D D M M Y Y Y Y

Additional Documents Shared

1 2

3 4

Internet Banking Mobile Banking

View only (non-financial) Transaction (financial) Yes No

Additional Documents IDs (If applicable)

CIN Sales Tax
TAN Excise
GST

*Key Contact Person N A M E M I D D L E N A M E S U R N A M E

*Mobile no. of Key Contact Person (all SMS alerts will be sent to this mobile number by default)

Page 1
*Email ID

For e-statement preference Daily Weekly Monthly (Bank Intimations / Account Statements / Trade Advices will be sent on this ID by default)

Whether Physical Statement is required Yes No Tick if e-statement is not required

(Monthly)

2(a). MODE OF OPERATIONS

SINGLY JOINTLY SEVERALLY As Per Board Resolution

PROPRIETOR / AUTHORISED SIGNATORY

3. REGISTERED ADDRESS OF THE ENTITY FROM (YEAR)

Address Line1
Address Line2
City
State Pin code Country
Contact Details _.
Country Code STD code Landline No. Mobile No.
E-Mail ID

Business Premises Self Owned and free Self Owned and encumbered Rented

4. OPERATING ADDRESS OF THE ENTITY Preferred Mailing Address Same as registered Address

Years / Months at Current Address Y Y M M Years in City

Address Line1
Address Line2
City
State Pin code Country

Contact Details

Country Code STD code Phone No. Extension

E-Mail ID

Mobile No.

Business Premises Self Owned and free Self Owned and encumbered Rented

5. CO-APPLICANT DETAILS
1. Main promoter/ Proprietor/ Partner/ Director

Title Mr. Ms. Mrs. Dr. Others ( ) Gender Male Female Third Gender
Full Name
First Name Middle Name Surname

Father’s/ Legal Gaurdian Name

Date of Birth D D M M Y Y Y Y Marital Status Married Unmarried Others ( )

No. of Dependants Nationality

Mother’s Maiden Name AADHAR No.

PAN No. Annual Income

Percentage of Shareholding %

Religion Hindu Muslim Christian Sikh Zoroastrian Buddhist Others ( )

Category SC ST OBC General Others ( )

Educational Qualification Undergraduate Graduate Post Graduate Professional Others ( )

Type of Residence Self owned and free Self owned and encumbered Rented Owned by parents
If Self owned - Ownership Individual Joint

RESIDENTIAL ADDRESS DETAILS Preferred Mailing Address Years/Month at Current Address Y Y M M Years in City

Page 2
Address Line1
Address Line2
Landmark
City
State Pin code Country

Residential Contact Details

Country Code STD code Landline No. Mobile No.

E-Mail ID

In case of rented accomodation, Please provide permanent address details

2. Promoter/ Partner/ Director/ Guarantor

Title Mr. Ms. Mrs. Dr. Others ( ) Gender Male Female Third Gender
Full Name
First Name Middle Name Surname
Father’s/ Legal Gaurdian Name

Date of Birth D D M M Y Y Y Y Marital Status Married Unmarried Others ( )

No. of Dependants Nationality

Mother’s Maiden Name AADHAR No.

PAN No. Annual Income .

Percentage of Shareholding %

Religion Hindu Muslim Christian Sikh Zoroastrian Buddhist Others ( )

Category SC ST OBC General Others ( )

Educational Qualification Undergraduate Graduate Post Graduate Professional Others ( )
Type of Residence Self owned and free Self owned and encumbered Rented Owned by Parents
If Selfowned - Ownership Individual Joint
RESIDENTIAL ADDRESS DETAILS Preferred Mailing Address Years/Month at Current Address Y Y M M Years in City
Address Line1
Address Line2
Landmark
City
State Pin code Country
Residential Contact Details

Country Code STD code Landline No. Mobile No.

E-Mail ID
In case of rented accomodation, Please provide permanent address details

3. Promoter/ Partner/ Director/ Guarantor

Title Mr. Ms. Mrs. Dr. Others ( ) Gender Male Female Third Gender

Full Name
First Name Middle Name Surname
Father’s/ Legal Gaurdian Name

Date of Birth D M M Y Y Y Y Marital Status Married Unmarried Others ( )

No. of Dependants Nationality

Mother’s Maiden Name AADHAR No.

Page 3
PAN No. Annual Income

Percentage of Shareholding %

Religion Hindu Muslim Christian Sikh Zoroastrian Buddhist Others ( )

Category SC ST OBC General Others ( )

Educational Qualification Undergraduate Graduate Post Graduate Professional Others ( )

Type of Residence Self owned and free Self owned and encumbered Rented Owned by Parents
If Selfowned - Ownership Individual Joint

RESIDENTIAL ADDRESS DETAILS Preferred Mailing Address Years/Month at Current Address Y Y M M Years in City

Address Line1
Address Line2
Landmark

City
State Pin code Country

Residential Contact Details

Country Code STD code Landline No. Mobile No.

E-Mail ID

In case of rented accomodation, Please provide permanent address details

4. Promoter/ Partner/ Director/ Guarantor

Title Mr. Ms. Mrs. Dr. Others ( ) Gender Male Female Third Gender
Full Name
First Name Middle Name Surname
Father’s/ Legal Gaurdian Name

Date of Birth D D M M Y Y Y Y Marital Status Married Unmarried Others ( )

No. of Dependants Nationality

Mother’s Maiden Name AADHAR No.

%
PAN No. Annual Income
Percentage of Shareholding

Religion Hindu Muslim Christian Sikh Zoroastrian Buddhist Others ( )

Category SC ST OBC General Others ( )
Educational Qualification Undergraduate Graduate Post Graduate Professional Others ( )
Type of Residence Self owned and free Self owned and encumbered Rented Owned by Parents
If Selfowned - Ownership Individual Joint
RESIDENTIAL ADDRESS DETAILS Preferred Mailing Address Years/Month at Current Address Y Y M M Years in City
Address Line1
Address Line2
Landmark
City

State Pin code Country

Residential Contact Details

Country Code STD code Landline No. Mobile No.

Page 4
E-Mail ID
In case of rented accomodation, Please provide permanent address details

6. DETAILS OF CREDIT FACILITY AVAILED FROM BANKS/FINANCIAL INSTITUTION (Including ESFB Bank) Amount in Lakhs

Sanctioned Amount/ Sanction/Disbursement

Name of Bank/Financial Institution Nature of facility Limit Date Present outstanding Security offered

7. DETAILS OF SECURITIES OFFERED TO EXISTING LENDER (COLLATERAL)

Particulars Of Name of owners Relationship Current Value

Sr.No Lender Name
Securities with Borrower in Lacs

Amount in Lakhs

8. FINANCIAL DETAILS OF THE APPLICANT Amount in Lakhs

Particulars (FY ) (FY ) (FY )

Net Sales

PBT

Net Profit After Tax

Net Worth

9. DETAILS OF ASSOCIATES/GROUP ENTITIES Amount in Lakhs

Name of Entity Nature of Business Net Sales Net ProfitN et Worth

10. PROMOTER/ PARTNER INDIVIDUAL LOAN DETAILS (Please provide separate sheet in case of more than 3 lines)

Promoter/ Partner Name Type of Loan Availed fromS anctioned Amount Present Outstanding

11. PROPOSED CREDIT FACILITIES

Type of Facilities Amount (In Lakhs)P urpose for which it is requiredS ecurity Offered
Primary Security (Details with Whether Collateral Security
approx.value to be mentioned Offered (Please mention
Yes or No)
Cash Credit/Overdraft Yes No

Working Capital Demand Yes No

Loan

Page 5
 Term Loan Yes No

Letter of Credit Yes No

Buyers' Credit Yes No

Bank Guarantee Yes No

Others
( ) Yes No

Others
Yes No
( )

In case of term loan requirements, the details of machinery may be given as under:

Total Cost of Machine (In case of

Type of Purpose Whether Imported Name of imported machine, the break-up of In case of machinery, Promoter's Loan
Asset of Asset or Indigenous Supplier basic cost, freight, insurance and Place of installation Contribution Required
customs duty may be given)

12. DETAILS OF PROPOSED COLLATERAL SECURITY

In case of property offered Property Approximate Free from Presently mortgage

Sr.No Type of Property Owned By
not owned by borrower, Market encumbrance
Location to which
Relationship with borrower (City/Town) Value (Rs. in Lacs) Financial Institution

Self occupied residential

Rented residential
Self occupied commercial Yes No
1 Rented commercial
Industrial self occupied
Others ( )

Self occupied residential

Rented residential
Self occupied commercial
2 Rented commercial Yes No
Industrial
Others ( )

Self occupied residential

Rented residential
Self occupied commercial
3 Rented commercial Yes No
Industrial
Others ( )

Self occupied residential

Rented residential
Self occupied commercial
4 Rented commercial Yes No
Industrial
Others ( )

13. PSL CATEGORY

Priority Sector / MSME Category (Furnish certificate issued by CA regarding purchase price of plant and machinery/equipments or the same shall be taken from audited financials

Direct Agri : Agriculturist/ Farmer & allied Agricultural activity Small Manufacturing Enterprises : Manufacturing units with
such as Diary, Piggery, Poultry, Fishery, Bee-Keeping, Cattle Investment in Plant & Machinery greater than Rs.25 lakhs but not
Feed, Poultry Feed, Horiculture, Fertilisers, Pesticides, Seeds ect. exceeding Rs.5 Cr.
Proprietorship Food & agro based processing units in rural areas Medium Manufacturing Enterprises : Manufacturing units with
& grading sorting & transporting of agri produce under taken by Investment in Plant & Machinery greater than Rs.5 Cr but not
Individuals in rural areas. exceeding Rs.10 Cr.
Indirect Agri : Food & Agro Based Processing Units Operating Micro Service Enterprises : Service sector Units with
From Semi Urban/ Urban Areas, Arathias/ Grain Merchants Investment in office Equipment upto Rs.10 lakhs.
operating from anaj mandies, Service Units Contracting tractors/
borewells to farmers, Dealers of agri machinery/ pesticides & Small Service Enterprises : Service sector Units with
fertilizers, units running storage facilities agri produce. Investment in office greater than Rs.10 lakhs but not exceeding
Rs.2 Cr.
Khadi & Village Industries (KVI Sector) : Khadi & Village
Industries
Medium Service Enterprises : Service sector Units with
Investment in office greater than Rs.2 Cr. but not exceeding
Micro Manufacturing Enterprises : Manufacturing Units with
Rs.5 Cr.
investments in Plant & Machinery upto Rs.25 Lakhs

Page 6
(If Applicable) Agriculture Land Details
Land details: I/We own/ Cultivate land to the extend of acres at attached herewith 7/12 documents/
copy of land revenue receipt / copy of the property document.

Applicant Signature
I/ We hereby declare that information furnished above is true and accurate

14 . 1. TRADE REFERENCE2 . TRADE REFERENCE

Name of Entity Name of Entity

Contact Person Contact Person

Relationship with Applicant : Supplier Customer Relationship with Applicant : Supplier Customer

Competitor Competitor

Others ( ) Others ( )

Address Line1 Address Line1

City : City :

STD Code STD Code

Phone No. Phone No.

Mobile No. Mobile No.

PIN Code PIN Code

Email ID Email ID

15.
DECLARATION
DECLARATION(Please
(Please
read
read
carefully
carefully
and
and
sign
sign
at at
thethe
end
end
of of
this
this
section
section
after
after
you
you
have
have
filled
filled
in in
the
the
details
details
in in
the
the
form)
form)

1. No director of the Equitas Small Finance Bank is a director, manager, managing agent, employee or guarantor of the Company, or of a subsidiary of the Company, or of
the holding company of the company, or holds substantial interest in the Company or a subsidiary of the holding company of the Company and no directors of any other
banks holds substantial interest or is interested as director or as a guarantor of the Company. In Case of any Relation Please fill up as under
(a). Details of relationship, if any, with any Director/Senior Officer of Equitas Small Finance Bank:
Name of the Director/Senior Officer : ______________________________________
Relationship with the Director/Senior Officer : ______________________________________
(b). Details of relationship, if any, with any Director of other bank/s
Name of Director and the Bank : ______________________________________
(c). Details of Directors of the company or its subsidiary company or its holding company, who are also on the board of Equitas Small Finance Bank.
Name of the Director/Senior Officer : ______________________________________
2. No relative (as specified by RBI) of a chairman/managing director or director of banking company (including the Lender) or a relative of senior officer (as specified by RBI)
of the lender, hold substantial interest or is interested as a director or as guarantor of Borrower.
3. I/We wish to avail the Finance facilities/products from Equitas Small Finance Bank. I have read, understood and agree to the Terms and Conditions displayed on the
Website of Equitas Small Finance Bank i.e www.equitasbank.com, which may be amended by Equitas Small Finance Bank from time to time and hosted and notified on
the Website of Equitas Small Finance Bank.
4. I/We authorize Equitas Small Finance Bank to conduct my/our credit history verification with CIBIL or any other credit rating agency and acknowledge that Equitas Small
Finance Bank shall have the right and authority to carry out investigations from the information available in public domain for confirming the information provided by me/us
to Equitas Small Finance Bank. I/We declare that I/We have not availed any credit facility from any bank or have obtained NOC from such bank(s) for opening of a current
account with Equitas Small Finance Bank.
5. I/We agree to furnish and intimate to Equitas Small Finance Bank any other particulars that we are called upon to provide on account of any change in laws/statutory
requirements either in India or abroad. I/We authorize Equitas Small Finance Bank to exchange, share or part with all the information provided herein with financial
institutions/agencies/statutory bodies/other such person, as may be required by Equitas Small Finance Bank. I/We shall not hold Equitas Small Finance Bank or its
agents/representatives liable for using/sharing such information.
6. I/We hereby declare that the information provided herein as well as in the documentry evidence provided by me/us to Equitas Small Finance Bank (the “Customer
Information”) is true, correct and complete in all aspects to the best of my/our knowledge and that I/We have not withheld any Customer Information that may affect the
assessment/categorization of the account as a Reportable account or otherwise. I/We further agree that any false/misleading Customer Information given by me/us or
suppression of any material fact will render my/our account liable for closure and the bank shall have the right to initiate any action, under law or otherwise.
7. If any of the information provided here is incorrect, I/We hereby agree to indemnify and keep indemnified Equitas Small Finance Bank, affiliates and their successors or
assignees.
8. I/We agree and understand that Equitas Small Finance Bank reserves the right to reject my/our Loan application form/request without assigning any reason thereof and
without being liable to me/us in any manner whatsover.
9. The Applicant has / have no objection to Equitas Small Finance Bank, agents / representatives to provide me / us information on various products, offers, and services
provided by Equitas Small Finance Bank Ltd through any mode (including without limitation through telephone calls / SMSs / emails) and authorise Equitas Small Finance
Bank Ltd, agents / representatives for the above purpose. YesN o

16. LIST OF DOCUMENTS

Please return this application form along with the following documents:
• KYC Documents of Proprietor/Partners/Directors and Company
• Audited P/L & Balance Sheet with all schedule for last 3 years
• Income Tax returns for last 3 years
• Self-Certified Latest Shareholding Pattern & List of Directors / Partners
• Shop Establishment Certificate (In case of Proprietorship), Copies of Partnership deed, and Certificate of Registration of firm (For Partnership
Firm) OR Copies of Memorandum of Association, Articles of Association and Certificate of Incorporation
Page 7
 • Auditor Certified Net Worth Statement of all Guarantors
• Bank Account Statement for last 12 months for all accounts
• VAT/ GST / Service Tax Return for turnover achieved in Current Financial Year (YTD)
• Copy of Property Documents offered as collateral security
• Projected Financials for succeeding financial year
• Copy of Latest Sanction Letter of facilities being enjoyed
• 1 year audited Financials of Group/Associate companies
• Company Profile, Business Model, Promoters Profile, Management Profile, Products Dealing in etc
• Year to date Performance with details of order in hand

17. SCHEDULE OF CHARGES

Working Capital Finance Charges & Fees

• Non-Refundable Login fee of Rs. _____ plus GST as applicable at

Processing Fees login Stage
• Processing fees of 1% of Loan Amount plus GST as applicable
• Renewal Fees of 0.50% of the Loan amount plus GST as applicable

Expiry of Limits/ Non Renewal Charges • Additional 2% over and above the contracted rate

Overdrawn Charges/Security not perfected/covenant not complied with • Additional 2% over and above the contracted rate

Non Submission of Stock Statement Charges • Additional 2% over and above the contracted rate
(Only in Case of Cash Credit Customers)

Co-Applicant 1 Co-Applicant 2

Primary Applicant PHOTO

PHOTO
Signature Signature

Co -Applicant 3 Co-Applicant 4

Signature
PHOTO PHOTO
Signature Signature

LOGIN FEES/COST/CHARGES
Login Fee: Rs_________________ only plus GST as applicable Please note the Login Fee & the Processing Fee is non-refundable in nature

19. BANK USE SECTION

Login Fee Details Amount Cheque/DD NEFT/RGST

Cheque No. Bank Name Branch Name
Branch Name Branch Name Product Code
Sourcing Branch Code DSA Name Lead Generator
Lead Warmer Lead Converter
Other Details

I have met the customer at: Communication Address Business Address Other
I I have seen the original KYC documents and returned these to the customer. The customer has signed in my presence
Copy/Photo taken for record
Signature/Stamp
Name Date

Employee ID/RM Code

D D M M Y Y Y Y

Page 8
 20. NATURE OF INDUSTRY
• Advertising/Media • Agriculture • Airlines • Arms/Antique/Art Dealer
• Auto Finance Co. • Automobile • Bar/Casino/Night Club • Bullion/Forex Dealer
• Cement • Chemicals/Dyes/Paints • Consultancy • Courier/Freight Forwarders
• Consumer Durables • Dairy/Food Processing • Departmental/Grocery Store • Education
• Engineering Goods • Exchange House • Electronics/Computer Hardware • Fertilizers/Seeds/Pesticides
• Fishery/Poultry • Furniture/Timber • Gems & Jewellery • Government Contractor/Contractor
• Hospital • Hotel/Resort • Housing Finance Co. • Insurance Co.
• Iron and Steel • Health Club/Spa • IT/Software/BPO • Liquor Distributor
• Marble/Granite • Mining • Nursing Home/Clinic/Diagnostic Center • Other Pvt. Financial Corp.
• Petroleum Oil & Gas • Printing/Publishing • Plastic/Paper & Allied Products • Pharmaceutical/Chemist
• Real Estate • Realty & Infrastructure • Scrap Metal • Telecom
• Term Lending Co. • Transportation/Logistics • Textiles/Garments/Handloom • Travel & Tourism
• Self Employed Professional (Doctor/CA/Architect/Lawyer/Consultant) • Self Employed Professional (Entertainment/Alternate Medicine Practitioner/Beautician)

21. FATCA - CRS Declaration Form (*Fields are mandatory)

Entity Type: Financial Non-financial GIIN No.: _________________________________________________
Country of Incorporation:__________________________________ City of Incorporation:________________________________________
1. I / We declare that the Entity is tax resident of any country other than India Yes No (If Yes, please fill Part A & B)
2. The Controlling Person / Ultimate Beneficial Owner / Proprietor is tax resident of any country other than India Yes No (If Yes, please fill Part C)
Part A (To be filled if YES is declared for the above statements except for Proprietorship customer)
Customer Identification No. ______________________________________Issuing Country_________________________________________________________________________
Address used for Tax Purpose / reported to Tax Authorities in foreign country Registered Communication Business Other (if business or other, provide the address)
Address: __________________________________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________________________________________
Details of Country(ies) in which the entity is resident for tax purpose and the associated Tax ID number:

Country Tax Identification Number (or equivalent) Identification Type (TIN or Other please specify)

Part B (To be filled by Non-financial entities)

Entity is: Traded in Stock Exchange Subsidiary of listed company Controlled by a listed company Not Listed
Name of the listed company ______________________________________ Name of the stock exchange ___________________Type of Non-financial Entity: Active Passive
PART C (to be filled by Passive Non-financial Entities for Controlling Person and Proprietor, use additional form for any additional controlling person or beneficial owners)
Name*:____________________________________________________________________ Date of Birth: ____________________________________________________________
Country of Tax Residency: ____________________________________________________ % Beneficial Interest: _____________________________________________________
PAN: ______________________________________________________________________ Fathers Name: _________________________________________________________
Residential Address: __________________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________________________________
*Name of Controlling Person / Ultimate Beneficial Owner / Proprietor Address reported / updated with Tax authorities

Details of Country(ies) in which the controlling person is resident for tax purpose and the associated Tax ID number:

Country Tax Identification Number (or equivalent) Identification Type (TIN or Other please specify)

Country of Birth: ____________________________ City of Birth: _____________________________________________________ Nationality: ______________________________

Occupation Type: Service Business Other Identification type : Passport DL PAN Gov ID Card Other
FATCA CRS Terms and Conditions
The Central Board of Direct Taxes has notified on 7th August 2015 that Rules 114F to 114H, as part of the Income-tax Rules, 1962, which Rules require Indian financial institutions such
as the Bank to seek additional personal, tax and beneficial owner information and certain certifications and documentation from all our account holders. In relevant cases, information
will have to be reported to tax authorities / appointed agencies / withholding agents for the purpose of ensuring appropriate withholding from the account or any proceeds in relation
thereto. Should there be any change in any information provided by you, please ensure you advise us promptly, i.e. within 30 days. If you are a US citizen or resident or green card
holder, please include United States in the foreign country information field along with your US Tax Identification Number. It is mandatory to supply a TIN or functional equivalent if the
country in which you are tax resident issues such identifiers. If no TIN is yet available or has not yet been issued, please provide an explanation and attach this to the form.
Certification:
I have understood the information requirements of this Form and hereby confirm that the information provided by me on this Form is True, Correct, and Complete. I further confirm that
I have read and understood the FATCA-CRS Terms and Conditions above and hereby accept the same.

Place:

Date: Signature Signature Signature Signature

22. Beneficial Owners (Following details to be captured for each beneficial owner)

Number of Beneficial Owners

Beneficial Owner’s Name N A M E M I D D L E N A M E

Beneficial Owner’s Designation

Beneficial Customer ID

Percentage Holding :
Beneficial Owner’s Signature :
Page 9
 23. DECLARATION FOR INTERNET BANKING FACILITY FOR COMPANIES / TRUSTS / CO-OPERATIVE
SOCIETIES / ASSOCIATION OF PERSONS / CLUBS / PARTNERSHIPS / LIMITED LIABILITY PARTNERSHIPS
In order to facilitate the operation of the said account, we hereby request Equitas Small Finance Bank to allow us, to operate the said account through the bank’s Internet
Banking facility by using the customer / user ID and the Internet Banking Login password, on the terms and conditions detailed hereunder which have been read and understood
by us. We acknowledge that the same are in addition to and not in derogation of the terms and conditions relating to the said account and Internet Banking facility.

1. M/s. _______________________________________________________ (Entity name) will be solely entitled to receive the customer / user ID and the Internet
Banking Login password to access the Internet Banking facility and to acknowledge the same.
2. The customer / user ID and the Internet Banking Login password shall be kept totally secret and confidential by the authorized signatory whosoever is using it.
3 All transactions carried on in the said account through use of the Internet Banking facility shall be binding on the Company / Trust / Co-operative Society / Association
of Person / Club / Partnership / Limited Liability Partnerships and Equitas Small Finance Bank shall at all times be kept saved and harmless from all actions, claims,
demands, proceedings, losses, damages, costs, charges and expenses whatsoever which Equitas Small Finance Bank may at any time incur, suffer or sustain or to
be put to as a consequence of or by reason of or arising out of transactions carried out through the Internet Banking facility.
4. Equitas Small Finance Bank shall at all times be informed of any changes in the operating instructions for Internet Banking facility by furnishing necessary documents
and writings and in such event to change the Internet Banking password forthwith.
5. Equitas Small Finance Bank shall not be responsible and liable to monitor the nature of expenses incurred by the use of the said Internet Banking facility.
6. All the provisions of the Foreign Exchange Management Act, 1999 and the rules made thereunder and the regulations of the Reserve Bank of India relating to foreign
exchange, in force from time to time shall be complied with by us.
7. I / We have read the terms and conditions in this application form as well as displayed on the Bank’s website pertaining to Internet Banking facility.
Default Transaction Limit: Rs.10 lakhs of NEFT / RTGS / Funds Transfer to Self & Third Party / Bill Payment / Online Shopping / VISA Credit Card Bill Payment per
day using OTP)
8. All the provisions of the PMLA Act, 2002, and the rules made thereunder and the regulations of the Reserve Bank of India relating to PMLA, in force from time to time
shall be complied with by us.

Place: _________________________

Signature Signature Signature Signature

24. DECLARATION FOR SOLE PROPRIETORSHIP

I refer to the account opened by you in the name of M/s. ______________________________________________________ and declare as under:
I, the undersigned, am the sole proprietor of the firm and am solely responsible for the liabilities thereof. I shall advise you in writing of any change that takes place in the constitution of
the firm and I will be liable to you for any obligation which may be standing in the firm's name in your books on the date of receipt of such notice and until all such obligations shall have
been liquidated.
I declare that I have an existing account with CA / CC / SB No. ____________________with ____________________Bank in the name of ___________________for the last _______years
I agree to indemnify and hold the Bank harmless in case of any loss suffered by the Bank, its customers or a third party or any claim or action brought by a third party which is in any
way the result of availing of services by me.
I agree that all the information disclosed in this document is correct and agree to inform you of any change in the information provided in this form or in related documents.
I have furnished to the Bank the Power of Attorney authorising the person(s) as indicated hereinbefore for operating the account.
I confirm having read the rules of the Bank regarding the conduct of the account as per deposit rules attached and the Citizens' Charter & Deposit Policy of the Bank.
I confirm having read the rules of the Bank regarding the conduct of the account and the rules and regulations pertaining to Phone Banking, Debit Card, Doorstep Banking, Anywhere
Banking, Internet Banking, Mobile Banking & Utilities Pay Facilities. I accept and agree to comply with the terms and conditions or any rules of the Bank that may be in force from time to time. l
acknowledge that it is my responsibility to obtain a copy of and read the same. I have received the deposit rules annexed to this account opening form and agree to abide by the same.
Yours faithfully,

Signature

25. DECLARATION FOR PARTNERSHIP FIRMS / LLP (To be signed by partners without rubber stamp)
We, the undersigned, are carrying on business in Partnership in the name and style of____________________________________________________________________________.
We declare that we, the undersigned, are the partners of the firm. The Bank may recover its claims from the estate of any or all the partners of the firm (Not applicable to LLP).
We hereby undertake that we will not change or vary the constitution of the firm without your prior approval in writing and our individual responsibility to the Bank will continue until we receive
from the Bank an acknowledgment and until all our liabilities with the Bank are discharged. The document and its contents submitted at the time of opening of this account are true and correct.
We agree to indemnify and hold the Bank harmless in case of any loss suffered by the Bank, its customers or a third party or any claim or action brought by a third party which is in any
way the result of availing of services by us under the above account title. We agree that all the information disclosed above is correct and agree to inform you of any change in the
information provided in this form or in related documents.
We confirm having read the rules of the Bank regarding the conduct of the account and the rules and regulations pertaining to Phone Banking, ATM / Debit Card, Doorstep Banking,
Anywhere Banking, Utilities Pay Facilities, Internet Banking and Mobile Banking. We accept and agree to comply with the terms & conditions or any rules of the Bank that may be in
force from time to time. We acknowledge that it is our responsibility to obtain a copy and read the same.
In the event of the death, insolvency or withdrawal of any partner the surviving partner or partners shall have full control or any monies then and thereafter standing to the firm's credit
and securities pledged, hypothecated or held in the firms account with you. It is understood that all monies now or hereafter standing to the credit of the account of the firm or securities
pledged, hypothecated or held in the account with you shall belong to the surviving partner in the event of any of us dying during the currency of the account. It is further understood that
if any one of us forbids operation on the account (which is not payable to all the partners jointly), the amount lying at credit shall not be payable except on the discharge of all the partners
or the surviving partners as the case may be.
We authorise the partners as mentioned above to operate the account and confirm that each of us will be jointly / severally be bound by the transactions and / or any other acts done or
authorised by these persons in conduct of the said account.
We have furnished to the Bank a Power of Attorney in favour of the authorised signatory(ies) mentioned above who is / are not partners of the firm.
We have read the deposit rules annexed to this account opening form and agree to abide by the same.
Place: Date:

Signature Signature Signature Signature

26. DECLARATION FOR TRUSTS / ASSOCIATIONS / SOCIETIES / CLUBS (With rubber stamp)
The account will be operated by ________________________________________________________________________________________ who has / have been authorised by the
Byelaws / Memorandum of Association / Articles of Association / Trust Deed / and Resolution No. _____________ dated ________________ of the Trustees / Director / Authorised
signatories. A certified copy of the resolution signed by all Trustees / Director / Authorised signatories is attached herewith.
A copy of the Byelaws / Trust Deed / Memorandum of Association and Articles of Association dated _______________ duly certified is sent herewith. In future if any change is required
in the name of the operators of the account, it will be effected by a resolution of the Board of Trustees and you will be informed accordingly in writing by all the trustees and you will allow
such persons to operate upon the account.
We agree to comply with and be bound by Bank’s rules now and from time to time in force for the conduct of such accounts. We have received the deposit rules annexed to this account
opening form and agree to abide by the same.
We shall submit prior permission communication from Ministry of Finance for accepting foreign contribution within 3 months and you may not accept any foreign contribution till
such time we submit the communication.
We certify that this is the only FCRA Account opened and held by the Trust and that the foreign contributions received by the Trust will be strictly in accordance with FCRA Act and Rules.
T Signature
1. ___________________________________________________________________ ___________________________
2. ___________________________________________________________________ ___________________________
3. ___________________________________________________________________ ___________________________
4. ___________________________________________________________________ ___________________________

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 NOMINATION FORM DA1 (Only for Sole Proprietorship Firms. Please choose any of the below option)
Yes, I / we wish to nominate (as per details below) No, I / we declare that I / we do not wish to make a nomination in my / our account
Nomination under Section 45 ZA of the Banking Regulation Act, 1949 and Rule 2(1) of the Banking Companies (Nomination) Rules, 1985 in the respect of Bank deposits.
I / We nominate the following person to whom in the event of my / our minor’s death the amount of the above opened Account / Fixed Deposits / Recurring Deposits, may be returned
to by Equitas Small Finance Bank Ltd.

Nominee Name
Is Nominee Address same as Prospect’s Current Address Y N
Nominee Address:

* Nominee Age
Relationship with depositor, if any Is Nominee, Equitas Customer Y N Customer ID:
**As nominee is a minor on this date, I / we appoint
to receive the amount of deposit in the account on behalf of the nominee in the event of my / our minor’s death during the minority of nominee.
Guardian relationship to minor Is Nominee Address same as Prospect’s Current Address : Y N
Nominee Address

Telephone (Res) S T D - Mobile

*Email ID

_____________________________________
Witness(es) *Signature/Thumb impression of the depositor

Name: __________________________________________________ Name: ________________________________________________

Signature***: _____________________________________________ Signature***: ___________________________________________
Address: ________________________________________________ Address: ______________________________________________
*Where deposit is made in the name of minor, the nomination must be signed by a person lawfully entitled to act on behalf of the minor. **Strike out if nominee is not a minor. ***Thumb impression(s) shall be attested by two witnesses.

27. ACKNOWLEDGEMENT
Received on Date D D M M Y Y Y Y Application No.
Notification of Sanction/Rejection will be communicated to you, with in three weeks after receipt of complete Application form with supporting documents,
post assessment of Proposal as per Equitas Small Finance Bank policy.
Booking Fees of Rs. received by Cheque No./DD dated drawn on Bank
Booking Fees of Rs. received by Account Debit Mandate from for (Account No.)
Fees and charges are subject to change at the sole discretion of the bank. Booking Fee collected at the time of application will not be refunded.
Call 1800 3000 1222 (Toll Free) and mention your loan application number to know the status of your application
Our representatives will be in touch with you on the matters
Bank Official Signature (Stamp) Bank Official Name
Phone No.
Location

Date D D M M Y Y Y Y

28. LIST OF DOCUMENTS

Please return this application form along with the following documents:
• KYC Documents of Proprietor/Partners/Directors and Company
• Audited P/L & Balance Sheet with all schedule for last 3 years
• Income Tax returns for last 3 years
• Self-Certified Latest Shareholding Pattern & List of Directors / Partners
• Shop Establishment Certificate (In case of Proprietorship), Copies of Partnership deed, and Certificate of Registration of firm (For Partnership
Firm) OR Copies of Memorandum of Association, Articles of Association and Certificate of Incorporation
• Auditor Certified Net Worth Statement of all Guarantors
• Bank Account Statement for last 12 months for all accounts
• VAT/ GST / Service Tax Return for turnover achieved in Current Financial Year (YTD)
• Copy of Property Documents offered as collateral security
• Projected Financials for succeeding financial year
• Copy of Latest Sanction Letter of facilities being enjoyed
• 1 year audited Financials of Group/Associate companies
• Company Profile, Business Model, Promoters Profile, Management Profile, Products Dealing in etc
• Year to date Performance with details of order in hand
29. SCHEDULE OF CHARGES
Working Capital Finance Charges & Fees
Processing Fees • Non-Refundable Login fee of Rs. _____ plus GST as applicable at
login Stage
• Processing fees of 1% of Loan Amount plus GST as applicable
• Renewal Fees of 0.50% of the Loan amount plus GST as applicable
Expiry of Limits/ Non Renewal Charges • Additional 2% over and above the contracted rate
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Overdrawn Charges/Security not perfected/covenant not complied with • Additional 2% over and above the contracted rate
Non Submission of Stock Statement Charges • Additional 2% over and above the contracted rate
(Only in Case of Cash Credit Customers)

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