DISBURSEMENT REQUEST FORM (‘DRF’)

Date: 31/07/2023

Place: BHOPAL

To,

POONAWALLA FINCORP LIMITED (‘PFL’),

201, and 202, 2nd Floor, AP81,

Koregaon Park Annex, Mundhwa,

Pune – 411036

Ref.: Proposal No. APPL00388425

_______________, Product: Business Loan

Dear Sir / Ma’am,

This is with reference to the loan facility availed by me/us from your organization vide the aforementioned Proposal
Number and I/We understand that your organization has sanctioned an amount of Rs 10,11,372/- /-
(Rupees TEN
…………………………………)
LAKH ELEVEN THOUSAND
in this regard (‘Loan Amount’).
THREE HUNDRED SEVENTY TWO ONLY
I/We hereby request you to disburse/ release the Loan Amount to the below mentioned bank account(s):

NAME OF BENEFICIARY:

Sr. Name of Bank Branch Account IFSC Code Amount Cheque

No Beneficiary Number ₹ / NEFT
M/S PALIWAL
1 TRADERS SBI SUTHALIYA 00000038677607537 SBIN0017103 10,11,372/- NEFT

For Balance Transfer (BT) Cases:

I/We hereby authorize PFL to close my/our loan account/proposal no. ______________________________ with
_______________________ (‘BT Institution’)_________________________ (Branch) and collect the original receipt
for payment from them. I/We am/are also submitting the Authorization letters as required for such Balance Transfer.

Sr. BT Institution Branch Amount Cheque /

No ₹ NEFT
This DRF supersedes any other communication, oral or written and/or any other DRF executed on a date prior to
the aforementioned date, by me/us in connection with the Proposal Number as stated herein above.

Signed and delivered by/ for and on behalf of the Borrower.