AJIO FUND RECOVERY REQUEST APPLICATION FORM

BANGALORE BRANCH

Attach Passport

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(I) PERSONAL INFORMATION

1. Name :
__________________________________________________________________________
First Name Middle Name Surname/Last Name

Name Father's/Spouse: ______________________________________________________________

First Name Middle Name Surname Last Name

2. (i) Residential
Address :_____________________________________________________________

___________________________________________________________________________________

___________________________________________________________________________________
City Pin Code Telephone No.

(ii) Permanent Address :______________________________________________________________

___________________________________________________________________________________

___________________________________________________________________________________

City Pin Code Telephone No.

3. Date of Birth : ______________________ Age : ___________ Years Day Month Year

4. Sex : Male/Female ______________________

5. No. of dependants : ______________________ Children Others Self Spouse*

6. Education :
_______________________________________________________________________
(Under Graduate / Graduate / Post-Graduate)

7. Occupational Details :

a. Employees of :
____________________________________________________________________

__________________________________________________________________________________
-Govt./Public Sector Undertaking / Public Ltd. Co. / Multi National Company / Reputed
Institution

b. Self - Employed :
__________________________________________________________________
-MBA / Engineer / Doctor / Architect / C.A.

c. Pensioner of :
_____________________________________________________________________
-PSU/State /Central Govt. /Public Sector Bank

(Voluntary Retirement taken on ____________________ as per copy of relieving letter

No.__________ dated ____________ enclosed) 8. Name and Address of Employer/Establishment :

___________________________________________________________________________________

___________________________________________________________________________________

8. Name and Address of the Employer / Establishment :

____________________________________

__________________________________________________________________________________

___________________________________________________________________________________

9. Designation :
___________________________________________________________________________________

10. Length of Service : _______ Years ____ Month

11. Monthly / Annual Income :

Self Gross Rs. : _______________________________________________________________

Net Rs. : ____________________________________________________________________

Other Regular Monthly Income Rs. : ______________________________________________

Please specify Source : _________________________________________________________

12. Do you own a House : YES / NO (Tick whichever is applicable)

If Yes, is the house mortgaged : YES / NO (Tick whichever is applicable)

Value of House (At Cost) : Rs. ______________________

13. Vehicle : Type of Vehicle : _____________________________

Two Wheeler : ______________________

Four Wheeler : ______________________ Make _____ Age ____ Make _____ Age ____

Owned / Company Provided / Hypothecated ____________

14. Present Liability : Rs. ______________________

15. Other Assets owned by : Self Property (other than House) : Rs.
_____________________________

Bank/Post Office Deposits, NSC's, LC Policy, Gold, Shares, Debentures, Units of UTI/Mutual Funds:

Others : Rs. ______________________ Total : Rs. ______________________

16. Loan Amount : Rs. ______________________________ Proposed Repayment Period :

____________________ Months / Years Proposed Monthly Repayment : Rs.

Rs. ________________________ (I) Details of Bank Account : Self

17. Name of the Branch : ______________________________ Telephone

No. :__________________

Type of Account : ____________ Account Number : ________________________________________

a) Two Personal Reference :

1) Name :
__________________________________________________________________

Address : _________________________________________________________________

Tel. No. ______________________________

2) Name :
__________________________________________________________________

Address : _________________________________________________________________

Tel. No. ______________________________

(IV) Declaration : I/We declare that all the particulars and information given in the application form
are true, correct and complete and that they shall form the basis of any loan, State Bank of India may
decide to grant me/us. I/We undertake to inform State Bank of India regarding change in my/our
occupation/employment /residential address and to provide any further information that the bank
may require. I/We confirm that I/we do not have any other credit facilities with any bank other than
that mentioned above. I/We confirm that if I/we avail of any credit facilities with any other bank in
future, I/we will furnish the details to State Bank of India immediately. I/We further authorize the
bank to credit all sums received by the bank or standing to the credit in my/our name jointly or
severally to the loan account, if necessary. I/we confirm that the funds will be used for stated purpose
and will not be used for speculative purposes. I/We are resident Indians. I also understand that the
sanction of the loan is subject to the execution of documents as per the Bank's requirements. I agree
that the Bank has a right to make such enquiries about me as it/they think(s) fit.

Place : ________________ _______________________

Signature of Applicant

Date : _________________

(V) Documentation: Please submit the following documents along with your application. - Latest
monthly salary slip showing deductions - of Self. - Latest Form 16 from employer (for employees) - of
Self. - Copy of IT return for last two years, duly acknowledged by ITO with computation of income, for
Professionals. - Copy of Passport or Voter's ID Card or Driving License for proof of Identity # - Copy of
ration card/Telephone Bill/Passport/Voter's I-Card for proof of residence. # #(not required from
existing customers) - Latest Passport size Photograph - of Self. - Last six months Bank Statement of the
account where salary is credited - of Self. - Verification of signature from the bank where salary is
credited or any employers. - Relieving Letters of Pensioner from the employer. - Proof of official
address (for other than employees). - Proof of Professional Qualification: Copy of highest professional
degree held.

Place: _______________ Signature of Applicant

Date: _______________

FOR BANK’S USE Appraisal / Recommended by: ____________________________________________

Date: ______________

___________________________________________________________________________________

___________________________________________________________________________________
___________________________________________________________________________________

___________________________________________________________________________________

Sanctioned by: _____________________________ Date: _________________