Application Form

DCB Home Loan DCB Business Loan

DCB PayLess Home Loan DCB PayLess Business Loan
Application No. Application Date

PLEASE FILL IN BLOCK LETTERS ONLY

Preferred Mailing Address: Res. Off.
Personal Details (To be filled in case applicant / co-applicant / guarantor is an individual)
Applicant Co-applicant Guarantor

*Account Type Normal Simplified (for low risk customers) Small Normal Simplified (for low risk customers) Small

KYC No.

Title Mr. Mrs. Ms. Dr. Mr. Mrs. Ms. Dr.

Name First Name Middle Name Last Name First Name Middle Name Last Name

Gender Male Female Third Gender Male Female Third Gender

Father / Spouse Full Name

Mother’s Full Name

Mother’s Maiden Name

Communication Address Flat / Building / Plot No. Flat / Building / Plot No.

Area / Locality

Landmark PIN PIN

City State City State

Residence Address Flat / Building / Plot No. Flat / Building / Plot No.

Area / Locality

Landmark PIN PIN

City State City State

No. of yrs at current residence

Current residence is Self owned Family Rented Company’s Self owned Family Rented Company’s

Rent per month, if rented No. of dependants No. of dependants

Phone No. with STD code

Mobile No.

E-mail ID

Relationship with Applicant N.A.

Date of Birth D D / M M / Y Y Y Y D D / M M / Y Y Y Y

Marital Status Single Married Others Single Married Others

Qualifications Graduate Post-Graduate Other Graduate Post-Graduate Other

Religion

Category OBC SC ST DT / NT MBC OBC SC ST DT / NT MBC

Others Others

Residential Status Resident Individual Non Resident Indian Resident Individual Non Resident Indian
Person of Indian Origin / Person of Indian Origin /
Foreign National Foreign National
Overseas Citizen of India Overseas Citizen of India
FATCA Details:
U.S. Person Yes No Yes No
Please fill
Country of Birth FATCA
Declaration
*Place of Birth form if you are
USA or other
*Citizenship country citizen /
resident
*Residence for Tax Purposes

Proof of Address Passport Driving Licence UID (Aadhaar) Passport Driving Licence UID (Aadhaar)
Voter ID NREGA Job Card Other __________ Voter ID NREGA Job Card Other __________
Letter issued by National Population Register Letter issued by National Population Register
2278-Ver 1.1-Feb 2018 M007 / Apr 19 / 1.8
Proof of Identity Passport No. ____________________ Expiry Date __________ Passport No. ____________________ Expiry Date __________
Driving Licence No. _____________ Expiry Date __________ Driving Licence No. _____________ Expiry Date __________
Voter Identity Card No. _______________________________ Voter Identity Card No. _______________________________
NREGA Job Card _____________________________________ NREGA Job Card _____________________________________
Aadhaar Number: _____________________________________ Aadhaar Number: _____________________________________
PAN: ________________________________________________ PAN: ________________________________________________
Letter issued by National Population Register ____________ Letter issued by National Population Register ____________

Business / Employment Details

To be filled in case applicant / co-applicant / guarantor is non-individual. Details of employer to be filled in case of salaried employee.

Applicant Co-applicant Guarantor

Occupation ¨ Salaried ¨ Self Employed ¨ Salaried ¨ Self Employed

¨ Self Employed Professional ¨ Others _____________ ¨ Self Employed Professional ¨ Others _____________
Salaried ¨ Public Ltd. ¨ Pvt. Ltd. ¨ PSU ¨ State ¨ Public Ltd. ¨ Pvt. Ltd. ¨ PSU ¨ State
¨ MNC ¨ Others _________________________ ¨ MNC ¨ Others _________________________
Nature of Business / Empl.
Name of the Concern / Empl.
Designation
Business / Employment Add

PIN PIN
City State City State
No. of yrs in current business /
employment Date of Commencement Date of Commencement
Phone No. with STD code
Fax No. with STD code
PAN
CIN
GST Number
Udyog Aadhaar No.
Details of previous business / Total Work Total Work
employment Experience Experience
Type / Category of Enterprise ¨ Micro ¨ Small ¨ Medium ¨ Micro ¨ Small ¨ Medium
Definition of Micro, Small and Medium Enterprises
(a) Manufacturing Enterprises i.e. Enterprises engaged in the manufacture or production, processing or preservation of goods as specified below:
(i) A micro enterprise is an enterprise where investment in plant and machinery does not exceed ` 25 lakh;
(ii) A small enterprise is an enterprise where the investment in plant and machinery is more than ` 25 lakh but does not exceed ` 5 crore; and
(iii) A medium enterprise is an enterprise where the investment in plant and machinery is more than ` 5 crore but does not exceed ` 10 crore.
In case of the above enterprises, investment in plant and machinery is the original cost excluding land and building and the items specified by the Ministry of Small Scale Industries vide its notification No. S.O.
1722(E) dated October 5, 2006 (Annex I).
(b) Service Enterprises i.e. Enterprises engaged in providing or rendering of services and whose investment in equipment (original cost excluding land and building and furniture, fittings and other items
not directly related to the service rendered or as may be notified under the MSME Act, 2006) are specified below.
(i) A micro enterprise is an enterprise where the investment in equipment does not exceed ` 10 lakh;
(ii) A small enterprise is an enterprise where the investment in equipment is more than ` 10 lakh but does not exceed ` 2 crore; and
(iii) A medium enterprise is an enterprise where the investment in equipment is more than ` 2 crore but does not exceed ` 5 crore.

Directors / Partners (Applicant) First Second Third

DIN
Name
Address

PIN PIN PIN

Phone No. with STD code
PAN
Aadhaar No.
Date of Birth D D / M M / Y Y Y Y D D / M M / Y Y Y Y D D / M M / Y Y Y Y
Mothers Full Name
Father / Spouse Full Name
Proof of Identity Passport No. ______________________ Passport No. ______________________ Passport No. ______________________
Expiry Date _______________________ Expiry Date _______________________ Expiry Date _______________________
Driving Licence No. _______________ Driving Licence No. _______________ Driving Licence No. _______________
Expiry Date _______________________ Expiry Date _______________________ Expiry Date _______________________
Voter Identity Card No. ____________ Voter Identity Card No. ____________ Voter Identity Card No. ____________
NREGA Job Card __________________ NREGA Job Card __________________ NREGA Job Card __________________
Other Document ___________________ Other Document ___________________ Other Document ___________________
Proof of Address ¨ Passport ¨ Driving Licence ¨ Passport ¨ Driving Licence ¨ Passport ¨ Driving Licence
¨ Voter ID ¨ NREGA Job Card ¨ Voter ID ¨ NREGA Job Card ¨ Voter ID ¨ NREGA Job Card
¨ UID (Aadhaar) ¨ Other __________ ¨ UID (Aadhaar) ¨ Other __________ ¨ UID (Aadhaar) ¨ Other __________
 Reference 1 (From relative only) Reference 2

Name Name
Relationship Relationship
Address Address

Phone Mobile Phone Mobile

Bank Account Details

Name of Account Holder Branch Account Account No. Account Type
Name of Bank operated since (SB / CA / OD)

Credit Card Details

Name of Bank Card No. Year of issue Year of expiry Card Limit Current Outstanding

Existing Relationship with DCB Bank Limited

Loan Account No. Bank Account No. Others

Income / Assets / Liabilities Details

Applicant Co-applicant / Guarantor
VALUE VALUE
ANNUAL TURNOVER ` `
GST Paid in Last Quarter ` `
INCOME
Gross Monthly Income ` `
Net Monthly Take Home ` `
Other Income (specify sources) ` `
Average Monthly Expenses ` `
Monthly Instalments you pay ` `
ASSETS
1. Property and other Assets ` `
2. Motor Vehicles ` `
3. Fixed Deposit (if any) ` `
4. Current Balance in PPF ` `
5. Current Balance in PF (your share) ` `
6. Other Investments (bonds / securities) ` `
7. Sum assured of life insurance policies ` `

Applicant Co-applicant / Guarantor

LIABILITIES Balance Balance Balance Balance Balance Balance
Name & address of institution from whom Outstanding Term Repayment Outstanding Term Repayment
loan has been availed with purpose of loan (`) (Months) (`) (`) (Months) (`)

1.
2.
3.
Total Liabilities ` `

Property Details
Property Address Flat / Building / Plot No. Area of land
Area / Locality Area of flat / house / office
Property Type Residential Commercial
Ownership Type Sole Joint
PIN Approximate Market Value `
Nearest Landmark Present Owner
 Loan Details

Loan Amount: Loan Tenure: years Interest Rate: Floating Rate Fixed and Floating Rate

Balance Transfer Yes No If yes then, Organization Name:

Seller Balance Transfer Outstanding Amount: Tenure Served:

For Home Loan Resale Builder Purchase (Ready) Under Construction (Builder Purchase) Self Construction Plot + Construction

For Business Loan Against Residential Property Loan Against Commercial Property Commercial Purchase LRD
Loan
Top up on Home Loan Top up on Business Loan

Purpose of loan Estimate of requirement of funds Estimate of sources to meet requirement of funds

Business Expansion 1. Total purchase price / ` 4. Loan requested `

construction cost
Purchase of Residential Property 5. Savings from Bank `

Home Construction 6. Disposal of investments

2. Incidental costs (if any) ` (fixed deposits / shares etc.) `
Purchase of Commercial Property
7. Amount already spent
Home Repair (source ) `

3. Other costs `
Education Purpose 8. Provident Fund
Please specify (refundable/non-refundable) `

Personal Use 9. Other (specify ) `

Total requirement of funds Estimate of sources of funds

A. (Sum of 1 to 3) Total ` B. (Sum of 4 to 9) Total `

Note: ‘A’ which is the total requirement of funds, should equal estimate of sources, ‘B’ which indicates the sources from the cost will be met.
It is important that you indicate in detail, the sources from where the cost will be met in order to help us process your application faster.

Processing Fee Details

Processing fee (non-refundable): ` Cheque / DD Number Dated

Drawn on in favour of DCB Bank Limited.

I / We agree to open a Savings / Current Account with

DCB Bank Limited.

Yes No
Applicant’s photo Co-applicant’s / Guarantor’s
DCB Current and Savings Accounts come with a host of benefits such as Signed across / photo signed across /
Thumb impression Thumb impression
Free RTGS / NEFT, Payable at Par Cheque Book, Free Phone / Internet /
Mobile Banking, Free access to VISA ATMs, Any Branch Banking and
much more.

Declaration
1. I / We declare that all the particulars and information and details given / filled in this application form are true, correct, complete and up to date in all respects and that I / we have not
withheld any information whatsoever and I / we understand and accept that they shall form the basis of any facility DCB Bank Limited (the “Bank”) may decide to grant me/us. The
Bank has the right to reject the application in case any of the information provided in this application form is found to be false / incorrect / misleading.
2. I / We confirm that there are no insolvency or bankruptcy proceedings or suits for recovery of outstanding dues or monies whatsoever or for attachment of my / our assets or
properties and / or any criminal proceedings have been initiated and / or are pending against me / us and that I / we have never been adjudicated insolvent or bankrupt by any Court or
other authority.
3. No action nor other steps have been taken or legal proceedings started by or against me / us in any court of law / other authorities for winding up, dissolution, administration or re-
organization or for the appointment of a receiver, administrator, administrative receiver, trustee or similar office or for my / our assets.
4. I / We unconditionally authorize the Bank to exchange, share or part with all the information / data or documents and details relating to my / our application and / or existing loans and /
or repayment/credit history to other banks, financial institutions, credit bureaus, agencies, IT department, statutory/regulatory bodies, etc., as the Bank may deem necessary or
appropriate as may be required for use of processing of the said information / data by such person(s).
5. I / We understand, agree and acknowledge that the Bank shall have the absolute discretion, without assigning any reasons, to reject my / our application and that I/we reserve no right
to appeal against this decision of the Bank. I/We further agree that the Bank shall not be responsible / liable in any manner whatsoever to me / us for such rejection or any delay in
notifying me / us of such rejection and any costs, losses, damages or expenses, or other consequences, caused by reason of such rejection or any delay in notifying me / us of such
rejection of our application.
6. The Bank reserves the right to retain the photographs and documents submitted and will not return the same to the applicant and/or co-applicant and/or guarantor.
7. I am / We are neither related to any of the Directors of the Bank nor I am / we are his / her relatives as defined under the provisions of the Companies Act, 2013.
8. I / We have been explained the product features of the loan I / we have applied for. I / We have been explained the detailed document checklist of the loan as mentioned in Bank's
website www.dcbbank.com. I / We have understood the terms and conditions of Micro Home Loan/ Micro Business Loan product of the Bank and I / we agree to abide by them.
9. From time to time, the Bank communicates various features / products / promotional offers which offer significant benefits to its customers and may use the services of third party
agencies to do so.
o I / We expressly authorize the Bank to use information or data relating to me / us, for communicating marketing offers as outlined above.
o I / We do not wish to receive offers as outlined above.
10. I / We understand that Processing Fee and Administrative Fee are non-refundable and my / our application being rejected by the Bank for any reason or same being withdrawn by
me/us, I / we shall not be entitled to refund of same.
11. I / We hereby unconditionally authorise the Bank to make any enquiries with any other finance company / bank / credit bureau / Reserve Bank of India (RBI) / agency/ies appointed by
RBI regarding my / our credit history with them.
12. I / We confirm that the funds will not be used for speculative or anti-social purpose.
13. I / We undertake to inform the Bank regarding the change in my/our occupation/employment and to provide any further information and documents that the Bank may require from
time to time.
14. I / We agree that my/our facility shall be governed by the terms and conditions of the Bank that are in force and may be amended by the Bank at its absolute discretion from time to
time.
15. I / We have understood, acknowledge and agree that a request and demand for any information and documents by any authority under the law will be mandatorily complied with by
the Bank.
16. I / We agree as a pre-condition of the facility given to me/us by the Bank and in that case, I/we commit default in the repayment of the facility or in the payment of interest thereon or any
of the agreed instalment of the facility on the due date(s), the Bank and/or the Reserve Bank of India (RBI) will have an unqualified right to disclose or publish my/our name (including
my/our photograph) as defaulter/s in such manner and through such medium as the Bank or RBI in their absolute discretion may think fit.
17. It will be in order for the Bank to disqualify / deny me/us from receiving any credit facility(ies) from the Bank in case it is proved that the declaration of my/our existing credit facility(ies)
made above contains misrepresentation of facts.
18. I / we hereby give specific consent to the Bank for disclosing / submitting the ‘financial information’ as defined in Section 3 (13 ) of the Insolvency and Bankruptcy Code, 2016 ( ‘Code’
for brief ) read with the relevant Regulations/ Rules framed under the Code, as amended and in force from time to time and as specified there under from time to time, in respect of the
guarantees given, securities created for securing the said facilities availed by the Borrower from the Bank, from time to time, to any ‘Information Utility’ ( ‘IU’ for brief ) as defined in
Section 3 ( 21 ) of the Code, in accordance with the relevant Regulations framed under the Code, and directions issued by Reserve Bank of India to the banks from time to time and
hereby specifically agree to promptly authenticate the financial information submitted by the Bank, as and when requested by the concerned IU.
19. In case of Guarantor, if applicable, I / We undertake to guarantee the loan granted by the Bank to me/us.
I/We shall not hold the Bank liable for sharing of information furnished by me with other Banks / Financial Institutions / Credit Providers / any other entities.
I/We understand that the Bank is relying on the information provided in this application form for the purpose of determining the status of the applicant named above in compliance with
FATCA (Foreign Account Tax Compliance Act) / CRS (Common Reporting Standards). The Bank is not able to offer any tax advice on CRS or FATCA or its impact on the applicant. I/we
shall seek advice from professional tax advisor for any tax questions. I/We agree to submit a new form within 30 (thirty) days if any information or certification in this application form
becomes incorrect or incomplete or not up-to-date. I/We agree that as may be required by domestic regulators/tax authorities the Bank may also be required to report, reportable details
to CBDT (Central Board of Direct Taxes) or close or suspend my / our account. I/We certify that I/we have provided the information in this application form and to the best of my/our
knowledge and belief the information and certification is true, correct, up-to-date, and complete including the taxpayer identification number of the applicant.
Aadhaar consent:
I/We have voluntarily submitted my/our Aadhaar/UID Number mentioned in this application form and consent to:
§ Seed my/our Aadhaar/UID Number issued by UIDAI, Government of India in my/our name with my/our aforesaid account.
§ Map it at NPCI (National Payments Corporation of India) to enable me/us to receive Direct Benefit Transfer (DBT) from Government of India in my/our above mentioned account. I/We
understand that if more than one Benefit Transfer is due to me/us, I/we will receive all Benefit Transfers in this account.
§ Use my/our Aadhaar details to authenticate me/us from UIDAI.
§ Use my/our mobile number mentioned in my/our account for sending SMS alerts to me/us
§ Consent for Authentication: I/We, the holder of the Aadhaar number stated in this application form, hereby give my/our consent to the Bank to obtain my/our Aadhaar number, name
and fingerprint/Iris for authentication with UIDAI. The Bank has informed me/us that my/our identity information would only be used for demographic authentication / validation / e-
KYC purpose and also informed that my/our biometrics will not be stored / shared and will be submitted to CIDR (Central Identities Data Repository) only for the purpose of
authentication.
I/We have been given to understand that my/our information submitted to the Bank herewith shall not be used for any purpose other than mentioned above, or as per requirements of law.

Signature / Thumb Impression of Applicant Signature / Thumb Impression of Co-applicant / Guarantor

Name of Applicant: Name of Co-applicant / Guarantor:
Date: Date:

MSME DECLARATION
I / We Mr. / Mrs. / M/s. ________________________________________ having place of business at ___________________________________________________________________________
_________________________________________________ am / are engaged in manufacturing/ service activity.
I/We declare that the purchase price of the total plant & machinery / equipment of our firm/company is ` _______________ (Rupees _______________________________________
______________________ )

TURNOVER DECLARATION
I/We Mr. / Mrs. / M/s. ________________________________________ having place of business / residence (for individuals) at ______________________________________________________
____________________________________________________________________________ engaged in manufacturing / service activity , have the annual turnover / income (for individuals) of
` _____________________ (Rupees ________________________________________________________________) for FY _______________________

I/We hereby state, confirm and declare that the above details are correct and complete in all respect.
_______________________________________
Signature (and Seal if applicable) / Thumb Impression of Applicant
Bank Copy
KYC verification carried out by

Employee Name & HRMS : __________________________________________________________________

Employee Designation: _____________________________________________
Branch : _________________________________________________
Date: __________________________ Employee Signature
Sourcing Channel
Name of Executive Branch Branch Employee Name DSA Scheme
 Pradhan Mantri Awas Yojana (PMAY) Inclusion - Credit Linked Subsidy Scheme (CLSS) Applicable for Home Loan only.

Are you applying for PMAY-CLSS? Yes No Transaction: Balance Transfer: Yes No

If Yes. Have you availed subsidy earlier Yes No

Particular CLSS / EWS / LIG CLSS - MIG1 CLSS - MIG 2

Annual Household Income (in lakhs)

Carpet Area No Specific Area UPTO 160 SQM UPTO 200 SQM

Woman Ownership Mandatory ¨ ¨ YES ¨ NO ¨ YES ¨ NO

Property Type: ¨ Flat ¨ Single Storey ¨ Individual House

Property Category: ¨ New purchase ¨ Re-purchase ¨ Existing & Owned
Ownership Mode (only in case of enhancement): ¨ Self-Owned ¨ Inherited
Self-Declaration for Pradhan Mantri Awas Yojana
I ____________________________, have applied for housing loan from DCB Bank Limited (DCB Bank”) under the “Credit Linked Subsidy Scheme (CLSS)- Pradhan Mantri Awaas Yojana
(PMAY)”.
I understand and agree to the terms and conditions of availing the subsidy under CLSS - Pradhan Mantri Awaas Yojana. All the benefits and terms and conditions of CLSS-PMAY have
been explained to me by DCB Bank officials.
I hereby declare the below mentioned information for my family members and myself:
1) None of my family members including myself own a Pucca House (all weather dwelling unit) in any part of India. The housing loan availed by me from DCB Bank is for purchasing
the first house of my family.
2) My household annual family income from all sources (including all earning members) is INR __________ (In words Indian Rupees ______________________________________).

Total Adult Family Members (to be filled by all loan applicants and property owners only)
UID Type (Aadhaar, Voter's Card,
Relationship
Name Age (Years) PAN Card, Passport No., Revenue UID Number
with Applicant
Authority Certificate, Others)
1.

2.

3.

4.

5.

3) If at any stage it is found that, I have provided any false information including false self-certificate / affidavit as proof of income, then DCB bank will have the right to take action,
at its discretion, as and when it deems fit.
4) I understand that asa DCB Home Loan customer and beneficiary of CLSS, on transfer/ shifting of the home loan to another financial institution, I shall not be eligible to claim any
benefit of interest subvention again under CLSS.
5) I understand that I shall be eligible to avail the benefit under CLSS only once.
6) I understand that, for a dwelling whose construction has been stalled due to any reason, the Subsidy released by Ministry of Housing and Urban Poverty Alleviation (Mo/HUPA)will be
recovered by DCB Bank along with the loan recovery.
7) I understand and agree that in the event of default in repayment of the Loan by the borrower/ beneficiary and the Loan becoming Non-Performing Asset (NPA), the lender,that is, DCB
Bank will proceed for recovery of the dues through such measures as considered appropriate, including foreclosure of the property. In all such cases, the amount of the recoveries will
be charged to the Subsidy amount on a proportionate basis (that is, in proportion to the Loan outstanding and the Subsidy amount disbursed).
8) I understand that the Subsidy processing is subject to audit by the appropriate Government authority. For any recovery notice of Subsidy from an appropriate authority, the same will
be recovered by DCB Bank from my loan account accordingly.
9) Processing fees will be charged only when original loan amount is in excess of INR 6,00,000 for EWS / LIG and INR 9,00,000 and INR 12,00,000 for MIG-I & MIG-II respectively and no
refund for the same will be provided.
10) I understand that all existing terms and conditions mentioned under the DCB Bank Home Loan Agreement and Sanction Letter will continue to be applicable.

Dated: D D M M Y Y Y Y

Place: Applicant's (and Seal, if applicable) Co-Applicant's Signature (and Seal, if applicable) /
Signature / Thumb Impression Thumb Impression

Witness(es):

Name : Name : Thumb

impression is
required to be
attested by
Signature : Signature : 2 witnesses.
For signature,
Address : Address : no witness is
required.

Place : Date: Place : Date:

Annexure –"R"
Details of The Beneficial Owners

DOB (MM/DD/YY) Occupation / Residential address (With email IDs &

Name Nationality
(If available) Profession Landline / Mobile numbers)

For Companies ( Private & Public)

Shareholders with more than 25 % of Shares/Capital ( whether acting alone or together or through one or more judicial person would be treated as BOs)
Partnership accounts/ Trusts(Public/Private)/ Association of Persons(AOP)more than 15% interest (Capital/Profit)in the Partnership/Trust /AOP
For Partnership firms, Signatures of all the Partners in the account to be obtained
For others, either all Authorized Signatories may sign OR those as per mandate in the account OR by the Directors/Trustees who have signed on the Resolution
For

Partners / Directors / Trustees / Authorised Signatories / AOPs

(Signature to be done under Rubber stamp of the entity)

DCB Bank Limited

CUSTOMER COPY
ACKNOWLEDGEMENT

Sr. No.:
Loan Application received on . Processing Fee (cheque / DD) received on . Request will be disposed of
and acceptance / rejection notification will be mailed within 15 (fifteen) days from the date of the receipt of completed application form with all supporting documents.

Date Employee Name HRMS No. Authorised Signatory