LOAN APPLICATION FORM FOR BARODA ASHRAY
The Branch Manager,
Bank of Baroda,
_______________________
INSTRUCTIONS:
1. Please use BLOCK LETTERS
2. All details must be filled in. If not applicable, please write N.A.
3. Please put wherever applicable
4. Applicants should ensure this form is complete in all respects along with all relevant
documents
I / We request you to grant me/us a loan facility under Baroda Ashray scheme for
Rs.____________. To enable you to consider the proposal, I / We submit the following
particulars:
I. MAIN APPLICANT’S PARTICULARS
Name (Shri /Smt /Ms)
Name of Father/Husband
Date of Birth
Nationality
Gender
Female Male
Marital Status Married Unmarried
(include Single,
Divorced, Widowed)
Subject Property Address
Mailing Address, if different from Subject
Property Address
Years of Residence at Current Address
Contact Nos.
e-mail id, if any
(H) (M)
Name of Spouse
Date of Birth of Spouse
Alternative Contact Person
(Name, Address, Phone)
No. of Dependents
Recent
Photo of
Spouse
(wherever
applicable)
Recent Photo
of Main
Applicant
Voter ID No.
Income Tax PAN: Passport No. Driving License No.
Occupation Status Working Self-Employed
Retired Other
Office/Business Address with Contact Nos
Current Official Designation
No. of Years in Present Occupation
Gross Annual Income
II. CO-APPLICANT’S PARTICULARS
(Applicable only where spouse is co owner of the property)
Name (Shri /Smt /Ms )
Name of Father/Husband
Date of Birth
Nationality
Contact Nos.
e-mail id, if any
Home :
Mobile :
:
Voter ID No.
Income Tax PAN: Passport No. Driving License No.
Occupation Status Working Self-Employed
Retired Other
Office/Business Address with Contact Nos
Current Official Designation
No. of Years in Present Occupation
Gross Annual Income
III. FINANCIAL DETAILS
Outstanding Mortgage(s)
Please furnish details of all mortgages against the Residential Property to be mortgaged
under reverse mortgage. In the event of the loan application being approved, it will be
conditional that any existing mortgage must be redeemed in full. In case of more than
one mortgage outstanding please provide details under Section VIII (Additional
Information).
Lender’s Name & Address
Loan Reference Number
Outstanding Balance
Monthly Payment
Due date of repayment of existing
mortgage
Is/Was the mortgage in arrears
YES NO
If YES, please give details
Have you or your spouse ever
- had a Court Judgement or any other
Order for non-payment of a debt issued
against you
- incurred mortgage, rent or loan arrears
(including credit card)
- been refused a mortgage or credit
- been declared insolvent
- entered into any arrangement with
creditors or been party to a mortgage
where the property has been taken into
possession on either a voluntary or
enforced basis?
Main Applicant Co-
Applicant/Spouse
YES NO YES NO
If YES, please If YES, please
give details give details
Order of discharge by the Insolvency
Court, if applicable
Enclosed To follow
IV. DETAILS OF ALL LEGAL HEIRS
No. of legal Heirs Relationship with Applicant(s) Contact details
Name and Addresses of legal heirs
1.
2.
3.
V. REVERSE MORTGAGE LOAN REQUIREMENTS
Amount of Loan Required
Period of the Loan Disbursement
Loan Purpose
Interest Rate Option
Fixed Floating
Mode of Payment Monthly Quarterly Half-Yearly
Annual Line of Credit Lump-sum

Initial Lump sum required and
Periodic Cash required
Rs.__________________________
Rs.__________________________
Do you want to have the applicable
fees/charges that do not have to be paid
at the outset of this loan application
added to the Reverse Mortgage Loan?
YES NO
DETAILS OF BANK ACCOUNT
(To be nominated by the borrower(s) to receive the loan disbursement s)
Name of the Bank and Address
Bank Account Number
Name(s) of the Account Holders
VI. SUBJECT PROPERTY DETAILS
( against the security of which Reverse Mortgage Loan is sought to be availed)
Address of the property
Type of Property House Bungalow Flat
Other (Please specify_________________)
Is the property being used wholly for
residential purposes
If NO, please specify details
YES NO
______________________________________
Please indicate the Tenure of the
property
If ‘Leasehold’, please indicate
Remaining Term
Name of the Lessor
Permission of the Lessor for mortgage, if
required
Freehold Leasehold
_______________ years
_____________________________________
YES NO
Type of Construction Brick Mortar/Cement Stone
Timber frame
Other (Please specify _________________)
Age of the property in years
Name(s) of all the Registered Owners of
the Property
Mode of Acquisition of the property by
the Applicant(s)
Does the owner of the Property include
any person other than the borrower and
his/her spouse
Is the property adequately insured
against losses/damage caused by fire,
flood and such other risks, as is usual for
YES NO
residential property?
Please provide details.
_______________________________________
VII. TENANTS/OTHER OCCUPANTS
Is any part of the property let or tenanted? YES NO
Other Occupants
Please provide details of person(s) who is/are not a loan applicant(s) (besides the
spouse) but will be living in the property during the life of the Applicant/Spouse of the
Applicant.
Name(s) of other occupants Relationship with borrowers(s)
VIII. ADDITIONAL INFORMATION
IX. DECLARATION
I/We declare that all the particulars and information given in this loan application form
are true, correct and that they shall form the basis of any loan that Bank of Baroda may
decide to sanction to me/us.
I/We have no insolvency proceedings/legal proceedings against me/us nor have I/We
even been adjudicated insolvent.
I/We confirm that the said residential property which is used as my/our ‘permanent’
primary residence is self-acquired, self-occupied and not let out/tenanted and there is
no third party interest. I/We also accept that the property will not be let out or no third
party interest will be created without Bank of Baroda’s prior written consent.
I/We confirm that I/we do not have more than one surviving legal spouse.
I/We acknowledge that the loan requested pursuant to this application will be secured
by a mortgage of the property in such form and manner as may be required by the
Lender and I/We agree that the loan will not be used for any illegal or prohibited
purpose or use.
I/We agree that where a periodic loan disbursement has been requested such
disbursements will be credited to the bank account nominated by me/us in Section V.
I/We accept that the written consent of all the loan applicants will be required to change
the above nominated Bank Account.
I/ We agree that Bank of Baroda may take up such references and enquiries in respect of
this application, as it may deem necessary.
I/We undertake to inform Bank of Baroda regarding any change in my/our occupation/
employment.
I/We understand that I/We have read the brochure/ terms and conditions of the
Reverse Mortgage Loan Scheme of Bank of Baroda and understood the contents. I/We
hereby agree to be bound by these terms and conditions. I/We further agree that
my/our loan shall be governed by the rules of Bank of Baroda which may be in force
from time to time.
A draft of the loan agreement of Bank of Baroda to be executed by me/us has been
received and understood by me/us and I/We agree to execute the loan documents as
per the terms of sanction of the proposed loan. I/We also confirm to abide by the same.
By signing this application form, I/We agree that any person interested now or in the
future in the loan and the mortgage may rely upon the truth and accuracy of the
information contained in this application and any supporting documentation,
information or security.
Signature of Applicant Date Signature of Co-Applicant Date