INDIAN OVERSEAS BANK

To
The Manager
Indian Overseas Bank
……………….. Branch

Application for Sanjeevini Loan scheme
Amount of Loan……………………...

Personal Details Applicant Co-applicant Guarantor
Name
First Middle Last First Middle Last
First Middle Last
Name of father / husband
Residential address :
House number, Street name
Locality
City /Town
State and Pin code
Residence is Owned Rented
Official
Owned Rented
Official
Owned Rented
Official
Do you own a vehicle Two-wheeler Car Two-wheeler Car Two-wheeler Car
Permanent address:
House number, Street name
Locality
City /Town
State and Pin code
Phone Number (residence)
Phone Number (office)
Mobile Number
E-mail ID (personal)
E-mail ID (official)
Date of Birth Day Month Year Day Month Year
Day Month Year
Sex Male Female Male Female Male Female
Marital Status Married Unmarried Married Unmarried Married Unmarried
Number of dependents Children …… Others……. Children …… Others……. Children … Others…….
Income Tax PAN / GIR No.
Passport Number
Voters ID No.
Qualification
Graduate
Post Graduate
Graduate
Post Graduate
Graduate
Post Graduate
Occupation service
consultant
Service
consultant
Service
consultant

Affix
Passport size
photo
of co applicant
Affix
Passport size
photo
of applicant
Affix
Passport
size photo
of
Guarantor
If in service, designation
Name of the employer
Address of employer
Number of years in
employment/ profession
Total work experience
Income Details Income / month
(Applicant)
Income / month
(co-applicant)
Guarantor
Income from salary /
Occupation/profession
Net income as per salary
certificate/I.T return
Other income
Rent
Income of spouse
others - specify
……………….
Expenses:
Rent
Installment for other loans
Family maintenance expenses
Bank accounts Applicant Co-applicant Guarantor
Name of Bank, Branch
Savings / Current A/c Number
Term deposits Deposit amount Due on
1
2
Deposit amount Due on
Property owned Applicant Co-applicant Guarantor
Land and building
Location
Value
Any other property
……………….
……………….
Liabilities Applicant Co-applicant Guarantor
Loan against property
Any other borrowing
Other guarantees
For construction/repair/renovation of clinic/hospital
Details of property in which the activity is to take place
Location
Built in area / plinth area in the case of construction/renovation
In the case of old house, age of the building
Whether approval of appropriate authority obtained
Whether the property is free of encumbrance
Total cost of construction/repair
Less: Loan required
Margin: (how the margin is to be met)
Loan for purchase of vehicle/ambulance
Make and model of vehicle to be purchased
Name of the dealer
In case of used vehicle, year of manufacture and age
Cost of vehicle
Loan amount required
Repayment period required
Loan for purchase of equipment
Items to be purchased
………………………
………………………
………………………
Name of the dealer from whom purchased
Cost of the articles to be purchased
……………………..
……………………..
……………………..
Loan amount required
Repayment period required
Names of two references with address
1.
2.
Security offered
Nature and type of security
If Immovable property location of property / in case of other
security, the details thereof:
Value of the security
In whose name the security is held
Is the security fee of any encumbrance

Declaration
I/we hereby confirm having read the terms and conditions for the above scheme and agree to abide by the same. I/we confirm that the particulars given above are true and correct and I/we have not withheld any information that may be vital for sanction of the loan applied for by me/us. I/we confirm that the loan amount will be utilised for the purpose stated and not for any speculative or anti social purpose. I/we confirm that I/we have not been declared insolvent or any insolvency proceedings are initiated against me/us. I/we agree that the Bank may make any references and enquiries in respect of this loan application, as may be deemed necessary. I/we agree that sanction of the loan is at the sole discretion of the Bank and shall be governed by the rules of the Bank in force. I/we will execute necessary security documents as per Bank requirement before availing the loan. I/we also understand that the Bank has the right to recall the loan if they are not used for the stated purpose.
CIBIL Disclosure Requirement
I/we hereby agree and give consent for the disclosure by Indian Overseas Bank of all or any such information and data relating to me/us, the information and data relating to my/our obligation in any credit facility granted/to be granted, by the Bank and guaranteed to me/us as a guarantor and default if any, committed by me/us in discharge of my/our obligation, as the Bank may deem appropriate and necessary, to disclose and furnish to Credit Information Bureau (India) Ltd and any other agency authorised in this behalf by Reserve Bank of India.
I/we declare that the information and data furnished by me/us to Indian Overseas Bank are true and correct.
I/we undertake that the Credit Information Bureau (India) Ltd. and any other agency so authorised may use, process the said information and data disclosed by the Bank in any manner as deemed fit by them; and the Credit Information Bureau (India) Ltd and any other agency so authorised may furnish for consideration, the processed information and data or products thereof prepared by them, to banks/financial institutions and other credit grantors or registered uses as may be specified by the Reserve Bank of India in this behalf.
Signature of Applicant Signature of Co-applicant Signature of Guarantor
Date:
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For Office Use
Date of receipt of application: Date of sanction/rejection
Reason for rejection:
Whether all columns have been filled up: Whether all documentary proof submitted:
Processing charges:
Signature of Manager