Annexure-C

APPLICATION FORM FOR SCHEMATIC ADVANCES

Office Use only

Cell/ Branch Application ID

Product
Business Mpower(TL/OD) BLFP Power Rent Equipment Power

Power Trade(TL/CC) Business Power Enterprise Power (TL/CC) Others

(Pl. specify)

PART-I GENERAL DETAILS

Section I - Applicant Details

Name

Are you an existing Axis Bank Customer? Yes No

If Yes, Provide Account No.

ConstitAxison Proprietorship Partnership Private Limited Company

Public Limited Company HUF Trust Others
(Pl. specify)

Nature of Business Trade Mfg. Services Registration No.*

(Pl. specify)

Date of Establishment D D M M Y Y Y Y PAN / GIR No.

Regd Office/Permanent Address :

City State PIN

Phone S T D Code Fax

Mobile

Email

(If different from above)

Correspondence Address :

City State PIN

Phone S T D Code Fax

Office Ownership : Self-Owned Rented / Leased Years at Current Office:

Brief description of business activity

* Company registration no./ partnership registration fno./ SSI reg./Sales Tax reg.

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 Section II- Co-Applicant Details

Co-Applicant1 Relationship with applicant Partner Director Others Shareholding (min 25%)
(Pl. specify)
Name of the Co-applicant Mr/Ms/Dr

Nationality

ConstitAxison Proprietorship Partnership Private Limited Company

Public Limited Company HUF Trust Others

(Pl. specify)
Regd Office/Permanent Address :

City State PIN

Phone PAN / GIR No.

( NOTE : If not having PAN / GIR No., fill Form 60 )

Co-Applicant 2 Relationship with applicant Partner Director Others Shareholding (min 25%)
(Pl. specify)
Name of the Co-applicant Mr/Ms/Dr

Nationality

ConstitAxison Proprietorship Partnership Private Limited Company

Public Limited Company HUF Trust Others

(Pl. specify)
Regd Office/Permanent Address :

City State PIN

Phone PAN / GIR No.

( NOTE : If not having PAN / GIR No., fill Form 60 )

Section III- Existing Banking Relationships

1. Accounts with other Banks :

Bank Branch / Address Account Type Account Number

2. Credit Facilities:

We declare that we do not enjoy credit facilities with any bank

We declare that we enjoy following credit facilities with other bank(s) :

Details of Borrowal Accounts:

I. Cash Credit / Over-draft Facility

Bank & Branch Limit Current Date of Rate of Int Security Renewal
Outstanding availement offered due on
(in Rs.lacs) of loan

(Enclose Copy of Sanction letters)

II. Term Loan and other borrowings

Bank & Branch Loan Amt Current Monthly Rate of Tenure of Balance Purpose
Oustanding Instalments Interest Loan months
(in Rs.lacs)

(Enclose Copy of Sanction letters)

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 Section III - Ownership & Management Details*

Mr/Ms/Dr
Share-holding % PAN
Residence Address
Please Paste
Residence Ownership Years at Current Residence
Colour Photo here Resi.Phone No. Mobile No. Gender
Nationality Date of Birth D D M M Y Y Y Y
Passport / Driving License No. Expiry Date D D M M Y Y Y Y
Education SSC / HSC Graduate Post Graduate Professional

Mr/Ms/Dr
Share-holding % PAN
Residence Address
Please Paste
Residence Ownership Years at Current Residence
Colour Photo here Resi.Phone No. Mobile No. Gender
Nationality Date of Birth D D M M Y Y Y Y
Passport / Driving License No. Expiry Date D D M M Y Y Y Y
Education SSC / HSC Graduate Post Graduate Professional

Mr/Ms/Dr
Share-holding % PAN
Residence Address
Please Paste
Residence Ownership Years at Current Residence
Colour Photo here Resi.Phone No. Mobile No. Gender
Nationality Date of Birth D D M M Y Y Y Y
Passport / Driving License No. Expiry Date D D M M Y Y Y Y
Education SSC / HSC Graduate Post Graduate Professional

Mr/Ms/Dr
Share-holding % PAN
Residence Address
Please Paste
Residence Ownership Years at Current Residence
Colour Photo here Resi.Phone No. Mobile No. Gender
Nationality Date of Birth D D M M Y Y Y Y
Passport / Driving License No. Expiry Date D D M M Y Y Y Y

Education SSC / HSC Graduate Post Graduate Professional

* Proprietor in case of proprietorship firms, partners in case of partnership firms, directors in case of companies,
trustees in case of Trusts

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 PART-II SCHEME DETAILS

Section I - Loan Request Details

Amount Requested: Rs. Tenure months Expected Rate of Interest: %

Purpose of Loan : Business Expansion Acquisition of Property Renovation of current business premises

Takeover of existing loan Purchase of Equipment Working Capital

Any other general business / corporate purpose, please specify

In case of takeover of existing loan mention name of Bank and Branch:

B A N K B R A N C H

Section II - Security Details

1 Primary Security (Stocks and Book debts in case of Power Trade or Equipment under Equipment Power or any
other fixed assets under Term Loan)

2 Collateral Security
I) Immovable Property
Name of Registered Owner / Developer

Relationship with the Borrower

Property Address

Area of Property (sq. ft) Built-up area of Property (sq. ft) Age of property years

ii) Other security (Shares/FD)

3 Guarantors
Personal Guarantor Details

Mr/Ms/Dr F I R S T M I D D L E L A S T

Residence Address

Please Paste

Resi.Phone No. Mobile No. Gender

Colour Photo here Nationality Date of Birth D D M M Y Y Y Y

Net Worth: (Rs.)

Relationship with the Borrower

Mr/Ms/Dr F I R S T M I D D L E L A S T

Residence Address

Please Paste

Resi.Phone No. Mobile No. Gender

Colour Photo here Nationality Date of Birth D D M M Y Y Y Y

Net Worth: (Rs.)

Relationship with the Borrower

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 Corporate Guarantor Details

Name of the Guarantor:

ConstitAxison Partnership Private Limited Company Public Limited Company

Registration No. PAN No.

Regd. Office Address

Phone No. Net Worth: (Rs.)

Section III - Additional Details

To be filled in case of Business Loan for Property

Estimated Requirement of Funds: Estimated Sources of Funds

Purchase Price Rs. Margin Rs.
Incidental Costs (brokerage etc) Rs. Loan Funds Rs.
Stamp duty & Registration Rs.
Other costs (pl specify___________) Rs.

Total Estimated Requirements Rs. Total Estimated Sources Rs.

To be filled in case of Power Rent

Name of the Lessee

ConstitAxison Private Limited Company Public Limited Company Others

Regd Office/Permanent Address :

City State PIN

Gross Rentals Per Month Lease Period (in months)

To be filled in case of SSI Power/Power Trade

For Working Capital Proposal

Audited Year-1 Audited Year-2 Current Year (Estimates)

Purchases

Credit generally received*

Sales**

Credit generally extended*

Closing Stock *

Gross Profit
Audited financial statements of last two years

* In case of variation on account of seasonal factors, minimum and maximum can be indicated separately.

** A justification for the turnover estimates to be provided.

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As against a turnover of Rs _______ lacs achieved in the previous year the turnover for the current year is estimated at
Rs ________ lacs. We are confident of achieving the said level of sales on account of the following:

For Term Loan Proposal

Estimated Requirement of Funds: Estimated Sources of Funds

Purchase Price/Project cost Rs. Margin Rs.

Incidental Costs Rs. Loan Funds Rs.

Stamp duty & Registration Rs.

(if applicable)

Other costs (pl specify___________) Rs.

Total Estimated Requirements Rs. Total Estimated Sources Rs.

Need for proposed expansion

Implementation Schedule

Repayment Schedule

To be filled in case of Equipment Power

Estimated Requirement of Funds: Estimated Sources of Funds

Value of Equipment/Vehicle Rs. Margin Rs.

(as per the proforma invoice)

Installation charges Rs. Loan Funds Rs.

Other costs (pl specify___________) Rs.

Total Estimated Requirements Rs. Total Estimated Sources Rs.

Name of the Equipment/Vehicle Model

Manufacturer

Declaration

1. We certify that the information provided by us in this application form is true in all respects and that this shall form the basis
of any facility / service that the Axis Bank (the Bank) may decide to grant to us at its sole discretion. We also understand that
the Bank reserves the right to seek any information from any source or to give any information and /or assign any work to any
third party at its sole discretion. We further agree that the facility that may be provided to us shall be governed by the rules
of the Bank that may be in force from time to time. We will be bound by the terms and conditions of the facility that may be
granted to us.

2. We understand that as a pre condition, relating to grant of the facility to us, the Bank requires our consent for the
disclosure by the Bank of information and data relating to us, the credit facility availed of/to be availed of in relation thereto
and default, if any, committed by us, in discharge thereof. Accordingly, we hereby agree and give consent for the
disclosure by the Bank of all or any such information and data relating to us, the credit facility availed of/to be availed of in
relation thereto and default, if any, committed by us, in discharge thereof, as the Bank may deem appropriate and
necessary, to disclose and furnish to the Credit Information Bureau (India) Ltd [“CIBIL”] , and any other agency authorised in
this behalf by Reserve Bank of India [“RBI”].

3.We declare that the information and data furnished by us to the Bank are true and correct.

4. We undertake that :

a) CIBIL and any other agency so authorised may use, process the said information and data disclosed by the Bank in the
manner as deemed fit by them; and
b) CIBIL and any other agency so authorised may furnish for consideration, the processed information and data disclosed or
products thereof prepared by them, to Bank's)/ Financial Institution's) and other Credit Grantors or Registered Users, as may
be specified by the RBI in this behalf.

5.We confirm that the enclosed copies of financials / Bank Statements/ Title / Legal and other documents etc. are submitted
by us against our loan application and are true copies.

6. We understand that charges paid to the Bank towards out of pocket expenses and/or log-in/ processing fees are non-
refundable and upon the application being withdrawn by us or being rejected by the Bank for any reason whatsoever in
the pre-sanction or post-sanction stage , we will not be entitled to any refund either in part or in full.

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7. We understand that all charges pertaining to the loan including the Processing fees of 1% of the loan amount or as per the
sanction letter and prepayment penalty of 2% of the principal outstanding or as per the sanction letter are to be borne by us.
We further understand that the relevant Stamp Duty, Legal Expenses, Valuation Expenses ,expenses pertaining to creation of
charges with ROC, charges for documentation and any other out of pocket expenses as per actuals will be borne by us.

8. We understand that disbursement will be subject to production of necessary documents as may be required by the Bank from
time to time , satisfactory completion of Bank's appraisal and documentation process and compliance with Bank's laid down
norms /guidelines

9 We confirm that we shall utilise the said Credit Facility only for the purposes of Business as mentioned above.

Signature of the Applicant Signature of Co-applicant Signature of Co-applicant

Date : Place :

Additional Declaration from NRI

1. We undertake that the loan proceeds shall not be utilised either singly or in association with any other person, for any of
the activities in which investment by persons resident outside India is prohibited, namely;(I) the business of chit fund, or (ii)
Nidhi Company, or (iii) agricultural or plantation activities or in real estate business (excluding development of townships,
construction of residential/ commercial premises, reads or bridges), or construction of farm houses; or (iv) trading in
Transferable Development Rights (TDRs).

Signature of the NRI Applicant/Co-applicant Signature of the NRI Guarantor

Date : Place :

Enclosures:

Receipt Acknowledgement

We acknowledge that we have received the Application Form dated from

(Name of the borrower)
for a loan amount of Rs. Lacs under the product.
(Product Scheme)

For Axis Bank Ltd.

Authorised Signatory

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