Self-Declara on for Date of Birth Mismatch in PAN and Officially Valid Document Submi ed

(To be filled and signed by customer)

Date:

To, Poonawalla Fincorp Limited

Dear Sir/Madam,

Subject: Self Declara on with reference to mismatch of Date of Birth in PAN and Officially Valid
Document.

I have applied for obtaining loan from Poonawalla Fincorp Limited (“PFL”) and have given necessary
consent(s) for the same. Further, I understand that there is a mismatch in Date of Birth between
Permanent Account Number and Officially Valid Document (OVD).

I undertake & state that my original Date of Birth is _________________________ which is as specified
in

PAN or OVD (Type of OVD _______________, OVD Number _______________) and that
I request PFL to consider the same for the aforesaid purpose.

I will be solely responsible for any consequence(s) arising out of the difference in Date of Birth in my PAN
and officially Valid Document (OVD), provided by me for applica on of loan with PFL. Regards,

_________________

Customer Name:

Classifica on | INTERNAL