Centre / Branch :

Application for Power Homes

Application ID :

You are applying as a Salaried - Individual Self-Employed - Professional Self-Employed - Others

Are you an existing UTI Bank Customer? Yes No (If Yes, Provide Account No.: )

Dear Sir / Madam,

I/We request you to sanction me/us a loan of Rs. for the purpose of
repayable in months by way of Post-dated Cheques / Deduction from salary by employer (check-off facility) / ECS / SI.

Personal Details (For individuals Only)

Name of the Applicant :
Title Surname First Name Middle Name

Preferred Name : Date of Birth : DD: MM: YYYY:

Father’s / Spouse’s Name :
Mother’s Maiden Name :
Residence Address :
Landmark : City :
State : Pin Code : Nationality :
Tel. : (O) (R) Fax : Mobile No.:
Pager No.: E-mail :
Permanent Address :
Landmark : City :
State : Pin Code : Tel. :

Other Details:
Details (Please Tick)
Sex : Male Female Marital Status : Single Married No. of Children : No. of Dependents :
Education : SSC / HSC Graduate Post Graduate Institute / University :
PAN Card No.: Passport No. : Passport Expiry Date : / /
Voter’s ID Card No.: Driving Licence No. :
Occupation : Doctor Lawyer CA MBA Engineer Others (specify)
House Owned by : Self-Owned Rented / Self-Leased Co. Provided / Lease Parents Paying Guest
If Rented / Self-Leased, the Monthly Rent is Rs.: Years at Current Residence :
Vehicle(s) Owned : Yes No If yes, please provide other details
Type of Vehicle : Two-Wheeler Four-Wheeler No. of Vehicle(s) Owned : Hypothecated : Yes No
Vehicle 1 Vehicle 2
Model : Model :
Make : Make :
Year of Purchase : Year of Purchase :
Hypothecated to : Hypothecated to :

Co-applicant Details
Co-applicant : Yes No If Yes, whether : Spouse Parents Others (please specify) :

Name of the
Co-Applicant : Title Surname First Name Middle Name

(Note : For Co-applicant cases, please fill the separate Co-applicants form)

Employment / Business Details

If Salaried, Type of Organisation : Govt. / Public Sector Pvt. Ltd. Public Ltd. MNCs

If Self-Employed, Type of Organisation : Pvt. Ltd. Public Ltd. Partnership Proprietorship Others (specify) :
Name of Current
Employer / Business :
Office Address :
Landmark : City :
State : Pin Code : Tel. : (O) Ext.:
Fax : Mobile No.: E-mail :
Designation : Date of joining (for salaried individuals) : DD: MM: YYYY:
No. of Years in Current Employment / Business : Type of Business :
In case Self-Employed, please provide the business commencement date : DD: MM: YYYY:
Name & Address of Previous Employer / Business :
City : State : Pin Code : Tel.: (O) :
Designation : No. of Years in Previous Employment / Business :

Spouse Details
Name of the Spouse : Date of Birth : DD: MM: YYYY:
Is He / She an Earning Member ? If Yes, please provide Net Monthly Income Rs. :
Office Name & Address :
Tel. : (O) :

Financial Details
Salaried Self-employed
Gross Monthly Salary : (Rs.) Gross Monthly Income : (Rs.)
Net Monthly Salary : (Rs.) Net Monthly Income : (Rs.)
Other Income (If any) : (Rs.) Other Income (If any) : (Rs.)
Investment in Shares / Units / Bank Deposits / Others (Please specify) :
Total Investment In Value : (Rs.) Are you a Tax Payer ? Yes No

Bank and Credit Card Details

Bank 1 - Primary Bank 2 Bank 3

Bank Name

Bank Branch

Account Type

Account No.

Estimated Balance in all Accounts : (Rs.) As on dated : DD: MM: YYYY:

Do you have Credit Cards ? Yes No If yes, no. of Credit Cards :

Card 1 Card 2 Card 3

Visa / Master Card / Amex /

Diners Club / Others

Name of the Bank

Card No.

Valid from (mm/yy)

Valid upto (mm/yy)

Type of Card

Credit Limit

Credit Outstanding

Loan Servicing Details

Do you have any other Existing Loan(s) ? Yes No (If yes, please provide the following details)
Loan 1 Loan 2
Loan Type : Loan Type :
Name of Financier : Name of Financier :
Monthly Instalment : Monthly Instalment :
Loan Amount : Loan Amount :
Current Outstanding : Current Outstanding :
Balance Months to go : Balance Months to go :
Date of Loan Availed : Date of Loan Availed :
Purpose of Loan : Purpose of Loan :
Have any additional Loan(s) Servicing ? Yes No Total Monthly Debt Service amount : Rs.
 Loan Request
Loan Amount Requested : Rs. Tenure Requested : (Months) EMI : (Rs.)
Mode of receiving Processing Fees : By Cheque Deduct from Disbursement Amount
Upfront Processing Fees : (Rs.) Cheque No. : Date of Receipt :
Drawn on : No. of Upfront Instalment(s) :
Payment To : Vendor Builder Bank (In case of Takeover Cases) Other (specify) :
Disbursal Instructions : Draft / Pay Order, in favour of A/c No.
Disbursal Instructions : Credit in A/c (UTI Bank customers only)
No. of PDCs Received : Date of PDCs 5 th 20th
PDCs No.: Bank Name / Address :
PDCs No.: Bank Name / Address :
PDCs No.: Bank Name / Address :

Guarantor Details
Type of Guarantor : Individual Corporate Relationship with Applicant :
Name of Guarantor : Date of Birth : DD: MM: YYYY:
Father’s / Spouse’s Name (in case of individual only) :
Residence Address :
City :
State : Pin Code : Tel. : (O) (R)
Fax : Mobile No.: Pager No.: E-mail :
Office Address :
City :
State : Pin Code : Tel. : (O) (R)
Fax : Mobile No.: Pager No.: E-mail :
Designation : No. of Years in Current Employment / Business :
In case Self-Employed, please provide the business commencement date : DD: MM: YYYY:
Gross Monthly Salary / Income : (Rs.) Gross Annual Turnover : (Rs.)
Net Monthly Salary / Income : (Rs.) Net Monthly Income : (Rs.)
Investment in Shares Bonds / Units Bank Deposits NSC Others (Please specify) :
Total Investment In Value : (Rs.) Are you a Tax Payer ? Yes No

Would you like to avail of any other facility offered by the Bank ? Yes No If yes, Please tick on relevant boxes.

Personal Power Power Homes Consumer Power Power Drive Study Power Financial Advisory Services
Savings A/c Current A/c Encash 24 Fixed Deposits Recurring Deposits Salary Power
Business Classic NRI Services Depository Services iConnect™ International Debit Card

Security Document Details

Security Document : Ref. No.: Date of Purchase :

Security Document : Ref. No.: Date of Purchase :

Security Document : Ref. No.: Date of Purchase :

Security Document : Ref. No.: Date of Purchase :

Total Value of Securities given : Rs.

About your references

(One reference has to be non-relative / non-colleauge)
Reference 1 Reference 2

Name : Name :

Relation with applicant : Relation with applicant :

Address : Address :

Pin Code : Pin Code :

Tel. (R) : (O) : Tel. (R) : (O) :

Mobile : Mobile :

E-mail : E-mail :
 Expenditure Details

Household Expenses : Loan Payments to Banks :

Third Party Loans : Expense Commitments :

Other Expenses : Total Expenses :

Lifestyle Details

Products you have at home (Please Tick) DVD / VCD Player / Hi-fi music
1 system Microwave Air Conditioners

Mobile Phone Computer / Laptop Internet Connection

Preferred mode of payment while shopping Cash Debit Card Credit Card Cheque

Preferences (Individual)

Language Preferred :

Hobbies & Interests : Remarks

Arts & Antiques :

Coins :

Handicraft :

Computers and Technology :

Meditation / Yoga :

Painting :

Photography :

Sculpting :

Theater / Movies :

Music :

Others :

Favourite Cuisine : Indian Chinese Thai French

: Italian Mexican Others (specify)

Frequency of Travel

Once a year Twice a year Three times or more

How many times did you travel outside India in the last one year ?

Not even once Once Twice Three times or more

Are you interested in sports ? Yes No

If Yes which one ?

Cricket Football Golf Tennis

Pool Motor sports Others (specify) :

Family Details

If married, Wedding Anniversary Date :

No. of children :

Details of children : 1) Age : Sex : 2) Age : Sex :

Details of children : 3) Age : Sex : 4) Age : Sex :
Stream of education of children (Please tick)

Medicine Engineering Management

Others : Not applicable

Do any of your children reside / study abroad ? Yes No

Does anyone from your family want to pursue higher education (India / Abroad) ? Yes No
 Property Details
(to be filled by DSA / Bank Officer)
Purpose of Loan : Purchase Construction Purchase & Construction Extension Improvement

Details of Property Estimate of requirement of funds Estimate of sources of funds

Property Address : Total Purchase / Construction Cost (a) : Loan Requested Rs.
Rs. Own Contribution - Amount already
Incidental Cost (if any) (b) : Spent Rs.
Rs. Sources
City Other Cost (Please specify) (c) : Savings from Bank : Rs.
State : Pin : Rs. Disposal of Investment / FD / Shares, etc.
Area of Property / Land : Total (a+b+c) : Rs. Rs.
(In sq. Ft.) Construction Provident Funds : Rs.
Build up Area (in sq. Ft.) Stage : Ready To Commence (Refundable)
Cost of Land : Rs. Under Construction (Specify the Stage % and Provident Funds : Rs.
Builder Name : expected completion date) (Non-Refundable)
Stage I (25%) Date : Estimate Total Sources :
Project Name : Stage I (50%) Date : Rs.
Stage I (75%) Date : Is this UTI Bank approved project ?
Purchased from : Builder Society Stage I (100%) Date : Yes No
Resale Self-Construction Expected Possession Date : Do you propose to rent this unit ?
In case of Purchase, please specify Seller Yes No
Name : If Yes, Rent expected Rs.

If property not selected, by when do you intend finalising it ?

Date :
Place :

Applicant’s Signature DSA / Bank Officer Stamp and Signature

Declaration
I/We declare that the particulars and information given in the Application Form are true, correct, complete and upto date in all respects and I/We have not withheld any information. I/We confirm that
I/We have had no insolvency proceeding initiated against me/us nor have I/We ever been adjudicated insolvent. I/We have read the application form and am/are aware of all the terms/conditions of
availing finance from UTI Bank Ltd. I/We authorise the Bank to make references and enquiries relative to information. In this application which the Bank considers necessary. I/We authorise the
Bank to exchange, share/part with all information relating to my/our loan details and repayment history information to other Banks/Financial Institutions, etc. as may be required and shall not hold t
Bank liable for use of this information. I/We undertake to inform the Bank regarding change in my/our residence/employment and to provide any further information that the Bank may require. he
I/We agree that my/our loan shall be governed by the rules of the Bank which may be in force from time to time. I/We understand that the Bank has the right to reject my/our application without
providing any reason.
The Borrower(s) and Guarantor(s) agrees to have given their express consent to the Bank to disclose all information and data furnished by them to Credit Information Bureau (India) Ltd. (”CIBIL”). The
Borrower(s) and Guarantor(s) further agree that they shall further execute such additional documents as may be necessary for this purpose.

Date :

Place :
Guarantor’s Signature Co-applicant’s Signature Applicant’s Signature

Guarantor’s Co-applicant’s Applicant’s

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Passport size Passport size Passport size
Photograph Photograph Photograph

DSA / Bank Details (Only for office use)

DSA Name : Branch Name :

DSA ID : Branch ID :
Name of DSA Officer : Name of Bank Officer :

(Stamp and Signature of DSA) (Signature of Bank Officer / Bank Manager)

Please specify the Marketing Programme (if any)

Any Specific Note :