To be filled if applicant is not employed currently

Name & Address of Previous Employer / Business :

City : State :

Designation :

Pin Code : Tel.: (O) :

No. of Years in Previous Employment / Business :

Name of the Spouse :

Is He / She an Earning Member ? If Yes, please provide Net Monthly Income Rs. :

Office Name & Address :

Spouse Details

Financial Details

Loan Servicing Details

Date of Birth : DD: MM: YYYY:

Tel. : (O) :

Salaried / Pensioners

Gross Monthly Salary : (Rs.)

Net Monthly Salary : (Rs.)

Pension : (Rs.)

Other Income (If any) : (Rs.)

Investment in Shares / Units / Bank Deposits / Others (Please specify) :

Total Investment in Value : (Rs.)

Self-employed

Gross Monthly Income : (Rs.)

Net Monthly Income : (Rs.)

Other Income (If any) : (Rs.)

Are you a Tax Payer? Yes No

Do you have any other Existing Loan(s) ?

Loan 1

Loan Type :

Name of Financier :

Monthly Instalment :

Loan Amount :

Current Outasanding :

Balance Months to go :

Date of Loan Availed :

Purpose of Loan :

Have any additional Loans(s) Servicing ? Yes No

Yes No (If yes, please provide the folowing details)

Loan Request

Loan Amount Requested : Rs.

Mode of receiving Processing Amount :

Upfront Processing Fees : (Rs.)

Drawn on :

By Cash in a bank

Cheque No. : Date of Receipt :

Loan Request Plan : Lumpsum Annuity Combination of Lumpsum and Annuity

If Lumpsum Plan : Amount Requested Rs.

If Annuity Plan : Whether Monthly Quaterly

If Combination of Lumpsum and Annuity Plan : Lumpsum amount Requested Rs.

/-

Half Yearly Annual

/- Balance in Monthly Annuity

Guarantor Details

(If Applicable)

Type of Guarantor :

Name of Guarantor :

Father's / Spouse's Name (in case of individual only) :

Residence Address :

Individual Corporate Relationship with Applicant :

Date of Birth : DD: MM: YYYY:

State :

Fax :

Office Address :

State :

Fax :

Mobile No.: Pager No.:

Pin Code :

City :

Tel. :

E-mail :

City :

(O) (R)

(O) (R)Tel. :Pin Code :

Designation :

In case Self-Employed, please provide the business commencement date : DD: MM: YYYY:

No. of Years in Current Employment / Business :

Gross Monthly Salary / Income : (Rs.)

Net Monthly Salary / Income : (Rs.)

Investment in

Total Investment in Value : (Rs.)

Shares Bonds / Units Bank Deposits NSC

Gross Annual Turnover : (Rs.)

Net Annual Income : (Rs.)

Others (Please specify) :

Are you a Tax Payer? Yes No

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

Fixed Deposits

Vehicle Loan

Assets Finance

Personal Loan

Home Loan

Business Loan

Security Document Details

Abour your references(One reference has to be non-relative / non-colleague)

Security Document :

Security Document :

Security Document :

Security Document :

Total Value of Securities given : Rs.

Ref. No.:

Ref. No.:

Ref. No.:

Ref. No.:

Date of Purchase :

Date of Purchase :

Date of Purchase :

Date of Purchase :

Reference 1

Name :

Relation with applicant :

Address :

Tel. (R) : (O) :

Pin Code :

Mobile :

E-mail :

Reference 2

Name :

Relation with applicant :

Address :

Tel. (R) : (O) :

Pin Code :

Mobile :

E-mail :