if

(Tobe stamped as an agreement and as an affidavit with additional stamp duty for notarial act,
sWorn before Notary Publicin accordance with stamp duty in force in the State)

Before,
The Notary Public/Judicial/Executive/Special Magistrate

Public/Place of Local Jurisdiction of the Magistrate to be

(Place of Practice of the Notary
given here as the case may be)

PERSONALASSETS AND LIABILITIES STATEMENT

For Loans up to 25 Lacs)_
Please notethefollowing before compiling Opinion Report
Guarantors to be
a.Copies of Documentary evidence in respect of assets of Borrowers/
obtained and kept on record.

b.Bank account statement for the past one year to be obtained.

c.Self certification will be the basis for the Opinion Report.
d.Other assets to include cars etc.

Name: Shri/ Smt/ Kum..

S/o, Wlo, D/o....

Aadhar Number:
Mobile No.
Resident of. . .

Landline or Alternate Mobile No.......PAN No....

DOB.. Age.... Date of Retirement..

...Net Annual Income/ NMI......
Profession....
Description ofimmovableproperty
House Address/ Location Owned/ Leased Value, Encumbrance,
if any, for loan
Flat No
availed and amount.
(Area of land and

House)
Other assets-Deseription andvalue
Description Value Description Value Description Value
NSCs PF Gold
PPF ornaments

Mutual Shares/ Others

Funds Debentures (please
specify)

Total Assets Rs.

Liabilities
Amount
Description Amount Description
Home Loan Personal Loan

Car Loan PF Loans

Other Loans Other liabilities

Total Liabilities Rs.

I hereby declare thatthe particulars furnished by me are correct. I enclose photocopies of relevant
documents on support of my statement. I undertake to furnish original documents, if needed by

Bank, for verification.

Signature of the applicant/ Guarantor