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Part Disbursement Request Form

This document is a subsequent disbursement request form for a home loan from a customer to their bank. The customer provides their loan account number, property address, contact details, and requests a disbursement amount. They authorize the bank to disburse funds either through demand drafts made out to specific payees and amounts, or through RTGS/NEFT/bank transfers providing the required transaction details. The customer declares that the information provided is true and correct and that they have submitted receipts for their contribution payments to the builder.

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ravi
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159 views

Part Disbursement Request Form

This document is a subsequent disbursement request form for a home loan from a customer to their bank. The customer provides their loan account number, property address, contact details, and requests a disbursement amount. They authorize the bank to disburse funds either through demand drafts made out to specific payees and amounts, or through RTGS/NEFT/bank transfers providing the required transaction details. The customer declares that the information provided is true and correct and that they have submitted receipts for their contribution payments to the builder.

Uploaded by

ravi
Copyright
© © All Rights Reserved
Available Formats
Download as PDF, TXT or read online on Scribd
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Subsequent Disbursement Request Form

(For Home Loan/LAP)

Date:
Place Loan A/c No.
Customer Name
Property address

City State PIN Code


Mobile Number Reg. Email ID

Disbursement Details
Builder demand/requirement (if self-constructed) `
I have submitted original builder demand letter/requirement letter (if self-constructed).
I/We hereby authorize bank to disburse an amount of ` as per below:

Details for disbursement through Demand Draft: (Mark as NA if not applicable)

Sr No. DD Favoring Amount (in `)


1
2
3
4 Internal - TATA AIG GENERAL INSURANCE CO. LTD (Property Insurance)
Total Amount

Details For disbursement through RTGS/NEFT/Transfer: (Mark as NA if not applicable)

Particulars Favoring Details 1 Favoring Details 2

RTGS/NEFT/Transfer

Beneficiary Name

Bank Name

Bank A/C No.

IFSC CODE - In capital letters

RA/Disb./App. Form/Feb. 2020/Ver - I


Disbursement Amount (in `)

*Information to Borrower:
• In every demand raised by the builder, customer will have to make payment towards his own contribution (e.g.- If the Property value is 10 Lakh ,
3 lakh is your contribution and Loan amount is 7 Lakh For every demand that builder raised for part of 7 lakh, customer will also pay part of 3 lakh).
• Customers also need to submit his/her contribution payment receipts along with disbursement request form.(Please ignore this if your own
contribution is paid upfront and receipts are already submitted)

Customer Declaration
• I/We hereby declare that the above particulars and information given in the form are true and correct. I have submitted original receipts of my
payment to builder/developer/ towards self-construction along with this request.

Yours Faithfully,

Signature Applicant / POA holder Signature Co-Applicant 1/POA holder Signature Co-Applicant 2/POA holder

For more details on Part Disbursement, visit Axis bank website for FAQ’s or Call us on 1860-419-5555/1860-500-5555 (local charg es apply)

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