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Odisha Gramya Bank

………………………….Branch OGB MORTGAGE LOAN Passport Size Photo

APPLICATION FORM of the Applicant

I/We here by apply for a Term Loan/Cash Credit of Rs……………….(Rupees………………

……………………only, which may kindly be sanctioned. I/We furnish the details as under.

Applicant’s Name:
Co-Applicant’s Name / 1. 
2. 
Particulars of the Applicant
Permanent Account Number
Voter ID Number
Driving License Number
Aadhar No (UID)
Date of Birth
Mobile/Land line phone(with STD code)
Email
Correspondence Address: / Permanent Address:
PIN / PIN
Educational Qualification
Tick √ in the appropriate box / Matriculate / Graduate / Diploma
10+2 / Post Graduate / Others
Occupation
Tick √ in the appropriate box / Salaried / Self-Employed / Business
Sales/Commissioned Agent / Land Lord
Others (Please Specify)
Employer/Business
Industry Type
Company/Business Address
PIN
Position
Tick √ in the appropriate box / Director / Proffesional / Sr. Management
Supervisor / Clerical / MiddleManagement
Executive / Sales / Others
Job Title / Length of Service / Years / Months
Income Details
I confirm that my Gross Monthly Income over the last 12 months is______The sources of this income are: (Tick √ in the appropriate box)
Fixed Monthly income (excluding any contributions made to my CPF account by my employer)
Variable Income (Such as commissions, bonus or allowance from employer)
Rental Income
Others (Please specify)______
[ Please provide the relevant supporting documents]
Financial Details
I confirm that the below is the list of all outstanding credit facilities I have currently, including any credit facility applied for over the last 6 months and pending approval.
Sl No / Type of Facilty / Financial Institution / Loan Amount
Outstanding/
Credit Limit (Rs.) / EMI/ Installment / Applicable
Interest Rates(p.a.) / Loan Tenure
1
2
3
4
5
Please provide complete and accurate details along with relevant supporting documents (Bank statements, etc). Incomplete/Inaccurate information may lead to delay in processing your application.
Particulars of the Co-Applicant
Permanent Account Number
Voter ID Number
Driving License Number
Aadhar No (UID)
Date of Birth
Mobile/Land line phone(with STD code)
Email
Correspondence Address: / Permanent Address:
PIN / PIN
Educational Qualification
Tick √ in the appropriate box / Matriculate / Graduate / Diploma
10+2 / Post Graduate / Others
Occupation
Tick √ in the appropriate box / Salaried / Self-Employed / Business
Sales/Commissioned Agent / Land Lord
Others (Please Specify)
Employer/Business
Industry Type
Company/Business Address
PIN
Position
Tick √ in the appropriate box / Director / Proffesional / Sr. Management
Supervisor / Clerical / MiddleManagement
Executive / Sales / Others
Job Title / Length of Service / Years / Months
Income Details
I confirm that my Gross Monthly Income over the last 12 months is______The sources of this income are: (Tick √ in the appropriate box)
Fixed Monthly income (excluding any contributions made to my CPF account by my employer)
Variable Income (Such as commissions, bonus or allowance from employer)
Rental Income
Others (Please specify)______
[ Please provide the relevant supporting documents]
Financial Details
I confirm that the below is the list of all outstanding credit facilities I have currently, including any credit facility applied for over the last 6 months and pending approval.
Sl No / Type of Facilty / Financial Institution / Loan Amount
Outstanding/
Credit Limit (Rs.) / EMI/ Installment / Applicable
Interest Rates(p.a.) / Loan Tenure
1
2
3
4
5
Please provide complete and accurate details along with relevant supporting documents (Bank statements, etc). Incomplete/Inaccurate information may lead to delay in processing your application.
Details of Property to be mortgaged Amt in Rs. Lacs
Mouza / Khata / Plot / Area / Declared Owner / FSV
Type of property
Tick √ in the appropriate box / Residential Plot / Industrial Plot
Commercial Plot / Residential Flat
Commercial Complex / Row House/Bunglow/Villa
Date of Valuation
Name of valuer (should be empanelled valuer of OGB):
Declaration & Authorization (Important: Please Read before signing)
·  I/We understand that the Bank may require a deposit account to be opened or an existing account nominated, to be used as the repayment account for all administrative charge, monthly instalments, and payment of arrears, fire insurance premiums, annual review charges, valuation fees, legal costs and all other charges imposed by the Bank. I/We acknowledge that I/we have read and understood fully all the Bank’s prevailing Standard Terms and Conditions governing accounts and the terms contained in this application form and agree to be bound by them in connection with the deposit account(s) that may be opened hereunder as well as any and all account(s) designated as deposit account(s) by the Bank that may at this date already be opened by me/us and/or that may hereafter be opened by me/us with the Bank.
·  I/We consent to the Bank disclosing all the information contained in this loan application form, the letter of offer and all my/our bank account(s) details to the insurance company that the Bank specifies in order to enable such insurance company to process my/our application for the mortgage insurance.
Signature of the Applicant Signature of the Co-Applicant
Place Place:
Date: Date: