Consumer Finance

Application Form
Please fill in all the required details in BLOCK LETTER. Tick

Case ID
D

Date

* Mandatory Fields

boxes as applicable.

Sourcing Details
Case Referral Type*

WOW Plus

WOW

Dealer Code*

WOW Lite

WOW Extension

Normal

DDF

Dealer Name*

Executive Mobile No.*

Executive Name*

Promotion Case*

Yes

Credit Program Code*

No

Sourcing Surrogate Info 1*

Sourcing Surrogate Info 2*

Sourcing Surrogate Info 3*

(Please turnover for surrogate details)

Personal Details

Name*
Date of Birth*

F
D

I
M

R S
M

Marital Status*

Married

Identification Document

Credit Card

(Tick Any One)

T
Y

M
Y

Unmarried

Male

Gender*
Passport

Voter ID

PAN Card

Female
Driving License

Ration Card

Corresponding ID No.
Contact Details

Residence is*

Owned

Rented

Co. Provided

Parental

Bachelor Acco/ Sharing/ PG

Residence Address*
City*

Area/ Locality*

Pin Code*

Landmark*
State*

Mobile No.*
Residing Since*

Phone 2

Years

Months

Email ID
(Please provide your e-mail id in Block letters since the Loan Summary Letter would be mailed on the same)

Residence Address

Preferred Mailing Address*

Yes

Residence-cum Office*

Office Address

No

Employment/Business Details

Employment Type*

Self-Employed

Constitution of the Company*

Salaried

Proprietorship

Housewife

Partnership

Student

Pvt. Ltd.

Pensioner

Public Ltd.

MNC

Others

Name of the Company/ Business*

Designation

Department

Employee ID
Office/Business Address
City*

Area/Locality*
Landmark
State*

Pin Code

Office Phone

Extension No.
Product Details

Count of Products being financed*

Asset Category*
Consumer Durables
LCD / LED / Home Theatre
Washing Machine / Refrigerator / Oven
Lifestyle Products

Desktop / Laptop

AC

Furniture

Camera

If Others (Please specify)

Furniture
Luxury Watches

Home Improvement
Digital Lifestyle Products
Gross Tenor*

Applied Loan Amount *

<=67%

LTV *

Color TV

68-70%

71-75%

76-83%

Fitness Equipment
If Others (Please specify)
months
No. of Advance EMIs*
84-90%

months

>90%

Undertaking

I/We hereby apply for a Finance facility for the Consumer Durable & Lifestyle Products Loan mentioned in this application.
I/We declare that all the particulars and information and details given/filled in this Application Form are true, correct, complete and up-todate in all respects and that I/We have not withheld any information whatsoever.

DNC
Yes
Mobile No.

I, would like to know through telephonic calls, or SMS on my mobile number mentioned in the Application Form as well as in this
undertaking, or through any other communication mode, various BFL loan offer schemes or loan promotional schemes or any other
promotional schemes and hereby authorize M/s Bajaj Finance Limited, (BFL) it's employee, agent, associate to do so. I confirm that laws in
relation to the unsolicited communication referred in National Do Not Call Registry (the NDNC Registry) as laid down by TELECOM
REGULATORY AUTHORITY OF INDIA will not be applicable for such communication/calls/ SMSs received from BFL, its employees, agents
and/or associates.

No

Signature of the Applicant

www.bajajfinservlending.in

ACKNOWLEDGMENT
We acknowledge the receipt of your application for a loan from Bajaj Finance Ltd. Please furnish documents mentioned overleaf
for approval of your loan application. Please write to us at the given mail id for your queries and suggestions :
[email protected]

Applicant Name
Loan Amount Applied:

Sales Representative Mobile No.

Sales Representative Name

Processing Fee: Rs.
. Interest Rate :
% Annum. Bounce Charges: Rs 350/EMI/Loan. CASE ID
Late payment penalty will be charged 2% pm on an amount of EMI outstanding as on that date.
Date D
Please not each product will be treated as different loan. No foreclosure or pre payment charges
Processing time of loan will be upto 15 days
Note:

Bajaj Finance Limited

Credit at the sole discretion of Bajaj Finance Ltd.
This is a preprinted acknowledgement and does not require any signature. Corporate Office: 4th Floor, Bajaj Finserv Corporate Office, Off Pune-Ahmednagar Road, Viman Nagar, Pune 411 014, Maharashtra, INDIA
Registered Office: Mumbai - Pune Road, Akurdi, Pune - 411 035. Maharashtra, INDIA
Please quote the Case ID no. in future reference
Tel +91 20 3040 5060 Fax +91 20 3040 5020 www.bajajfinservlending.in

Help us know you better

Your Preferred Language

1)

What is your Net Monthly Income?

2)
< Rs. 15000

Rs. 15000 - 25000

Rs. 50001 - 75000

>Rs. 75000

Rs. 25001 - 50000

Microwave

Cooking Range

Electric Chimney

Laptop

Desktop

Vacuum Cleaner

Please tell us about your refridgerator

280 L or less

Greater than 280 L

Do not own

Please tell us about your TV

Normal TV

Normal-Flat TV

LCD/LED

Size of the TV

21 inch or less

Between 21 to 30 inch

30 inch or more

Please tell us about your washing machine

Semi Automatic

Fully Automatic

Do not own

Please tell us about your car

New Car

Used Car

Do not own

5-10 Lakhs

10 - 15 Lakhs

What is your gross monthly salary ?

Which of the following do you own?

Printer

Plasma

What is the no. of cars that you own?

Please tell us the price of your car

< 5 Lakhs

Month and Year of Purchase

M M

Y Y

Type of Internet Access at Home

Broadband

Dial Up

What type of Credit Card do you have

Platinum/Titanium

Gold

What type of Insurance do you have

>15 Lakhs

Silver

Motor

Life

Do not own

Wireless Data Card

Do not have

Others
Property

Medical

Plant & Machinery

Others
Have you travelled abroad in the last one year?

Do not own

Yes

No
DECLARATION

I/We hereby apply for a Finance facility for the Consumer Durable & Lifestyle Products Loan mentioned in this application.
I/We declare that all the particulars and information and details given/filled in this Application Form are true, correct, complete and up-to-date in all respects and are true to my/our
knowledge and that I/We have not withheld any information from Bajaj Finance Ltd. whatsoever.
I/We confirm that no insolvency proceedings or suits for recovery of outstanding dues or monies whatsoever or properties and/or any criminal proceedings have been initiated
and/or are impending against me/us and that I/we have never been adjudicated insolvent by any court or other authority. I/we have not taken any action and no other steps have
been taken or legal proceedings started by or against me/us in any court of law / other authorities for the appointment of a receiver, administrator, administrative receiver, trustee or
similar officer or for my/our assets.
I/ We declare that I/ We have not made any payment in cash, bearers cheques or of any other kind along with or in connection with this Application Form to the person collecting
my/our Application Form. I/ We shall not hold Bajaj Finance Ltd liable for any such payment made by us to the person collecting this Application Form.
I We authorize Bajaj Finance Ltd. and all its group companies and their agents to exchange, share or part with all the information and details relating to my/our existing loans and/or
repayment history to other Bajaj group companies, banks, financial institutions, credit bureaus, agencies, statutory bodies etc. as may be required or as they may deem fit and shall
not hold BFL (or any of its group companies or its/their agents/representatives) liable for use/sharing of this information.
I/We understand and acknowledge that Bajaj Finance Ltd shall have the absolute discretion, without assigning any reasons (unless required by applicable law), to reject my/our
application and that Bajaj Finance Ltd shall not be responsible/liable in any manner whatsoever to me for such rejection or any delay in notifying me/us of such rejection and any
costs, losses, damages or expenses, or other consequences, caused by reason of such rejection, or any delay in notifying me/us of such rejection, of my/our application.

Place
Date

D D

M M

Y
Signature of Applicant

Note: BFL shall be entitled at its sole and absolute discretion to reject / approve Application Form Submitted by the applicant/s.

Sourcing Surrogate Details (Only for Office Use)

Credit Program

Sourcing Surrogate Info 1

Credit Card

Credit Card Type

Credit Card No.

Designation

Total Work Experience (in years)

Net Monthly Salary

Make of Car

Model of Car

Car is New/ Used & Purchase Year

Name of Financier

Type of Loan

Loan Amount

With Passenger Car Ownership

Repayment Track Record (RTR) - BFL

None

None

Designation

Total Work Experience (in years)

Bank Account Type

Account Since (approximate number of years)

Salary Income Proof Program

Banking Surrogate
Individual With OD/ CC Account

OD/ CC Limit (in Rs.)

Own Property (House/ Business)

Instant
Debit Card

Sourcing Surrogate Info 3

Credit Card Issuer/ Bank

Employed in 2000 companies

Repayment Track Record (RTR) - External

Sourcing Surrogate Info 2

None
Net Monthly Salary

Limit Utilization (in %) (as told by customer)

Average Monthly Balance

Using the Account Since

House Type

House Owned by

Connection is Landline/ Postpaid

Monthly Average Bill Amount

Connection Since

Debit Card issuer/ Bank name

Debit Card type

Account since (age of account)

Type of Business

Office Premise is Owned/ Rented

Average Monthly Turnover

Self Employed - Self Traders

Supporting Documents Submitted

Bajaj Finance Limited

Corporate Office: 4th Floor, Bajaj Finserv Corporate Office, Off Pune-Ahmednagar Road, Viman Nagar, Pune 411 014, Maharashtra, INDIA
Registered Office: Mumbai - Pune Road, Akurdi, Pune - 411 035. Maharashtra, INDIA
Tel +91 20 3040 5060 Fax +91 20 3040 5020 www.bajajfinservlending.in

Documents Checklist
Photo Identity Proof*

Passport, PAN Card, Voters ID Card, Driving License, Photo Credit Card

Address Proof*

Ration Card, Driving License, Voter ID card, Passport, Sale Deed / Property purchase agreement (for owned properties)

Your application will be assessed quickly after receiving the required documents. Please quote the application number mentioned in this slip for any enquiries.
*Documents requirement might vary according to Credit Program chosen.
Consumer Durables
Minimum Loan Amount

Lifestyle Products
Minimum Loan Amount

Maximum Loan Amount

Maximum Loan Amount

0
0

Maximum Tenor

Months

Maximum Tenor

Months

For cheque swapping, bounce, penal and other charges please refer to www.bajajfinservlending.in