File No.

:
Agent:
HLA/DSA/CRA Code:

APPLICATION FOR LOAN UNDER APNA OFFICE – 1 / 2 (Individuals)

Please take due care & fill in all the details in CAPITAL LETTERS only. A completed & correctly filled in Form will help us in processing your Application
faster. An incomplete / incorrect Application is liable to be rejected.

PERSONAL INFORMATION

APPLICANT CO-APPLICANT
Surname First Name Middle Name Surname First Name Middle Name
Full Name

Father’s Name

Date of Birth, Age, & Sex DD MM YYYY DD MM YYYY

Age: years Male Female Age: years Male Female

Income Tax PAN

[attach Xerox Copy]

Place of Birth

Marital Status Single Married Others Single Married Others

Exact Educational Qualification, Name

of Institute / University from which
Qualification obtained, & Year of
Passing (please specify & attach Proof)

Category SC / ST OBC Others SC / ST OBC Others

Please specify Relation of Co-applicant with Applicant: ___________________________________________

Dependents
No. of Dependents: Children ____________________________ Adults _____________________________.

Residence Address _______________________________________________________________________________________

_______________________________________________________________________________________
_______________________________________________________________________________________

_______________________________________________________________________________________

Nearest Landmark ___________________________ Dist. _________________ State __________________

PIN STD Code _________ Ph. # _______________ Mob. # __________________

E-mail _____________________________________ No. of years at above Residence __________________

Residence Status: Owned Rented If rented, Rent p.m. _____________________

Permanent Address _______________________________________________________________________________________

_______________________________________________________________________________________

_______________________________________________________________________________________

_______________________________________________________________________________________

Nearest Landmark ___________________________ Dist. ________________ State ___________________

PIN STD Code __________ Ph. # _______________________________________

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Details of Loans / Cash Credit / Overdraft Facilities availed: [Please attach separate sheet if space is insufficient]

Name of Bank / FI Sanc. Date, ROI, Term, & Purpose Details of Security Offered Sanc. Amt. / Limit EMI, if any O/s. Bal. as on Date

Have you / your Spouse ever stood as Guarantor? Yes No

If yes, give details: _________________________________________________________________________________________________________

INCOME INFORMATION

APPLICANT CO-APPLICANT
Present Office Address ___________________________________________ ___________________________________________
___________________________________________ ___________________________________________
Dist. ______________ State ___________________ Dist. ______________ State ___________________
PIN STD Code __________ PIN STD Code __________
Phone No. ______________ FAX _______________ Phone No. ______________ FAX _______________
Office Status: Owned Rented Office Status: Owned Rented
If rented, Rent p.m. ___________________________ If rented, Rent p.m. ___________________________

Nature of Professional Activities &

Number of Employees

Experience No. of years in current Prof. Practice : _______ years No. of years in current Prof. Practice : _______ years
Total Experience: _______________________ years Total Experience: _______________________ years

Details of Registration with Statutory Are you regd. with any Statutory Authority? Yes / No Are you regd. with any Statutory Authority? Yes / No
Authority If yes, Name of Authority: ______________________ If yes, Name of Authority: ______________________
___________________________________________ ___________________________________________
Registration No. _____________________________ Registration No. _____________________________

Gross Annual Income Rs. /- p.a. Rs. /- p.a.

Net Annual Income Rs. /- p.a. Rs. /- p.a.

Note:
(1) Please attach the copies of ITRs, Income Computation Statements, & full set of Financials for the last 3 Assessment Years, along with a Note
on the Professional Activities.
(2) If Loan is required under Apna Office – 2, the Detailed Project Report should also be provided.

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LOAN INFORMATION

Loan Required (Rs.): Type of Rate of Interest: Floating / Fixed-10

Term Desired (Max. 10 years): Mode of payment of EMI: ECS / PDC / Escrow
Due Date of EMI: Whether to start EMI immediately {required only in case of Construction}? Yes No
Purpose of Loan: Purchase of Office / Hospital Construction of Office / Hospital Extension of Office / Hospital
Improvement / Renovation Purchase of Equipments

FINANCIAL INFORMATION

Particulars Applicant [Rs.] Co-applicant [Rs.] Particulars Applicant [Rs.] Co-applicant [Rs.]
Bank Savings / Deposits Life Ins. Policies / PLI
Other Properties Shares & Securities
Current Balance in PF / PPF Other Assets (Pl. specify)

Monthly Expenses: Rs. _____________________/- p.m. Are you a Shareholder of LICHFL? Yes / No

Bank A/c. Details [Please attach copies of Bank Statements for at least past 6 Months]

Name of the A/c. Holder Name & Address of the Bank Type of Account Account No.

PROPERTY INFORMATION [Please attach copies of Title Documents]

FULL ADDRESS OF THE PROPERTY ________________________________________________________________________________________

________________________________________________________________________________________________________________________
Nearest Landmark ____________________________ Dist. ___________________ State _______________________ PIN

Area of Land / Undivided Share of Land: __________________ Sq. Ft. In case of Leasehold Plot : -
Built-up Area: ___________ Sq. Ft. Carpet Area: ___________ Sq. Ft. Name of Lessor: _______________________________________________
Name (s) of Owner (s) : ______________________________________ Term of Lease: _______________ Dt. of Expiry of Lease : ______________

In case of Purchase of Ready-built / Under Construction Office / In case of Construction / Extension of In case of Improvement /
Hospital: - Office / Hospital: - Renovation: -
Name & Address of Vendor / Builder: ___________________________ Const. Stage (% completed): _________ Year of Construction of Office /
_________________________________________________________ Exp. Completion Dt.: ________________ Hospital: ___________________
Year of Construction (in case of Ready-built): ____________________ [Note: Please attach the detailed [Note: Please attach detailed
% complete: ______________ Exp. Completion Dt.: ______________ Construction / Extension Estimates] Improvement / Renovation
Date of Sale Deed: __________ Validity of Sale Deed (days) ________ Estimates]

Cost / Value of the Property (Rs.):

Cost of Land / Undivided Share of Land (UDL): ____________________ Cost of Office / Hospital (excl. Land / UDL Cost): ______________________
Estimated Cost for Construction / Extension: ______________________ Estimated Cost for Improvement / Renovation: _______________________
Cost of Amenities: ______________________ Total Cost: _________________________ Valuation of Property: __________________________

Cost of Equipments to be Financed, if any (Rs.): [Please attach separate sheet if space is insufficient]

Name of Equipment Price (Rs.)

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Sources of Funds (Rs.):

Means of Finance Total Requirement Invested so far

Promoter’s Contribution
Disposal of Investment / Property
Loan (s) from LICHFL
Others (Pl. Specify) _________________________________________________
Total Funds

LIFE INSURANCE POLICY DETAILS [Please attach separate sheet if space is insufficient]

Policy No. Name of Insurer & Name of Type of Sum Premium Mode of Dt. of Present
Branch Policyholder Policy & Assured Amount Premium Comm. Surrender
Term (Rs.) (Rs.) Pmt. [M / Value (Rs.)
Q / H / Y]

Are you opting for Griha Suraksha (Group Mortgage Redemption Assurance Scheme)? Yes / No.

REFERENCES

Name: _____________________________________________________ Name: _____________________________________________________

Address: ___________________________________________________ Address: ___________________________________________________
___________________________________________________________ ___________________________________________________________
______________________________________ Dist. ________________ ______________________________________ Dist. ________________
State ______________________________ PIN State ______________________________ PIN
STD Code ___________ Ph. # (R) _______________________________ STD Code ___________ Ph. # (R) _______________________________
Ph. # (O) ____________________ Mob. # _________________________ Ph. # (O) ____________________ Mob. # _________________________
E-mail ID: __________________________________________________ E-mail ID: __________________________________________________

DECLARATION

I / We declare that all the particulars and information given in the Application Form are True, Correct, and Complete, and that they shall form the basis of the Contract for any
Loan LICHFL decides to grant to me / us. I / We have no Insolvency Proceedings against me / us nor have I / we ever been adjudicated Insolvent and further confirm that I /
we have read the LICHFL Brochure giving details of its Loan Schemes and understood its contents. I / We have understood and selected the Interest Rate Option available. I /
We am / are aware that the option on Interest Rate once selected cannot be changed and change (s) may be permitted only at the sole discretion of LICHFL on such Terms
and Conditions as decided by LICHFL. I / We agree that LICHFL may take up such references and make enquiries in respect of this Application, as it may deem necessary
from my / our Banker (s) or Others. I / We undertake to inform LICHFL regarding any change in my / our Occupation and to provide any further information that LICHFL may
require. LICHFL may make available any information contained in this Form and other Documents submitted to LICHFL and information pertaining to the Loan to any
Institution or Body. LICHFL may seek / receive information from any source / person to consider this Application. I / We further agree that my / our Loan shall be governed by
the Rules of LICHFL which may be in force from time to time. I / We understand that the Upfront Fee is not refundable under any circumstances, and the Loan Sanction or
Rejection is at the sole discretion of LICHFL, even after payment of such Fee. I / We am / are aware that the Original Title Deeds (including the Chain of Title) in respect of the
Property standing in my / our name will have to be deposited to LICHFL as Security for the Loan. I / We am / are also aware that if the Equipments are also financed, the
same will have to be Hypothecated to LICHFL as Security for the Loan. In purchase cases, I / we am / are aware that the Loan Cheque will be given in the favour of the
Vendor only and I / we agree to this procedure.

Recent Passport-size Recent Passport-size

Applicant’s Signature : _______________________________________
Photograph of the Photograph of the Co-

Co-applicant’s Signature : _______________________________________ Applicant with applicant with Signature

Signature across across

Place: ___________________________ Date: ____________________

Mail Correspondence to: Residence Address Office Address Permanent Address

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Recent Passport-size
Photograph of the
File No.:
Agent:
Recent Passport-size
HLA/DSA/CRA Code:
Photograph of the Co-

Applicant with applicant with Signature

Signature across across

APPLICANT CO-APPLICANT

Specimen Signature

Surname First Name Middle Name Surname First Name Middle Name

Full Name

Please draw Route Map of the Property in the space provided below.

FOR OFFICE USE

(To be completed by the Area Office)

S. No. Date of Visit Visited by Observation Amount Paid, if any Initials

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S. No. Date of Visit Visited by Observation Amount Paid, if any Initials