Application Form for Loan / Over Draft Against Gold

cum Account Opening

Bank Use only (* Fields are Mandatory) Application No.: IND

Existing Customer ID: Channel Details:

Account No.:

RM Name: RM / CSE / RO / CBE (Code):

Branch: *Segment Code SOL Code: Date: D D M M Y Y Y Y

Type of Facility: Term Loan EMI Bullet Payment Overdraft (Cheque book available ONLY for overdraft facility)

Personal Details
*Name: Mr. Mrs. Ms. Dr. Prof. *Date of Birth: D D M M Y Y Y Y
Maximum
32 characters
(First Name) (Middle Name) (Last Name)

Maximum 19
*Gender: Male Female Third Gender Cards: Debit Card ATM Card Short Name:
characters.
This name
Other
*Marital Status: Single Married *Nationality: Indian (please specify)
would appear
on the card.

Category: General OBC SC ST Others

If PAN number
*Permanent Account Number (PAN): Form 60 Form 61 is not available
please fill in
Form 60 or
Aadhaar Number: *Mother’s Maiden Name: Form 61 (incase
of agricultural
Current Residential Address: income and if
one enters into
any transaction
specified in
Income Tax
City: Pin: Rule 114B)

Landmark: Current
Residential
State: Country: Address will be
by default
Communication
Telephone: *Preferred Mobile No.:
(with STD Code) Address

Preferred Email ID:

Permanent Address: Same as Current Residential Address

City: Pin:

Landmark:

Telephone:
State: (with STD Code)

Office Address: Name

City: Pin:

Landmark:

State: Telephone:
(with STD Code)

Extn.: Fax:
(with STD Code)

Applicant’s Profile

*Occupation: Salaried Self Employed Agri / Allied Retired / Pensioner House Wife

Please affix
Gross Annual Income / Less than 50K 50K - < 1.5 Lakhs 1.5 Lakhs - < 3 Lakhs 3 Lakhs - < 5 Lakhs a recent
Family Annual Income (`):
photograph
5 Lakhs - < 10 Lakhs 10 Lakhs - < 50 Lakhs 50 Lakhs and above

Sign across the photo

Existing Credit Facility: House Loan Vehicle Loan Consumer Loan Education Loan

Business Loan Credit Card Annual Repayment thereof (`): ____________________

286-Ver 1.0-Jan 2014 1

 Co-applicant / Second Applicant
*Name: Mr. Mrs. Ms. Dr. Prof. *Date of Birth: D D M M Y Y Y Y
Maximum
32 characters

(First Name) (Middle Name) (Last Name)

Maximum 19
characters.
*Gender: Male Female Third Gender Cards: Debit Card ATM Card Short Name: This name
would appear
Other on the card.
Marital Status: Single Married *Nationality: Indian (please specify)

If PAN number
Category: General OBC SC ST Others
is not available
please fill in
*Permanent Account Number (PAN): Form 60 Form 61 Form 60 or
Form 61 (incase
of agricultural
Aadhaar Number: income and if
one enters into
Current Residential Address: Same as 1st Applicant any transaction
specified in
rule 114B)

Current
Residential
Address will be
by default
City: Pin: Communication
Address
Landmark:

Telephone:
State: (with STD Code)

Co-applicant / Second Applicant’s Profile

*Occupation: Salaried Self Employed Agri / Allied Retired / Pensioner House Wife

Gross Annual Income / Less than 50K 50K - < 1.5 Lakhs 1.5 Lakhs - < 3 Lakhs 3 Lakhs - < 5 Lakhs
Please affix
Family Annual Income (`):
5 Lakhs - < 10 Lakhs 10 Lakhs - < 50 Lakhs 50 Lakhs and above
a recent
photograph
Existing Credit Facility: House Loan Vehicle Loan Consumer Loan Education Loan

Sign across the photo

Business Loan Credit Card Annual Repayment thereof (`): ____________________

Aadhaar Number: Non-Individual

Purpose of Loan / Overdraft

Agriculture Agriculture Allied

Land Holding: Less than 5 acres More than 5 acres

Business Expansion Name of the Firm:

Others
Segment: Manufacturing Trading Service (please specify)

Nature of Business:

Original Investment Amount in Plant & Machinery / Equipment `:

Repay Loans to
Name of Lender Rate of Interest of Loan % p.a.
Informal Sector

Education Institution Name

Course Name Management Medical Engineering Architecture Law

Personal Home Renovation Medical Expense Travel Expense Others

Loan / Overdraft Details

Amount (`): (In words)

Prepayment / Part
Tenure years Processing Fee % %
payment charges

Base Rate: % Spread: Rate of Interest (% p.a.)

Mode of Disbursal: A/c. Credit A/c. No. DD Cash

RTGS / NEFT IFSC: A/c. No.

Name of Account Holder:

Bank Name:

Type of Account: Savings Account Current Account

2
 Services
SMS Banking & Alert Facility:
Alerts facility enables you to receive alerts on your Email ID and / or Mobile regarding large debit, large credits, SI failure, balance below AQB and balance update. New alerts may be added from
time to time.

I / we don’t wish to receive any Bank related promotional calls, SMS alerts or emails. Please fill a
separate Mobile
Banking
DCB – On The Go (Mobile Banking) Email Account Statement Internet Banking Utility Bills Registration
Form for
Joint Account
Phone Banking Preferred Language Options: English Hindi Marathi Gujarati Tamil Telugu Holder

Investment: Life Insurance Mutual Fund Wealth Management General Insurance

Passbook Cheque book for Current Account / Savings Account Cheque book for “OD”
Account Statement: Frequency of statement would be as per the product feature.

Nominee Details for Loan / Over Draft against Gold + Current & Savings Account
I / we _________________________________________________________ Name(s) and address(es) nominate the following person to whom in the event of my / our
death the amount in the account may be returned by the Bank:

Nominee Name: Relationship, if any

Please ensure
that the
Address of Nominee: Age: years nominee is not
a minor

In case you have specified a nominee above, please indicate if you wish to make mention of the nominee name on the passbook,
Yes No
statement & DCA issued in respect of your account and / or the passbook issued to you.

I/We do hereby declare that what is stated above is true to the best of my/our knowledge and belief.
Thumb
impression is
required to be
attested by
2 witnesses.
In case of
signature, no
witness is
Witness(es): Signature(s) / Thumb Impression(s) of Applicant required.

Name : Name :

Signature : Signature :

Address : Address :

Place : Place :

Date : Date :

Form 60 / 61 (to be filled by those who do not have either PAN or GIR) In case of Agriculture Income, please fill up form 61 separately.

Form 60 Form 61 [See provision to clause (a) of rule 114C(1)]

Form of declaration to be filed by a person who has agricultural income and is not in
1. Full name and address of the Declarant: receipt of any other income chargeable to income-tax in respect of transactions
specified in clauses (a) to (h) of rule 114B.
2. Particulars of transaction:
1. Full name and address of the Declarant:
3. Amount of the transaction: 2. Particulars of transaction:
4. Are you assessed to tax: Yes No 3. Details of documents being produced in support of address in column (1):

5. If Yes, Yes No
a) Details of Ward / Circle / Range where the last return of income was filed:
I, hereby
declare that my source of income is from agriculture and I am not required to
b) Reason for not having PAN / GIR No.: pay income-tax on any other income if any.

6. Details of the document being produced in support of address in column (1): Date :

Place : Signature of the Declarant

Verification Verification

I, hereby declare that what I, hereby declare that what

is stated above is true to the best of my knowledge and belief. Verified today, is stated above is true to the best of my knowledge and belief. Verified today,

the day of 20 the day of 20

Date: Date:

Place: Signature of the Declarant Place: Signature of the Declarant

3
 Demand Promissory Note
` Date D D M M Y Y Y Y
On demand I / we (jointly and severally) unconditionally promise to

pay DCB Bank Limited (“DCB Bank”) or its assigns or order the sum of Rupees

together with compounding interest on such sum from this date at the rate of DCB Bank Base Rate Plus %, i.e.

percent per annum or such other rates which DCB Bank may specify from time to time with monthly rests, for value received.
Presentment for payment and noting and protest of this note are hereby unconditionally and irrevocably waived.
Paste revenue
stamp and
sign across

Signature of the Applicant(s)

Demand Promissory Note Delivery Letter

To,
The Branch Manager Date D D M M Y Y Y Y
DCB Bank Limited
Branch

Dear Sir,
Please take delivery of the accompanying Demand Promissory Note dated for ` made by me / us

in favour of DCB Bank Limited (“DCB Bank”).

I / We further request DCB Bank to note that I / we dispense with a notice of dishonour in terms of Section 98 (a) of the Negotiable Instruments Act, 1881 and that in the
event of payment not being made on demand, DCB Bank is at liberty to give time for payment to me/us without discharging me/us from liability.

Date: D D M M Y Y Y Y
Place:
Applicant 1 Applicant 2

Standing Instructions:
I / We hereby authorize the Bank to recover my / our dues on the due date or any other bank charges by debiting my / our account number

_________________________________ at your ____________________________ branch.

____________________________________ ____________________________________
Signature and Code of the Bank Signature of the Applicant(s)
Official verifying the signature

Customer Information & Due Diligence (CIDD) Form

Information Details
Countries where business associates located
(for Businessmen, only)

Source of Funds for Credits in the Account Savings Salary Business Proceeds Sale of Property

Investments Inheritance Professional fee

Other (please specify)

Wire Transfers Expected Into the Account Yes No Value `

From the Account Yes No Value `

Foreign Inward Remittances Expected Yes No Approximate Value `

For Bank Use Only

Any of the Signatories / Beneficial Owners of the entity a Political /
Yes No if yes, please give position
Public Figure or related to a Political / Public Figure
Does it seem that the initial Deposit and/or the declared transaction profile is in line with the status/occupation declared? Yes No

_______________________________________________________________
Signed in my presence
Name & Signatures of the Officer along with Signature Code Number
4
 Declaration cum Terms & Conditions – Loan / Overdraft against Gold + Current & Saving Account
I / we hereby agree to abide by the following terms and conditions :- to time, without prejudice to the right to declare an Event of Default under Clause Bank under law. The Bank reserves the right to retain the photographs and
1. All particulars / information given in the application form are true and complete 12 herein and/or to right to sell the Gold Security and any other security documents submitted with this application form and will not return the same to
and no material information has been suppressed / withheld. I / we acknowledge furnished by me/us and/or exercise any other right or remedies available with the applicant(s).
that DCB Bank Limited shall have no liability for any consequences arising out of the Bank hereunder or under law, I / we shall, within 7 (seven) days of a notice 16. All disputes arising out of and / or relating to this including any collateral
any erroneous details provided by me/us. I / we authorize the Bank to carry out from the Bank in this regard, at the Bank's sole discretion, deposit with the Bank, document shall be subject to the exclusive jurisdiction of the Courts / Tribunals
such credit checks and at such time, as it may deem necessary. The Bank may such additional security, as may be required. in Mumbai only.
sanction this Loan / Overdraft at its sole discretion. 10. I / we hereby represent(s) and warrant(s) that: (a) I / we declare that I / we am/are 17. I / we understand that the sanction of this Loan / Overdraft is at the discretion of
2. I/We am/are the owner / joint-owners and am/are in possession of the gold citizen(s) of India; (b) I / we confirm(s) that my / our title to the gold jewellery / the Bank and upon my/our executing necessary security and other formalities as
jewellery / ornaments offered as security ("Gold Security") over which I/We shall/ ornaments deposited / to be deposited by me / us as security is not defective / required by the Bank. I / we authorise the Bank to conduct such credit checks as
consent to create a first and exclusive charge by way of pledge in favour of the challenged by any person in any manner nor is it spurious or of inferior quality as it considers necessary in its sole discretion and also authorise the Bank to
Bank by depositing the same with the Bank to be kept with the Bank during the it has been acquired by me/us from genuine sources, is my / our bonafide release such or any other information in its records for the purpose of credit of
tenor and/or till the payment of all the outstanding amounts / dues of the Loan / property and no other person has any claim, lien or charge against it; (c) I / we appraisal / sharing or for any other purpose. I/ We further authorise the Bank to
Overdraft. I/We agree that the Bank shall be entitled to open such sealed packet confirm(s) that the value of the Gold Security as determined by the assayer and make any enquiries with any other finance company / bank / registered credit
and conduct investigation in connection with the quality of Gold Security at set out in the valuation report is acceptable and final and binding on me/us; (d) I / bureau regarding my/our credit history with them and also authorise the Bank to
my/our cost at any time without notice and even in my/our absence. we shall utilize the Loan / Overdraft solely for the purpose stated in the provide details of my/our credit history to any other bank / finance company /
3. The valuation of the Gold Security shall be done by an independent assayer application form and will not be used for any speculative or anti-social purpose; registered credit bureau.
appointed by the Bank and the Loan / Overdraft amount shall be determined by (e) I / we shall perform and is / are bound by all the covenants / conditions set out 18. The Bank shall have the right to make disclosure of information relating to me/us
the Bank on the basis of the value of the Gold Security as set out in the valuation herein, in the sanction letter and any further conditions as may be prescribed by to any Credit Bureau and/or any other governmental / regulatory / statutory or
report supplied by the assayer. Such value shall be governed by the Gold Rate the Bank from time to time. In the event of any defect in the title/ownership to the private agency as required under law from time to time. I / we hereby authorise
published by the Bank from time to time. jewellery / ornaments, I/we shall indemnify the Bank of all loss, damage, harms, and give consent to the Bank to disclose, without notice to me/us, information
costs and consequences arising out of such defects. furnished by me/us in application form(s) / related documents executed / to be
4. Upon maturity, I/we shall either repay the Loan / Overdraft alongwith interest,
and such other dues as are payable by me/us to the Bank ("Dues") or I/we may, 11. The Bank may, without assigning any reason and upon written notice mailed or executed in relation to the Loan / Overdraft availed from the Bank, to the Bank's
at any time, request a renewal / enhancement of the Loan / Overdraft which the delivered to me / us restrict/cancel in full or in part the Loan / Overdraft and other branches / Subsidiaries / affiliates / Credit Bureau / Rating Agencies,
Bank may grant us at its sole and absolute discretion, subject to the continuation demand repayment thereof. Upon such notice, the Dues shall become forthwith Service Providers, banks / financial institution, governmental / regulatory
of the pledge over the Gold Security in favour of the Bank and provision of such due and payable by me / us to the Bank and I/we undertake to clear the dues authorities or third parties for KYC information verification, credit risk analysis, or
other security and in such form as the Bank may require and such variations in immediately on such demand. for other related purposes that the Bank may deem fit.
the lending norms, Terms & Conditions, rate of interest as the Bank may 12. The following events shall constitute events of default hereunder ("Events of 19. I / we confirm having received, read and understood the terms and conditions
prescribe as per its policies prevailing at the time of such renewal/enhancement, Default"), upon the occurrence of which the Dues shall become immediately due applicable to this Loan / Overdraft against Gold and accept hereby without
subject to payment of a fee as the Bank may prescribe. and payable by me / us to the Bank and further enable the Bank to enforce the notice the terms and conditions unconditionally and agree that this terms and
5. The interest payable on the Loan / Overdraft shall be charged on actual / Gold Security and any other security furnished hereunder and sell the same: (a) conditions may be changed by the Bank at any time and will be bound by
reducing basis computed on the basis of a year of three hundred and sixty-five Failure on my/our part to perform any of my / our obligations hereunder or under amended terms and conditions.
days. Subject to prevailing policy of the Bank with regard to (a) the Loan / the sanction letter or if any circumstance or event occurs which adversely 20. The Loan / Overdraft will carry interest at the rate specified in the Demand
Overdraft amount applied by me/us and sanctioned to me/us; and / or (b) loan- affects my / our capacity to repay the Loan / Overdraft or any part thereof or Promissory Note executed by me/us. The interest rate for the Loan / Overdraft is
to-value, I/we may be required by the Bank to pay the interest amount on perform any of my / our obligations; (b) If any of the representations or linked to the Bank's Base rate and can be revised from time to time at the Bank's
monthly basis. statements or particulars made by me / us in the application form or herein are discretion. I/we shall be deemed to have notice of changes in the Bank’s Base
6. I / we agree that the Loan / Overdraft may be prepaid, in whole or in part, by found to be false, misleading or incorrect; (c) If the Loan / Overdraft is not repaid Rate and consequently to changes in applicable rate of interest if such changes
me/us in accordance to the provisions, terms and conditions of the Bank on the date of maturity; (d) In the event of non-servicing of interest by me / us on are displayed on the notice board of the Bank’s branch or published on the
prevailing at the time of such pre-payment, including without limitation the the due date; (e) Upon detection of any systemic fraud in relation to the quality of website of the Bank (www.dcbbank.com) and I/we are liable to pay interest at
payment of prepayment or part payment charges as the case may be, as the gold by the Bank; (f) If the value of the Gold Security falls lower than the such revised rate from its effective date.
stipulated by the Bank, which prepayment and/or part payment charges may be required margin of the Bank as applicable from time to time, due to change in
21. The address for all communication shall be the one furnished in this application
applied and collected by the Bank either at the time of maturity or closure or market price (whether actual or reasonably anticipated) or any other reason or if
form, if not intimated to the Bank regarding any subsequent change of address
renewal, whichever is earlier. Without prejudice to any other rights that the Bank there is any deterioration or impairment of any security or any part thereof, which
in writing and under acknowledgement from the Bank.
may have under the law, in case of non-payment of any dues, I / we shall be liable causes the security in the judgment of the Bank to become unsatisfactory in
to pay additional interest/default interest at such rate as may be prescribed by character or value; (g) If it is discovered that there is any collusion between the 22. In the event of loss of pledged gold jewellery / ornaments by the Bank, the
assayer and me/us resulting in a fraudulent and erroneous valuation of the Gold liability of the Bank is limited to replacing the value of the lost gold jewellery /
the Bank on the entire Loan / Overdraft plus the interest due on that date. ornaments as disclosed in the appraiser's certificate.
Security or in case the Bank has a reasonable suspicion in this regard; (h) If any
7. I / we shall bear, pay and reimburse all costs, charges and expenses, relating to
attachment, distress, execution or other process against me / us or any of the 23. I / we understand and acknowledge that the Bank shall have the absolute
administration charges, interest tax, service tax, duties (including stamp duty), discretion, without assigning any reasons (unless required by applicable law), to
security / Gold Security is enforced or levied upon; (i) In the event of my/our
sales tax / VAT and taxes (of any description as may be levied from time to time reject my/our application and that the Bank shall not be responsible / liable in
death, insolvency, failure in business, commission of an act of bankruptcy of
by the Government or other authority) and all other costs and expense any manner whatsoever to me/us for such rejection, or any delay in notifying
either of us; (j) An attempt by me / us, without prior written consent of the Bank,
whatsoever in connection with (a) application for and grant and repayment of me/us of such rejection and any costs, losses, damage expenses, other
to create any charge, lien, mortgage or any other encumbrance over any of the
Loan / Overdraft; (b) recovery and realization of the Loan / Overdraft together consequences, caused by reason of such rejection or any delay notifying me/us
security / Gold Security; (k) Failure on my/our part to repay the Dues immediately
with interest; (c) enforcement of Gold Security and/or any other security of such rejection, of my/our application.
when demanded by the Bank.
furnished by me/us; (d) clearance of arrears of all taxes and any other charges
and levies of the Government in respect of Gold Security and any other security 13. Upon the occurrence of an Event of Default, the Bank shall be entitled to sell the 24. I / we understand and acknowledge that the Bank retains the right to mortgage,
furnished by me/us and insuring the Gold Security and any other security Gold Security and/or any other security furnished by me/us in the open market assign, securitize, sell or dispose of the Loans / Overdraft to any bank, financial
furnished by me/us. Also, legal costs on actual basis and other charges and after giving me / us a notice of 7 (seven) days which I / we agree is a reasonable institutions or other agencies. Moreover, it has the right to transfer the receivable
expenses which may be incurred in preparation of any documents related period for the purposes of Section 176 of the Indian Contract, 1872. The to any Special Purpose Vehicle (SPV).
and/or incidental to the Loan / Overdraft, as also for the enforcement or proceeds so realized from the sale of the Gold Security and/or any other security 25. I / we confirm that no insolvency proceedings or suits for recovery of
attempted enforcement of the Gold Security and/or any other security created. furnished by me/us shall be utilized towards the repayment of Dues under the outstanding dues or monies whatsoever or for attachment of my/our assets or
Loan / Overdraft. In the event that the proceeds so realized are insufficient to properties and/or any criminal proceedings have been initiated and/or are
8. I / we hereby authorise the Bank to carry out the RTGS / NEFT transaction as per
meet the amount of Dues, the Bank may take such other and further actions as it pending against me/us and that I/we have never been adjudicated insolvent by
details mentioned in the application form. I / we understand that RTGS / NEFT
may deem necessary to realize the balance amount from me/us. In case of more any court or other authority. I / we also hereby declare that I/we have no
request is subject to the RBI regulations and guidelines governing the same. I /
than one borrower/applicant, we agree that our liability shall be joint and several. borrowings from any other agency, etc. on the date of application other than
we further acknowledge that the Bank accepts no liability for any consequences
arising out of erroneous details provided by me/us. 14. I/We agree that the Bank may elect to send notices / communications either by those mentioned herein above.
9. The Gold Security and any other security furnished by me/us to the Bank will be writing by post / courier / hand-delivery or through any electronic mode and shall 26. I / We hereby authorize the Bank to recover my / our dues on the due date or any
released only upon payment in full of the Dues by me/us to the Bank. The Bank be deemed to have been sent. other bank charges by debiting any of my / our account at your DCB branch.
has the right to retain / apportion the Gold Security and any other security 15. The Bank shall have the right to stipulate any other and further terms and 27. The borrower(s) agree that for the purpose of renewal, in case the Bank decides
furnished by me/us against any other dues outstanding to the Bank arising out of conditions that it may deem fit at any time prior to or after the grant of the Loan / to open a new loan account the Bank reserves the right to close exiting loan
any other facility extended by the Bank to me/us. In case the value of Gold Overdraft, which shall be binding on me/us. All rights of the Bank stipulated account by transferring the outstanding to the new loan account or in existing
Security falls lower than the required margin of the Bank as applicable from time herein shall be in addition to the rights, powers and remedies available to the loan account.

¨ I / we consent / ¨ do not consent to receive information / services etc. for Marketing purposes through Telephone / Mobile / SMS / Emails by the Bank / its agent. I / we confirm that, I / we have read and understood the Declaration, and that all the details
provided on the application form are true and correct. I / we agree and acknowledge that only direct telephone numbers (not board / general telephone numbers of offices / corporates / employers) will be accepted for registration of “Do Not Call”. I / we authorise
the Bank to disclose, from time to time any information relating to my / our Loan / Overdraft Against Gold Jewellery to any regulatory/ Government/ legal authority parent, affiliate, and associates of the Bank, and to third parties engaged by the Bank, for purpose
such as marketing of services.
In the event of Loan / Overdraft becoming Non-Performing Asset (NPA) for any reason, either due to non-servicing of interest or otherwise, or occurrence of any Events of Default, the Bank reserves the right, without any intimation to me/us, to reduce the
unavailed Loan / Overdraft limit and also to disallow any further debit transactions in the Loan / Overdraft account despite the outstanding dues in the Loan / Overdraft account have not crossed the sanctioned Loan / Overdraft account limit. The Bank would not
be liable and responsible for any damages / inconvenience caused to me/us arising out of such action taken by the Bank.

Signature of the Applicant 1 Signature of the Applicant 2

Bank Use Only

Bank Official Name:

Signature of the Branch Official

DCB 24-Hour Customer Care

Call Toll Free: 1800 209 5363
Email: customercare@dcbbank.com
Web: www.dcbbank.com

5
 For Office Use Only
To be filled by Branch
I recommend for sanction of loan/overdraft to the applicant(s) against pledge of gold ornaments as mentioned in the
appraiser's certificate / valuation report on the following terms and conditions:
Date D D M M Y Y Y Y

Type of Facility c Term Loan - EMI Bullet Payment

c Overdraft
Facility of ` _________________________ /- (Rupees in words _______________________________________________________________________)
Being lowest of:
a) amount of loan applied for ` ________________
b) _________% of the appraiser's valuation of the pledged gold ` ________________, ie ` ________________ (lowest valuation, if valued by two valuers)

Rate of Interest DCB Bank Base Rate plus __________________________ ie. __________________%
Rebates if any _______________________________________ (please attach approvals from relevant authority)

Repayment c Term Loan - on Demand /repayable in _______________ EMI

c Overdraft - On Demand / Expiry of Limit

Security GOLD ornaments total weight ____________________ gms, value ` _________________________

Processing Fees c Yes

Collected c N.A.

ISA documents c Yes

obtained c N.A.

CIBIL / Dedupe / c Yes, No adverse comments

Field Verification c N.A.
(if applicable) done

PDC details c PDCs for ` __________________________ /- obtained

c _________________ blank PDCs obtained

PSL c Yes Category _____________________________________________________________________

categorisation c N.A

Weaker section c Yes Category _____________________________________________________________________

categorisation c N.A

Recommended by Approved by

Bank official Branch Manager

Date and Time: Date and Time:

Approval from appropriate authority has been obtained for any rebate in interest rates, or applicable charges or LTV or tenor, or if the loan / overdraft facility is over and above
the powers of Branch manager (If Yes, please attach confirmation)
c Yes, description of rebate ____________________________________________________________________________________
c N.A

The Loan / Overdraft amount has been disbursed and its details are as specified below:
Account Details Account Number ______________________________ Customer Code ____________________________________
Sanction Limit ` _____________________________
Amount ` _____________________________
Disbursed
Loan / Limit c SB/CA/OD account number:_____________________________________ in the name of _____________________________________________
Credited to: c Issue a Pay order / DD in the name of ______________________________________ payable at ________________________

To be filled by Branch / NPC

Disbursed by _________________________________________________________ Signature _____________________________________ Code No. ________________________

Verified by ___________________________________________________________ Signature _____________________________________ Code No. _________________________

Acknowledgement Application No.: IND

Date: D D M M Y Y Y Y Account Number:

Name:

Processing Fee (`): Rate of Interest:

Total Assessed Value (`): Name of Branch Official Name of the Appraiser

Signature of the Signature of the Signature and

Applicant(s) Branch official Seal of Appraiser

DCB Bank Limited 6

 Risk Classification * Kindly fill the following details:

Expected Annual Turnover (`): Less than ` 1 Lakh Upto ` 1 Lakh Upto ` 10 Lakhs Upto ` 50 Lakhs

Upto ` 1 Crore Upto ` 5 Crores Upto ` 10 Crores Upto ` 25 Crores More than ` 25 Crores

Expected number of transactions in a month: Up to 20 21 to 50 More than 50

Basis of Categorisation: Politically Exposed Person Domiciled in Risk Country Trust Sleeping Partner

High Risk Profession Others (Please specify):

Information: Politically Exposed Person due to position / status as:

If Domiciled in Risk Country - Country Name:

Nature of Business / Occupation:

*Details of Customer’s Source of Funds & Estimated Net Worth:

Income from Employment Income from Business Income from Investments Inherited Funds

Others (Please specify):

Risk Classification of Account (L / M / H):

Declaration for Signing in Vernacular Language

I _____________________________________________________________________, son / daughter / wife of ___________________________________________ adult and

inhabitant ______________________________ of residing at____________________________________________________________________________________________
__________________________________________________________________________________________________, do hereby state and declare as solemn affirmation

as under :

I have been read out and explained in the language known to me, the contents of the loan documents and all other documents incidental to availing the loan from
___________ DCB Bank by me / by Mr. / Ms. __________________________________________________________ and I signed the said documents after having
understood them and by signing the same I / he / she / they do hereby agree to abide by all the terms and conditions of the Loan and the clauses of the same.

I declare that whatever I have stated hereinabove is true and correct to the best of my knowledge and belief.

Solemnly affirmed at ____________________________, on this ___________ day of May_____________

Signed

x x
________________________________ ________________________________
Name: _____________________________________ Signature of Applicant/co-Applicant
Relation of Applicant: ________________________ Signing in vernacular Language

Date: __________________

Place: _________________

7
 Loan / Over Draft Disbursal Checklist for Loan / Over Draft against Gold (To be filled by BOM / Branch Head)
Yes/No/ Remarks of
S. No. Particulars Please tick (Y)
NA BOM / BH
1 Current Fortnight Gold Rate
2 Existing Gold Loan Exposure of this customer
3 Total Gold Loan Exposure (incl the current disbursal)
4 Application form - Dully filled in
- Sign by all borrowers at all places
- Has valuer signed on annexure 1 of the app form
- DPN (Demand Promissory Note) duly stamped and executed
- Application cum agreement duly stamped (e-franked) as per local state laws
5 Photo duly affixed
6 KYC Documents available (OSV done) ID SV Address
- Please tick (Y)
7 Sourcing codes properly captured: GL Officer DCB Bank Br. Fullerton RM
- Please tick (Y)
8 If the processing fee recovered?
- By way of separate cheque / Demand Draft / Pay Order
- By way of debit to operative account
9 Has the PF cheque cleared
10 Is the PF posted to Gold Loan Processing Fee Account
11 Is the customer interaction / assessment sheet filled in after duly organised customer interview
12 Based on the customer interaction and available facts, is the customer profiling done Existing NTB PSL
- Please tick (Y)
13 Is the criteria of existing customer checked? 1. Existing CASA relationship for 6 months (3 months in case
of a excel / privilege customer) 2. Asset relationship for 12 months with no delq. 3. No AQB debits /
penalties in last 6 / 3 months. 4. Has telephone at residence / office
14 If the CIBIL done for loans > 10 lakhs
15 Is the valuation done (1 if Loan <= 7.5 lakhs, else 2) Valn 1 Valn 2
- Please tick (Y)
- Is the Machine calibrated?
- Is the valuation done as per format
- Is on the letter head / contains rubber stamp
- Done by empanelled valuer / their authorized representative, duly signed
- Gross wt, Net wt, Karat, Fine wt mentioned
- DCB Bank provided rate applied?
- Original report in file, one copy inside packet and one copy given to customer
16 Pledge and Custody process
- Is the latest transparent packet used for storage
- Is a copy of valuation kept inside packet
- Is the packet signed by borrower and 2 custodians
- Packets are held in dual custody
- All details duly entered in the Gold loan register and signed by both custodians
17 Loan Amount sanctioned <= 5 lakhs <=7.5 lakhs <=15 lakhs <=20 lakhs
- Please tick (Y)
18 Approved by (not less than) Branch Head RH/NSM/Product Hd Retail Assets Hd Retail Banking
- Please tick (Y)
19 Approval for negative Profile taken by
20 Deviation, If any LTV ROI PF
- Please tick (Y)
21 Deviation approved by RH/NSM/Product Hd Retail Assets Hd Retail Banking
- Please tick (Y)
22 Repayment by way of SI PDC
- Please tick (Y)
23 SPDCs taken
24 System checks done post disbursal vis-à-vis underlying docs and app form
- Correct scheme code chosen? OD412 for an overdraft product LN533 for an EMI based
Term Loan LN555 for a bullet payment term loan
- Name of applicant correctly mentioned
- Loan amount correctly booked
- Tenor of Loan correctly mentioned
- Repayment mode checked - SI properly linked
- ROI correctly mentioned INTTM Table correctly updated with
Base Rate ______ (base rate) + ______ (base rate-interest rate)
- PF correctly recovered / deducted
- PF deposited in right account
- Collateral details as per valn
- SRM setting done as per Fine Gold weight
- Sourcing codes properly marked
- PSL codes properly captured
25 Pay Order issued to the customer
26 Following Documents sent to RAOU:
- Application form cum agreement
- KYC documents (ISA)
- Customer Interaction Sheet
- Copy of valuation report
- Security PDCs
- Bank Statement for 6 months (non DCB Bank a/c)
- CIBIL report (if the case is > 10 lacs or asked by sanctioning authority)
- CPV / Visit Report
- PSL documentation / declaration
- A/c opening form / CIDD
- Disbursal checklist
MAKER Name: CHECKER Name:
Designation: Designation:
Signed by: HRMS ID: Signed by: HRMS ID:
286-Ver 1.0 - June 2013 DCB Bank Limited M012 / Oct 15 / 2.4