Loan lication Form

Fintree Finance Pvt. Ltd.

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ClN No. U65923MH 201 5PrC264997
211, Summit Business Bay,
Opp. Cinemax PVR off Andheri - Kurla Road,
Andheri (East), Mumbai - 400 093
*All
LoanAppricationFormNo.:
:-ZV7Z--
fields are compulsory to be fllled . Please fill all the fietds in CAPITAL LETTERS onty
For office use only : Fintree Representative Code f----
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Fintree Finance Pvt. Ltd.

source -- -- Empoweilng SMEGrowth

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Fintree Finance Pvt, Ltd. =
ProductAppliedfor: DigitalPaymentRegular i, SpecialProgram
Dear Sir/Madam,
We request you to grant us a business loan as per following details: Loan Applied for {.
LoanUtilisation: EForExistingBusinessE NewLineofBusiness EAnyother(Pleasespecify)
PurposeofLoan: EWorkingCaptial E AcquisitionofAssets E Anyother(Pleasespecify)
Type of Business Entity: E Proprietorship fl Partnership EI Corporate E Hur E LLP E others lnsurance opted E
A. Business Details
* Name of the Entity: (as per certificate of registration)
-Branch
* Trading Name (lf different from Entity):
* Natureof Business:EFood&BeverageEApparel EPetrol Pumps EGroceriesEClinics&Lab EAutomobileDealerships ECDTT EpharmacyEHotels
* [Spa&Salon ! I HomeAppliances EFurniture&Homefurnishing I Books&Stationary
Footwear EOpticians E other
Business Premises is: E Self -owned [J Rented/Leased EI Family owned *occupied Since: /
* PAN:
* Business Address:
Office

* city: *Pin
code,
*state: *Tel. No:
*Registered
Office Address: (for companies only)

* city:
*
state:
*Any
other associated business entity: E YES ENO 1lt yes please provide address, EDC Machine details, Bank Statement for 6 months)
* Doing Business * website
since: / :

*
Average Monthly furnover (in Rs, Lakhs) 1. Card Sales: E Rs. l-2 E Rs. 2-5 E Rs. >5 cash Sales
* Preferred mode of communication:
E Email E SMS MeetingTime: AM/PM * Weekly off: Day
Contact person:
* Name :
* Designation:
* * Phone no.
Relation with the borrower:

B. Personal Details of the Applicant

Name of Applicant: (as per PAN Card)

PHOTOGRAPH
* Father / Husband's Name
Please affix
a recent passport

*Date of Birth: size photograph and

*
Gender: E Male E Female E Transgender I I
sign across it
* *Email
PAN: ld
*
Aadhar Number:
* Education Level : E Undergraduate E Graduate E Postgraduate
E Any Other, Please sPecifY *
* Residential Premises is: El self owned E Rented E Family Owned E Leased Residing Since
*Residential Address:

*Pin
code:
e
* city:
@
* State: * o
Mobile No o
*Landline d
No. L

Permanent Address: U
G
ts
*
z
cod.,
tr
Pin

* city, *
Landline No.
*State:

of Loan Form
Fintree Contact Person Na
Name of APPlicant
Fintree Contact Person No'
Date of APPlication
Signature
Application No.
 C. Bank Details
ng based loan details (if any) (Note: Strike if not applicable)
ilt IV
I
il

Financier Name
Loan Amount (Rs.)
Loan Starting Date
Daily (Rs.)

Tenure
Balance Amount
*Cash-CrediUOD !imits with banks lt"tote: Strike if not applicable)
Present outstanding Security offered
Name of the facilitY Sanctioned amount
Name of the bank/ (Rs.) (Rs-)-

*Bank Account details:

Account No Nature of A/c operated
Sr Name of the Bank Branch since
(16 Digits) account
No.

EDC Terminal Status

* Details of EDC terminals (Note: Please provide bank statement for the listed terminal)
MID TID AMEX Active IV]SF
Name of Acquirer Location Operating
YiN
(Bank) Branch since

D. Statutory & ComPliance

*Any litigation, by you or against you: E YES EI ttO (lf Yes Please give details below)
Details:
Criminal/Civil Pending with(Authority) Plaintiff Defendant Amount involved (lf anY)
Case No. Date of case filing

E. References
Business Reference
*Name :

*Mobile: *
Email:
*R"l.tion
with the borrower:
Personal Reference
Name:
Mobile: Email

Relation with the borrower:

DECLARATION:
. lMe declare that all the particulars and information and details given/filled in this application form are true, correct, complete and up-to date in all
respect and that lMe have not withheld any information whatsoever. lMe understand that certain particulars given by me/us are required by the Yours Faithfully
operational guidelines by various regulatory authorities.
. lMe hereby conflrm that no insolvency proceedings or suits for recovery of outstanding dues or monies whatsoever or for attachment of my/our assets
or properties and/or any criminal proceedings have been initiated and/or are pending against me/us and that lMe have never been adjudicated
insolvent byanymurtorotherauthonty norhasany receiver, administrator, administrative receiver, trustee orsimilarofficerbeen appointed formy/ourassets.

' lMe authorise Fintree Finance Pvt. Ltd. and/or its associates/subsidiaries/ affiliates to obtain, verify, exchange, share or part with all the
information or othenrvise, at my office/residence and/or contact me and/or my family members and/or my employer/Banker/Credit Bureau/RBl and/or any
third party's they deem necessary and/orto do any such acts and till such time as they deem necessary and/or disclose to the Reserve Bank of India, UIDAI
or any other authority, including but not limited to, Credit Bureau or any other third person, the name/identity, credit information including but not limited to,
current balance, payment history defaults, ifany, etc.
' l^/V€ authorise Fintree employees/agents to access our premises for carrying out any verification/investigation and post disbursement scrutiny.
lAile also authorise them to approach our bankers for any relevant information forconsideration of loan and thereifter. Sign & Stamp
'1,4/veherebyconsenttoreceiveinformation/seryiceetcformarketingpurposethroughtelephone/mobile/SMS/EmailbyFintree/serviceprovider. Name & designation
' lMe authorize Fintree to markeUsell/promote/endorse any olher product or service beneflcial to me/us.
' uwe hereby authorise Fintree to purge the documents submitted by me, if the case is not disbursed/approved
for whatever reason within 3 months
ofapplication.
'lMeauthoriseUlDAltoreleasemy/ouridentityandaddressthroughblometricauthentication. Place:
' to avail information on products aid services of other companies and
authorise Fintree to cross sell other company,s
Y;,,Xt'€:1j'.'."r:ursconsent Date:
' person's/Asencv to vrsit our residence & business premises for verification, which incrudes takins
xH:"J|.T;iJ.ill:il::"r5J:[:'.r:-horised

Most lmportant Terms & Conditions

 Applicant 2
*
Name of Applicant: (as per pAN card)

* Father / Husband,s Name PHOTOGRAPH

:
Please affix
*Gender: *Date a recent passport
E Male EFemale
*
PAN:
ETransgender
*Email
of Birth // size photograph and
td: sign across it
*
Aadhar Number:
* Education
Level : E Undergraduate E Graduate E Postgraduate
* Residential premises E Any Other, please specify
*Residential is: E Self owned E Rented E Family owned E Leased *Residing
Address: Since

* city:
* State: Ptn Lode:
*Landline
No. *
Permanent Address: Mobile No

* city:
*state: "
Pin Code:
*
Landline No.
Applicant 3
Name of Applicant: (as per pAN card)

* Father / Husband,s Name PHOTOGRAPH

:
Please affix
*
Gender: E vtale E Female ETransgender *Date a recent passport
*
PAN: *Email
of Birth // size photograph and
ld:
* sign across it
Aadhar Number :
*Education
Level: E urndergraduate E Graduate E Postgraduate
* Residential premises EI any Other, please s pecify

*Residential is: El setf owned E Rented E owned *Residing

Address: Family E Leased Since

* city:
*Pin
*State: code,
*Landline
No.
Permanent Address: " Mobile No

* city: *
* Pin cod.,
state: *
Landline No.
Applicant 4
Name of Applicant: (as per pAN Card)

PHOTOGRAPH
* Father / Husband's Name Please affix
a recent passport
* *Date of Birth:
*
Gender: E vale EFemale ETransgender
*Email
// size photograph and
PAN: ld: sign across it
*
Aadhar Number r

* Education Levet
E Undergraduate E Graduate E Postgraduate
E nny Other, Please specify
* Residential Premises is: E Self owned E Rented E Family Owned E Leased *Residing Since
*Residential Address:

*Pin
* City: code:

*State:
*Landline " Mobile No
No.
Permanent Address:

* city,
Prn L00e:
*
*State: Landline No.
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