ANNEXURE - A

Application for Loan under
UBI Personal Loan Scheme

To
The Chief Manager/Manager
United Bank of India
_________________ Branch
Dear Sir,
I/We request you to sanction a loan of Rs.________________ (Rupees
_________________________) only under Personal Loan Scheme of the Bank. I/We furnish the following information.
Applicant 1 Applicant 2
1. Name of the Applicant :
2. Age :
3. Name of Father/Husband :
4. Address of the Applicant
and Tele. No
i) Residence :
ii) Office :
5. For Salaried Applicant
i) Name and address of the :
Employer
ii)Applicant’s designation/ :
position in the Employer’s organization and period since when employed
6. For Professional and Self- Employed applicant
i) Name and address of his/her :
firm/company and details
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Applicant's Photograph(Applicant 1)
Applicant's Photograph (Applicant 2)
Applicant 1 Applicant 2
ii) Line of activity of the firm/ :
company or the profession
iii) Applicant’s designation/ :
position in the firm/company
and period since when engaged
iv) Nature and value of securities :
offered
7. For Salaried Applicant
i) Monthly gross salary and net take home salary for the month of_________________________
(to be certified by the employer)
Applicant 1 Applicant 2
Gross Salary Deductions Gross Salary Deductions
Basic Rs__________ .PF Rs_________ Basic Rs_________ PF Rs__________
DA Rs__________ IT Rs_________ DA Rs_________ IT Rs__________
HRA Rs__________ Loan Rs_________ HRA Rs_________ Loan Rs__________
Others Rs__________ Others Rs_________ Others Rs_________ Others Rs__________
Total Rs__________ Total Rs_________ Total Rs_________ Total Rs__________
Net Take Home Salary Rs_________ Net Take Home Salary Rs__________
ii) For Professional and Self- Applicant 1 Applicant 2
Employed applicant
Gross Annual Income : Rs__________. Rs__________
(To enclose latest Income Tax Assessment Order/Return filed)
8. Particulars of a/c maintained with :
this branch or any other branch
of this Bank or any other bank
9. Purpose of Loan :
10. Amount of Loan applied for : Rs__________
11.Two persons who can be referred : to for information (Please give names and addresses)
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I/We undertake to repay the loan in __________ nos. monthly installments of such amount to be fixed by you, commencing one month after the disbursement.
I/We also undertake to abide by the terms and conditions laid down by the Bank in respect of the loan, if sanctioned, and agree to the Bank recalling the entire loan in the event of coming across any incorrect statement on my part.
I/We also enclose herewith the following papers/documents for your perusal and doing the needful.
A Letter of Authority addressed by me/us to my/our employer/employers authorizing them to deduct such sum beginning from such month as may be stipulated by the Bank from my/our monthly salary and remit the same to you for deposit to my/our loan account till full liquidation of the same together with interest and other charges and also authorizing them to pay the outstanding loan, if any, out of my terminal benefits in case of my/our death, retirement, resignation or discontinuance of the service and also an undertaking from my/our employer/employers confirming the same.
Copy of my/our photo-identity card(s) issued by Election Commission / PAN Card from IT authorities.
Pay slip issued by my/our employer/employers for last two months / copy of Income Tax Return filed with the Income Tax authorities for the last two years.
Copy of Form 16 in respect of financial year ended ______________ for tax deducted at source from
income chargeable under the head “Salaries”.
Employer’s certificate about my/our name(s), address(es), designation(s) and the period(s) of completed service.
Proof of my/our professional qualification, particulars of profession and period of engagement in such profession.
Copy of my/our bank pass book(s) with your bank for last 3 months.
I/We hereby declare that -
The statements given above are true and correct.
No part of the loan will be utilized for any purpose other than that stated.
Yours faithfully,
Date: Signature of applicant 1:
Place:
Signature of applicant 2:
Witness Signature
Full Name
Address
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