ULP NIFT, Bangalore PHOTO

Confidential Credit Information

Name:

D. O. B ; Mobile No.
Father’s Name
PANCARD No. VOTER ID No. DRIVING LICENSE No PASSPORT No.

Email:
Qualification
Current Residence Address

Rented Since………….
Own Since…………. Pincode: Resi. Phone No.
Permanent Residence Address

Pincode: Resi. Phone No.

Office Address

Pincode: Office Phone No:

Office Fax no.
Constitution
 Individual  Trust
 Proprietorship  Private / Public Ltd.Co.
 H.U.F  Minority
 Partnership  S.C / S.T

Marital status Spouse Name PAN No.of Spouse Dependents

Single /Married Children_____
Others_______

Occupation Start Date Designation Registration

Service Empl. No……………………
Business License No………………..

Details of Guarantee given

Trade Reference ( Minimum 3 required)

S.No Name Occupation Office Address with Residence Address with
Tel.No.’s Tel.No.s & Mob.No.
1.

2.

3.
Nature and Extent of dealings with Bank’s Branches and credit facilities enjoyed, if any
Name of Account Holder Name of Branch Nature of facility Account No.

Name of other bankers / Financial Institutions and Credit facilities allowed by them and securities charged to
them
Name of Account Holder Name of Bank & Branch Nature of facility Account No.

Annual income for last Income Tax Payment I-Tax Assment Wealth Tax Paymnts
Financial Year ( Assessment for last year) completed till AY (Assesment)

Particulars of Liabilities
S.No Name of Bank / FI Loan Type Sanction Date Loan Amt O/s.Amt Tenure EMI

Details of fixed Assets :

S.No. Nature of Property Address & Location Ownership status Value of Property

Brief Report on the Means / Assets :

S.No. Nature of Asset Purchase Value / Present Value Remarks
own contribution
1. Savings
2. Provident Fund
3. PPF
4. Movable Assets
5. Others

Investments:
S.No. Nature of Investment Name of Bank / Date of Amount Maturity Present
FI / Institution Investment Invested Period O/s.amount

Fixed Deposits
S.No. Nature of Deposit Name of Bank / Date of Amount Maturity Present
FI / Institution Deposit Invested Period O/s.amount

Insurance:
S.No. Name of Insurance Date of Policy SUM Annual Date of In Force / Lapsed
Company Assured Premium Maturity

I/We, solemnly declare that the above information is true to the best of my / our knowledge and belief
And undertake that any change there in will be immediately informed to the bank.

Date: Signature of Borrower / Guarantor