DBH

INDIVIDUAL LOAN APPLICATION FORM Tick (() against the appropriate box. Please write or type in BLOCK LETTERSPersonal anD employment detailsParticularsApplicantCo-applicant

Full NameKAZI MOHD. ABU SUFIANTABINDA HASAN KHAN

Fathers NameCOMMANDER (RETD.) KAZI ABU KASHEM, (S), BNM. OBAIDULLAH KHAN

Mothers NameSALEHA AKHTER CHOWDHURYHASINA KHAN

Husbands Name

If applicableN/AKAZI MOHD. ABU SUFIAN

Current Residential EASTERN PARADISE, APARTMENT NO. 401, 35 SHEGUNBAGICHA, DHAKAEASTERN PARADISE, APARTMENT NO. 401, 35 SHEGUNBAGICHA, DHAKA

address

Is the residence( RENTED ( Own ( Employers

Post Code. 10001000

Tel No.9354095

Date of Birth01/07/1977 AGE: 34 YRS.7 MONTHS 04/ 08/ 1984 AGE: 27 YRS. 6 MONTHS

Sex( MALE ( Female( MALE ( Female

Marital Status( Single ( MARRIED ( Other( Single ( MARRIED ( Other

No. of DependantsCHILDREN: 01 Others: CHILDREN: 01 Others:

Occupation( EMPLOYED ( Self employed( EMPLOYED ( Self employed

Qualification MASTERS OF BUSINESS ADMINISTRATION (MBA), MAJOR IN MARKETING IN 2006 FROM CITY UNIVERSITY CGPA 3.50 OUT OF 4.00 SCALE. MASTERS OF ARTS IN ORGANIZATIONAL MANAGEMENT IN 2005 FROM UNIVERSITY OF CENTRAL CALIFORNIA (BANGLADESH CAMPUS), CGPA: 3.25 ON 4.00 SCALE. POST GRADUATE DIPLOMA IN HUMAN RESOURCE MANAGEMENT IN 2004, UNDER INSTITUTE OF PERSONAL MANAGEMENT, BANGLADESH AND OBTAINED 1ST CLASS. AIRCRAFT MAINTENANCE ENGINEERING (ICAO TYPE II STANDARD THREE YEARS COURSE) IN 1999 FROM AIR TECHNICAL TRAINING INSTITUTE OF KOLKATA, INDIA. ELECTRICAL AND ELECTRONIC ENGINEERING (EEE) IN 2007 FROM AHSANULLAH UNIVERSITY OF SCIENCE AND TECHNOLOGY (AUST), DHAKA AND EARNED CGPA 3.35 OUT OF 4.00 SCALE.

DesignationCHIEF EXECUTIVE OFFICERFREELANCE ELECTRICAL CONSULTANT, PREVIOUSLY WORKED FOR ACI LOGISTICS & SMA ENGINEERING COMPANY

Office Name

& AddressSUPER STAR PROPERTIES LIMITED, UCEP CHEYNE TOWER (3RD FLOOR), 35 SHEGUNBAGICHA, RAMNA, DHAKAN/A

Post Code: 1000Post Code: N/A

Tel No.8391721-22N/A

Mobile No. & E-mail0175552207001819283848

No of Years in Present

Occupation04 MONTHS Retirement Age: N/A Yrs.

Retirement Date N/A / Yrs. Retirement Age: Yrs.

Retirement Date / /

DepartmentSSPL Employee No. 1142 N/A Employee No. N/A

Tax Identification Number 074-107-4711/SALARY CIRCLE - 6, TAXES ZONE - 3, DHAKA183-108-7316/ CIRCLE 60, TAX ZONE 6, DHAKA

Monthly Income (prime source)TK. 2,92,000/ Pay Date: FIRST WEEK OF EVERY MONTH TK. N/A Pay Date: N/A

Rental IncomeTk. NILTk. NIL

Other IncomeTk. NIL Source: NILTk. NIL Source: NIL

Total IncomeTK. 2,92,000/ Tk. NIL

Expense Rent: TK. 20,000/ Others: TK. 42,000/ Rent: Tk. NIL Others: Tk. NIL

LOAN APPLIED FORAmount: Tk. 35,00,000/Purpose: ( Construction ( Flat ( Extension ( Improvement ( Plot ( Others

Term: 15 Yrs.Monthly instalment you can pay to DBH:Tk. 50,000/

PROPERTY COST AND FINANCE DETAILS

Estimated Funds RequiredSources of Funds Required

Total Purchase Price orAmount Already Spent Tk.10,08,000/

Estimated Construction Cost Tk.48,08,000/Source: OWN

Registration CostLoan Requested from DBH Tk. 38,00,000/

Other Cost, if anyTk.4,00,000/Sources of Balance Amount

(please specify)SALE PERMISSIONSavings from Bank Tk.4,00,000/

COST, REGISTRATION COST Disposal of Investment Tk. 10,08,000/

Personal Borrowings Tk.________________

Loan from Provident Fund/EmployerTk.________________

Others (please specify) _________Tk.________________

Tk.

Total Funds Required Tk. 52,08,000/Total Planned FundsTk. 52,08,000/

Note:1. Total Planned Funds should at least equal Total Funds Required

2. Detailed sources of funds required are important to help us process your loan application

FOR OFFICE USE ONLY

AFFIX PHOTOAFFIX PHOTODATE OF RECEIPT _________________

OF APPLICANTOF CO-APPLICANTFILE NUMBER _________________

WITH SIGNATUREWITH SIGNATUREAPPLICATION FEES Tk. _________________

INITIAL _________________

Financial details

Details of savings and assets Particulars ApplicantCo-applicant

Savings in BankTK 2,00,000/TK 30,000/

Immovable Property (please specify)

N/A

Other Assets such as Insurance Policy (with maturity date), Saving Certificate, FDR, Wage Earners Bond, Share etc.1. JIBAN BIMA CORPORATION, 2. SUNLIFE INSURANCE COMPANY LTD. EXIM BANK DPS A/C. NO. 00712100187178

Details OF BORROWINGS and liabilities (Please give details on all your present outstanding and proposed loans)ApplicantCo-applicant

Sources of

LoanOutstanding Amount (Tk.)Monthly

Instalment (Tk.)Balance Term

(Months)Outstanding Amount (Tk.)Monthly Instalment (Tk.)Balance Term

(Months)

Employer

Bank4,73,127/27,830.75/17NilNilNil

Provident Fund

Car Loan

Others

BANK ACCOUNT DETAILS

Name of the Account HolderName of BankBranchType of AccountAccount No.

1. Kazi Mohd. Abu SufianPrime Bank LimitedDilkushaSavings1082160026265

2. Kazi Mohd. Abu SufianHSBC Ltd.GulshanSavings003192085001

PROPERTY DETAILS (TO BE PURCHASED/CONSTRUCTED/EXTENDED OR IMPROVED)For Flat/Plot Purchase For Own Construction/Extension

Developers Name HASAN AND ASSOCIATES LIMITED (HAL)Land Size ______ Sft; Value of Land Tk. ___________

Project Name: UDAYAN ROKTOKOROBIBuilt-up Area ______ Sft. No. of Units_________

Built-up Area: 1152 S.ft & 1 Car Parking Unit; Purchase Price Tk. 48,08,000/Address: Please mention complete postal address of the property UNIT ID # AT PLOT # J/4/9, BLOCK # J, SECTION # 3, MIRPUR, DHAKA POST CODE: 1216Cost of Construction Tk. ___________________________

Address: Please mention complete postal address of the property ___________________________________________________ ___________________________________________________

Post Code:

Expected Possession By 10/10/ 2012Present Stage of Construction: FINISHING WORK IS GOING ON

Do you propose to rent the dwelling unit? ( YES ( No If Yes then monthly rent expected Tk. 20,000/

Is the legal title to the property clear? ( YES ( NoWill DBH be able to obtain first mortgage on the property? ( YES ( No

GENERAL INFORMATION (APPLICABLE TO ALL THE APPLICANTS)

Have you or your spouse applied earlier to DBH for a loan? ( Yes ( NOHow did you get to know DBH?. Please select the mode of repayment convenient to you:

( Post dated cheques((post dated cheques from)

If yes, File/Loan A/c No. ______________( Radio( TV Bank HSBC

Amount and term __________________( Newspaper( Magazine Branch GULSHAN

Have you or your spouse given guarantee(s) for any borrower(s) ? ( Yes ( NO( Builder

( Relatives( Friends

( Mail Account No. 003-192085-001( Deduction from salary by employer (

If yes, File/Loan A/c No.___________( Others (please specify):( Any other (please specify)_________________

Name of borrowers

What other security will you be able to

provide? (please specify name and value)

ReFEREnces (names and addresses of two referees who are not related to you)

(DBH may make such inquiries from referees as it deems necessary)

Name 1) 2)

Occupation & Designation

Address

Tel:Off: Res:Tel:Off: Res:

DECLARATION: I/We declare that all the particulars and information given in the application form are true, correct and complete and that they shall form the basis of any loan DBH may decide to grant me/us. I/We confirm that I/we have read the brochure and understood the contents. I/We further confirm that I/we have had no insolvency proceedings against me/us nor I/we been adjudicated insolvent. I/We am/are aware that the Equated Monthly Instalment (EMI) comprising principal and interest is calculated on the basis of annual rests. I/We agree that DBH may take up such references and make such inquiries in respect of this application, as it may deem necessary. I/We undertake to inform DBH regarding any change in my/our occupation/employment and to provide any further information that you may require. I/We further agree that my/our loan shall be governed by rules of DBH which may be in force from time to time.

_________________

___________________

Applicants Signature

Co-applicants Signature

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