Capri Global Capital Ltd.

Regd. Office: 502, Tower A, Peninsula Business Park, Senapati Bapat Marg,
Lower Parel, Mumbai • 022 40888100, 43547200.

Loan Application Form Occupation Details Applicant

Photograph
Amount of Loan: Rs. ₹2,40,000 Source of Income: Self

Date of Loan: 17-Jan-2023 Gross Annual Income: Rs 2 - 5 Lacs

Loan Account Number: GL4379044247 Occupation: Self Employed

Nationality: Indian

Customer Risk Category: Low

Personal Details:
Applicant Name: - Manjeet PAN Card No/Form 60: Date of Birth: 23-AUG-1986
Kumar DSJLK2097K
Gender: Male Qualification: Graduation No. of Years in Current Residence: 50

Marital Status: Married Address: VPO Makrauli

State: HARYANA City: Rohtak District: ROHTAK
Land Mark: Near Toll Plaza Makrauli Pin Code: 124001
Email Address: 9050004095@cgcl.in Primary Contact No: 9050004095
Nominee 1 Name: Savita Devi Nominee 1 Relationship: Wife Nominee 1 Ph. No.: 8950786987
Nominee Details:
Nominee 2 Name: - Nominee 2 Relationship: - Nominee 2 Ph. No.: -
Bank Name: Punjab National Bank Branch Name: ROHTAK
Bank Details:
Bank Account Number: IFSC Code: PUNB0040600
Individuals: 1) Photo ID Proof 2) Residence Proof For list of acceptable documents, kindly refer to KYC
Documentation Policy available on our website www.capriglobal.in

I/We hereby request you to kindly grant the above-mentioned amount of Rs. ₹2,40,000 by taking total jewellery of
70.55 grams as security towards the above said amount. The details of the gold are mentioned below.)

CIN Number: L65921MH1994PLC173469 www.capriglobal.in

 Details of the Pledged Articles Photograph of Jewellery

The proportionate net weight at 22 Carat is 70.55 grams

Particulars Units Carat Total Wt
I/We declare and understand that purity 2of the gold as aforesaid
Bangle/Kada 22 is at least70.55
21.00 carat,
however same is subject to reconfirmation by Auditors/Valuers appointed by CGCL, whose
Total will be final and binding on me/us (“Lender’s Record”). The pledged
decision 70.55
gold’s value has
been arrived as per average of closing price of 22 carat gold for preceding 30 days as quoted by
the Bombay Bullion Association Ltd. Or the historical spot gold price published by regulated
commodity exchange.

Signature of Borrower
Signed by OTP
(-)

CIN Number: L65921MH1994PLC173469 www.capriglobal.in

Loan Application Form Occupation Details Applicant
Photograph
Amount of Loan: Rs. ₹2,40,000 Source of Income: Self

Date of Loan: 17-Jan-2023 Gross Annual Income: Rs 2 - 5 Lacs

Loan Account Number: GL4379044247 Occupation: Self Employed

Nationality: Indian

CIN Number: L65921MH1994PLC173469 www.capriglobal.in