APPLICATION 1.6 KOTAK MAHINDRA PRIME LTD.

FINANCE FACILITY APPLICATION FORM

ONLY FOR INDIVIDUAL

DETAILS OF: APPLICANT CO -APPLICANT GUARANTOR

IMPORTANT INSTRUCTIONS:
A) Fields marked with ‘*’ are mandatory fields. B)This form will pass through a scanner, Please fill the form in English and
in BLOCK letters.
Ex: A B C D E X Y Z
C) KYC number of applicant is mandatory for D) For particular section update, please tick in the box available before the
update application. section number and strike off the sections not required to be updated.

For office use only (To be filled by financial institution)

Application Type* New Update
KYC Number (Mandatory for CKYC update request)

PERSONAL DETAILS
CKYCR

Name* (same as ID proof) K O M A L A M O L R A U T

If any nick
name
Maiden Name (if any)

Father Name/Spouse A R U N
Name*
Mother Name* S H A R D A
Date Of Birth* 1 5 0 1 1 9 9 6 Gender* Male Female Transgender
Pan Number* F A U P R 1 5 9 5 G FORM 60 (IF PAN IS NOT APPLICABLE ATTACH FORM 60)
Marital status*
Married Single Other
Education
Post Graduate Graduate High School Below HSC

Number Of Dependents 0 2 Language Preference M A R A T H I

Religion Hindu Muslim Christian Jain Sikh Buddhist Others Disability YES NO

Caste SC ST OBC Others Citizenship* Indian Others

Residential Status* Resident Individual Non-Resident Indian Foreign National Person of Indian Origin
Occupation Type* Service Private Ltd.co Public Ltd.co Government PSU Others
Business SEP SENP
Other Retired Housewife Student Agri Service (Unorganized) X -Not Categorised
Nature of Business / Industry* GST.No

Please Tick if applicable

I/ we further declare /confirm that the vehicle purchased / to be purchased by me / us from the aforesaid loan shall be used by me/ us solely for the purpose of
business.
*PROOF OF IDENTITY (POI) AND PROOF OF ADDRESS (POA)
(Self attested copy of any of the following Proof of Identity(POI) and Proof of Address (POA) needs to be submitted)

Passport Number Expiry Date

Voter ID card

Driving License Expiry Date

National population
register letter
NREGA Job card

UID(Aadhaar) * * * * * * * * Offline * * * * * * * *
(Please mentioned only last four digits) Verification
of Aadhaar)
Address Line 1* A R U N K A D H A T K O S H I M G H A R
Line 2 T A L U K A D A U N D R A G E G A O N
Line 3 P U N E M A H A R A S H T R A
Line 4
 Declaration:
I here by submit my proof of prossession of Aadhaar Card and give my voluntary consent to use my Aadhaar Card Details to authenticate my details from UIDAI. I have
been explained by the representative of KMPL about the nature of information that may shared upon authentication. I have been given to understand that my information
submitted to the KMPL herewith shall not be used for any purpose other than requirement of law. I hereby declare thet all the above information voluntarily furnished by
me to KMPL is true, correct and complete in nature and I shall not dispute regarding the present declaration in future.
Address type* Self owned Rented Company provided Family Residential/Business Residential Business

Preferred Communication Address Proof of Address Deemed Address Proof & others
LandMark

City/Town/Village P U N E
District

State / U.T.Code M A H A R A S H T R A
Years Pin / Postal 4 1 3 1 0 5 ISO 3166 Country code
Code
ADDRESS DETAILS (Proof of Address should be of current address)
CURRENT RESIDENCE ADDRESS DETAILS(Self attested copy of any of the following Proof of Address(POA) needs to be submitted)

Same as official valid document as above Current address details(if different then official valid document)
Address type* Self owned Rented Company provided Family Residential/Business Residential Business
Address Line 1* G A T N O 2 6 3 4 M A I N T A I N
Line 2 R A G A F L A T N O 1 1 0 2 V I D H A T E
Line 3 H A W E L I P U N E U R U L I D E W A C H I
Preferred Communication Address Proof of Address Deemed Address Proof & others
LandMark M O U N T A I N R A G A
City/Town/Village P U N E
District

State / U.T.Code M A H A R A S H T R A
Years 5 Pin / Postal 4 1 2 3 0 8 ISO 3166 Country code
Code

OFFICE ADDRESS DETAILS

Address type* Self owned Rented Company provided Family Residential/Business Residential Business
Office Name*

Address Line 1* S T E P S E R V I C E
Line 2 U R U L I D E W A C H I M E N A N E
Line 3 W A S T I
Preferred Communication Address
LandMark

City/Town/Village P U N E
District

State / U.T.Code M A H A R A S H T R A
Years Pin / Postal 4 1 2 3 0 8 ISO 3166 Country code
Code

ADDITIONAL ADDRESS DETAILS OR

PERMANENT ADDRESS DETAILS

Address type* Self owned Rented Company provided Family Residential/Business Residential Business
Address Line 1*

Line 2

Line 3

Preferred Communication Address

LandMark

City/Town/Village

District

State / U.T.Code

Years Pin / Postal ISO 3166 Country code

Code
CONTACT DETAILS
Tel. (Res) Tel. (Off 1)

Tel. (Off 2) Office Ext

Mobile 1* 9 5 4 5 7 5 9 4 9 4 Mobile 2

Email ID* S T E P 2 M D @ G M A I L . C O M

PRIOR FINANCE DETAILS (IF ANY)

From

Loan Account No.

Amount Financed

Contract Month Year

Current Status

DETAILS WITH PRIOR ASSOCIATION WITH KMPL

Have you ever obtained finance from Customer Relationship No.

YES NO
KMPL earlier

Please provide details: Loan Account No.

Have you ever provided guarantee for customer financed by KMPL? If Yes, Customer name : ____________________________________________________
Whether Director or relative of director of KMPL / Kotak Group entity Yes / No If yes Specific declaration to be Provided
Whether A Firm in which any KMPL / Kotak Group director, or their relatives is interested as
Yes / No
partner / manager / employee / guarantor in that Firm
Whether A company in which directors of KMPL / Kotak Group or their relatives is interested
Yes / No
as major shareholder, director, manager, employee or director in that Company
Whether Director of any bank or related to director of any Bank. Yes / No
Whether A Senior Officer of KMPL or their relative* as per Code of Conduct policy of the
Yes / No
Company).

BANK DETAILS
Bank Name

Bank A/C No.

IFSC

Branch

Type of Account: Saving Current OD/CC Others___________

VEHICLE AND FINANCE DETAILS

1.Type of Loan* New Used Refinance Vehicle Equity Loan Prime Vishwaas Two Wheeler
2.Used For: Personal Business
3.Vehicle Details O L A
Model O L A S 1 X 4 K W H
Color Varient

Fuel Type: Petrol Diesel Others OTH Registration No.

___
YOM Smart Plug Device: Yes No
4.Ex Showroom Price 9 9 9 9 9 . 0 0 Discount

Margin Money 8 4 5 0 . 0 0
5.On Road Price 1 1 1 4 5 0 . 0 0 RTO Amount (To be filled 5 5 8 . 0 0
only if Reg.funding)
6.Finance Amount 1 0 4 2 0 0 . 0 0 EMI Amount 3 6 1 2 . 0 0 Tenure (In 3 6
Months)
7.Supply Dealer Name O L A F I N A N C I A L S E R V I C E S P R I V A T E
8.Finance Dealer Name O L A F I N A N C I A L S E R V I C E S P R I V A T E
9.Salesman 1) 6 5 2 2 3 5 8 2 2)
Name/Employee Code
3) 4)
REFERENCE

Relative Full Name A M O L R A U T

Address Line 1* U R U L I D E W A C H I
Line 2 P U N E
Land Line No. Mobile No. 9 5 4 5 7 5 9 4 9 4
Relationship With Applicant H U S B A N D
Friend Full Name G A N E S H K A D U
Address Line 1* D H A Y A R I
Line 2 P U N E
Land Line No. Mobile No. 8 6 0 5 0 8 7 7 8 7
Please tick whichever is applicable. Whether applicant would like to opt for Term Cover for group of borrowers (Kotak Car loan cover) offered by Kotak Mahindra
Prime Ltd. (KMPL) under the terms and condition Policy No.F2 as contracted by KMPL with Kotak Mahindra Life Insurance Company Limited. Yes No

I hereby declare that I am running business enterprises and original Investment in Cost of Plant and Machinery/ Cost of Equipment for running the business as per
income tax filing for latest year FY.___________ is Rs.________________
UDYAM CERTIFICATE RELATED INFORMATION
Is the entity an UDYAM Certificate holder : Yes No If yes, then provide following details State as per URC__________________

a) Your UDYAM Registartion Number : UDYAM b) Type Of Enterprise: Micro Small Medium

c) National Industry Classification Code: i)NIC 2 Digit _ _ (________________________) ii) NIC 4 Digit _ _ _ _ (________________________)

iii) NIC 5 Digit _ _ _ _ _ (________________________) d) Date Of UDYAM Registration

I/We declare/confirm that the vehicle/Loan shall be used by me/us solely for the for business purpose. further, I/We declare and undertake to abide by the usage
mentioned above.
INTEREST RATES AND SERVICE CHARGES (KMPL COPY)

SI No. Description Charges SI No. Description Charges SI No. Description Charges

1 Documentation Charges* Rs 3075 10 Prepayment charges on outstanding Principal Amount Flat 5.21% 18 LPG \CNG NOC Rs.885
Issue of Duplicate Copy of the Agreement/Duplicate NOC/ Rs.885 per
2 Credit Administration charges* Rs 775 11 Rs.885 per request 19 Statement of Account (Physical)
NOC of duplicate Registration Certificate request
Rs.2000/- + Interest calculated at Customer ROI for
Cancellation of Contract (other than foreclosure and
number of days between the date of disbursement
3 Stamping Charges* Rs 104 12 prepayment charges) at specific request of the Borrower and 20 NOC for Interstate Transfer Rs.885
and the date of receipt of funds, at specific request
agreed by the Lender
from customer for cancellation of contract.
NOC for Commercial to personal
4 Evaluation Charges* 13 Collection Charges for Clearing Mandate (per mandate) At Actuals 21 Rs.885
use
NOC to Convert from Private to
5 RTO Charges* 14 Clearing Mandate swap Charges Rs.500 per swap 22 Rs.885
commercial
Repayment Schedule/Account Outstanding Break up
6 Risk Containment Unit Charges* 15 Rs.885 per request 23 Advance Installment (if Applicable)* Rs 7224
statement
3% or
Rs.3000/-
7 Service Fees* Penal Charges (Sl. No. 16 & 17) 24 Amalgamation / Transfer of Equity
whichever
is higher
Legal / Collections / Incidental
8 NACH / Bank Charges* Rs 250 16 Dishonor Charges per Clearing Mandate Rs.750/- 25 At Actuals
Charges
9 Customer Rate of Interest (p.a) 16.95% 17 Delayed Payment / Late Payment Charges on Overdues 18% p.a. 26 Repossession Charges At Actuals
*These charges will be collected upfront at the time of disbursement 27 Any Other (If Applicable)

Note:- 1. Tax will be levied separately as may be applicable from time to time on all the charges.
2. Changes in charges from time to time are updated on Kotak Prime website. Visit http://www.Primeloans.kotak.com under the charges and fees.
3. For details of interest gradation approach, please visit https://primeloans.kotak.com/policies.htm
GST RELATED INFORMATION & DECLARATION

1) Are you registered under Goods and Service Tax (GST) regulations Yes No
2) If Yes, then provide the following details
a. Your GST registration number (GSTIN):
b. Whether the asset financed will be used exclusively in the business for which the GSTIN has been provided above: Yes No

c. Whether you have availed / will avail the Input Tax Credit of the GST amount paid on the purchase invoice of the asset: Yes No
d. How are you discharging your GST liability: < Forward charge / Reverse charge>?
"I / We hereby declare that the above GST details are true and correct to the best of my knowledge and
belief. I/we hereby undertake to inform Kotak Mahindra Prime Limited (KMPL) regarding any change in our
above GST information. I/We hereby authorise the KMPL to consider the aforesaid details to administer the GST
as per law or otherwise in respect of the aforesaid asset"
I/We hereby agree and undertake to indemnify KMPL in case of any claim from GST Authorities, due to any
error or omission in the facts and confirmation provided above
CUSTOMER DECLARATION

I hereby consent to receiving information from Central KYC Registry through SMS/Email on the above registered number/ Email address. I understand that as per
directions of Government of India, my KYC information will be updated in Central KYC Registry and I hereby authorise the KMPL to open my loan account in same name
as registered with UIDAI for issuing Aadhaar/Income Tax for issuance of PAN.

UNDERTAKING CLAUSE
I request you for a finance facility details of which are provided here in. The facility would be under Loan according to the terms and conditions mentioned in the
agreement to be entered between me, yourself, and the co-borrower /guarantor, if any. I certify that the information furnished in this application and or
documents provided there with is true and correct. I have signed the loan application form of Kotak Mahindra Prime Limited after filling it up fully (except parts
mentioned as Official use) & after understanding the contents and shall not dispute the contents later on. By signing this application form, I, hereby declare that I
have read and/or understood and/or made me understand by representative of Kotak Mahindra Prime Limited (KMPL) and further same shall be binding on me.
I do further understand that this is only an application form and final sanction of loan shall be at sole discretion of KMPL. I expressly undertake to inform you of
any change in my status, and residential/principal/registered address as and when such change takes place.
I agree and confirm that you may reject my request without assigning any reason and I reserve no right to appeal against such rejection. I authorize you to verify
or check any and all of the information provided by me in this application and/or documents provided therewith with any of the credit bureau /or any other credit
rating agency or third party for loan processing and in future during the term of Loan period.
I also authorize you to verify or check my references, employment/Business details, obtain any reports concerning/giving indication of my financial standing
including those of my family members or related entity. I authorize you to share any and all of the information provided by me in this application and/or any
documents provided with this application, with any credit bureaus and/or any other credit rating agency and/or third party. I hereby expressly authorizes you or
your agents to obtain my income and income tax details as and when the same is required by you for the purpose of verification any initial payment made
pursuant to this application shall not imply acceptance of this application/proposal. In case of rejection of my application only advance EMI will be refunded
without interest.
I agree that all documents submitted in connection with this application including, but not limited to, photocopies of original documents, photographs, signature
verification, address verification, bank details etc. shall become your sole property and shall not be returned /handed over by you to me and/or any person on
my behalf. I am interested in knowing information on your various products & I have no objection if you or your telecallers/Agents make marketing & Sales calls
and send Marketing, Sales and Promotional Material related to any of your Products/Group company product on my registered Mobile and Landline Number
and/or E-Mail IDs/Postal Address. I further have no objection if you/your authorized persons/agents/vendors send me communication concerning loan related
information/EMIs/overdue amount/notices/letters etc on my registered Mobile no through electronic means/WhatsApp and/or other electronic resources.
I understand that, any new phone number, mobile number, email id, provided by me while opting for any other finance facility from KMPL (e.g. Two wheeler
Loan, Car Loan, Kotak Prime personal loan etc.) shall be automatically updated in the KMPL records in lieu of the phone number, mobile number, e-mail id
provided at the time of obtaining the earlier Loan and/or previously registered with KMPL. Further, I understand and acknowledge that all further
intimations/communications pertaining to the loan account shall also be sent by the KMPL only to the new phone number, mobile number, email id and no
intimation/communications will be sent to the previously registered phone numbers, Mobile Numbers, Email id.
I hereby confirm that I have been explicitly communicated about the interest gradation approach by Kotak Mahindra Prime Limited's (KMPL's) representative as
well as the URL details for the same mentioned in https://primeloans.kotak.com/policies.htmare briefed to me before applying for the loan with KMPL. The
ownership of applying for loan facility with KMPL shall exclusively vests with me after analyzing all the factors and by exercising my independent discretion and I
shall not dispute the interest/charges levied for this loan post the loan is disbursed by KMPL.
I, the undersigned is fully aware that mere endorsement of hypothecation of KMPL on Registration Certificate or Insurance or invoice of the vehicle does not
itself establish that KMPL has approved the loan, and actual disbursement without subsequent cancellation of such disbursement of loan will be necessary to
create legal rights/ obligations of my behalf under the loan agreement. I hereby undertake to indemnify KMPL and keep indemnified for any direct or indirect or
consequential loss incurred by KMPL due to such wrong hypothecation in near future."
I agree that Loan Related information/documents viz Welcome Letter, Loan Agreement, Repayment Schedule will be sent on the E-mail ID provided by me in
the present Loan Application Form. I also agree & understand that I can also access the above mentioned information/Documents through Customer Care
Portal (https://www.primeloans.kotak.com Or https://kmplcustomerportal.kotak.com/kmpl-customer/customer/login.htm) of KMPL by self-Log in.
Further I declare and undertake to abide by the terms of this application form.
Date: 2 8 0 6 2 0 2 4
Place: P U N E

(Please fill in all applicable information before signing) Signature/Thumb Impression of Applicant

VERNACULAR DECLARATION (to be executed by non KMPL employee)

This letter is to confirm that I the undersigned,__________________ residing at ___________________________ inform, declare and confirm to Kotak Mahindra Prime
Limited, that I have read out and explained to Ms./Mr.____________________________ the content of this T&C and all other facility / security documents and the
relevant terms and conditions in connection with the availing of the facilities by the borrower, in the native language and Ms./Mr.________________________ has
confirmed that he/she has understood the same and agreed to abide by all said terms and conditions. Pursuant to being fully explained and understanding the content of
the documents, the aforesaid person is affixing his/her signature/ thumb impression and is counter signing this letter in token thereof.
I confirmed that whatever I have stated hereinabove is true and correct.

"Yours truly,

_______________________
FOR OFFICE USE - MANDATORY (To be fill up by KMPL employee only)

Prospect No.: T W 7 9 6 0 1 4 5 4
KMPL RM: S H U B H A M V A I R A T
KMPL SRM: A Z A M B A S H I R K A Z I
Bank RM:

Bank RM Employee Code:

RL Branch Name:

RL Branch Code:

ATTESTATION/FOR OFFICE USE ONLY (To be fill up by KMPL employee only)

Documents Received Certified Copies

KYC VERIFICATION CARRIED OUT BY

Date 2 9 0 6 2 0 2 4
Emp. Name S H U B H A M V A I R A T
Emp.Code 6 5 2 2 3 5 8 2
Emp. Designation A S S O C I A T E
Emp. Branch P U N E
INSTITUTION DETAILS
Name K O T A K M A H I N D R A P R I M E L I M I T E D
Code I N 1 9 9 1

EMPLOYEE SIGNATURE INSTITUTION STAMP

ACKNOWLEDGEMENT

Application No. For Kotak Mahindra Prime Ltd.

T W 7 9 6 0 1 4 5 4
Received from P U N E
Application form for Loan/Facility of Rs. 1 0 4 2 0 0 . 0
"Application will be processed within 14 working days, post receipt of complete information as required by KMPL’s internal policies" Authorised Signatory / Representative
Recd at P U N E
Date 2 8 0 6 2 0 2 4

Visit us at https://www.primeloans.kotak.com/

INTEREST RATES AND SERVICE CHARGES (CUSTOMER COPY)

SI No. Description Charges SI No. Description Charges SI No. Description Charges
1 Documentation Charges* Rs 3075 10 Prepayment charges on outstanding Principal Amount Flat 5.21% 18 LPG \CNG NOC Rs.885
Issue of Duplicate Copy of the Agreement/Duplicate NOC/ Rs.885 per
2 Credit Administration charges* Rs 775 11 Rs.885 per request 19 Statement of Account (Physical)
NOC of duplicate Registration Certificate request
Rs.2000/- + Interest calculated at Customer ROI for
Cancellation of Contract (other than foreclosure and
number of days between the date of disbursement
3 Stamping Charges* Rs 104 12 prepayment charges) at specific request of the Borrower and 20 NOC for Interstate Transfer Rs.885
and the date of receipt of funds, at specific request
agreed by the Lender
from customer for cancellation of contract.
NOC for Commercial to personal
4 Evaluation Charges* 13 Collection Charges for Clearing Mandate (per mandate) At Actuals 21 Rs.885
use
NOC to Convert from Private to
5 RTO Charges* 14 Clearing Mandate swap Charges Rs.500 per swap 22 Rs.885
commercial
Repayment Schedule/Account Outstanding Break up
6 Risk Containment Unit Charges* 15 Rs.885 per request 23 Advance Installment (if Applicable)* Rs 7224
statement
3% or
Rs.3000/-
7 Service Fees* Penal Charges (Sl. No. 16 & 17) 24 Amalgamation / Transfer of Equity
whichever
is higher
Legal / Collections / Incidental
8 NACH / Bank Charges* Rs 250 16 Dishonor Charges per Clearing Mandate Rs.750/- 25 At Actuals
Charges
9 Customer Rate of Interest (p.a) 16.95% 17 Delayed Payment / Late Payment Charges on Overdues 18% p.a. 26 Repossession Charges At Actuals
*These charges will be collected upfront at the time of disbursement 27 Any Other (If Applicable)

Note:- 1. Tax will be levied separately as may be applicable from time to time on all the charges.
2. Changes in charges from time to time are updated on Kotak Prime website. Visit http://www.Primeloans.kotak.com under the charges and fees.
3. For details of interest gradation approach, please visit https://primeloans.kotak.com/policies.htm