Annexure D

CREDIT INFORMATION FORM

Applicant/Co-Applicant/Guarantor

Name Father’s / Husband’s Name Mobile number & email ID

Nature of Service/Business Sidelines if any

Constitution

HUF Trust Ltd./Pvt. Others

Partnership
Individual Proprietary Ltd.

OBC Religion Male

GEN Female
Minority SC ST

Full Name of identical, connected or associated firms giving nature and place of business
name(s) of their bankers with address(es) and details of credit facilities allowed by them.

Full name & Address of individual, proprietor, partners, karta and co-parceners, directors
etc and their relationship with address(es) and details of credit facilities allowed by them.

Name along with Office Address with Residence Address Permanent Address
Father’s/Husband’s Telephone Numbers with Telephone with Telephone
Name Numbers Numbers
 * Name of owner/landlord (if rented)/licensees of premises must be supported by latest certified
documentary evidence such as receipt or rent, taxes, etc

BANK ACCOUNT DETAILS

Liquid assets (such as FDs, PPF, NSC, MF,
Bank account details
Bonds, Shares, Insurance policy, etc)
CD/SB account no. Bank’s name& branch Details Value (Rs.)

Fixed assets / Immovable properties Movable assets

Details Value (Rs.) Details Value (Rs.)

Total Total
Give nature and location of each asset and in case of immovable property the names in which it is held. If the
proprietor/partner has any land/building/flat, photocopy of last available land revenue/ panchayat tax
receipt to be enclosed and survey no. & other details of property to be given.

EXISTING BORROWING DETAILS

Bank’s name & Nature of Overdues,
Account number Limit Outstanding
branch facility if any

CREDIT CARD DETAILS

Credit Card no. Issuing Bank Credit Limit Expiry date Outstanding Overdue

DETAILS OF GUARANTEE GIVEN

Particulars of Individual liabilities of
Whether stood as guarantor, if so details proprietor/partner/director or latest
with extent of liability certified personal balance sheet or copy of
ITR with all annexure to be attached

I solemnly declare that the above information is true to the best of my knowledge and
belief and I undertake that any change therein will be immediately informed to the bank.
Place:
Date: Signature of Applicant / Co-Applicant / Guarantor