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Third GenderMale Female Others

Hindu Muslim Christian Sikh

Jain Parsi Others

Hindu Muslim Christian Sikh

Jain Parsi Others

Maiden Name

StateCountryState

Years in Same city Years in Same city

Years at Present Address

StateCountryState

Years at Present Address

Years at Present Address Years at Present Address

APPLICATION FORMTWO WHEELER LOAN

T I T L E F I R S T N A M E

M S

Passport No/Voter ID No/Pan No/Driving License

Driving License / Passport Expiry Date

Indian Others Indian Others

Third GenderMale Female Others

Others Others

T I T L E F I R S T N A M E

M S

T I T L E F I R S T N A M E T I T L E F I R S T N A M E

T I T L E F I R S T N A M E T I T L E F I R S T N A M E

L A S TM I D D L E N A M E L A S TM I D D L E N A M E

L A S TM I D D L E N A M E L A S TM I D D L E N A M E

Father’s Name

CKYC Number (if any)

GSTIN DETAILS

Person with Disability Yes No Yes No

Address registered for GSTIN Same as residence /communication address

Same as Permanent address Others (Use GST Annexure)

Residence / Communication address

Exemption Valid Till (if Yes)

Special Economic Zone Code (if Y)

GSTIN Registration Date

Same as residence /communication address

Same as Permanent address Others (Use GST Annexure)

Exemption Valid Till (if Yes)

Special Economic Zone Code (if Y)

Aadhaar Number

Date of Birth (DD/MM/YY)

Gender

Mother’s Name

E-mail Address

Phone Details

Nearest Landmark (Present Address)

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Signature of Applicant : Signature of Co-Applicant :

Name of Organization Name of Organization

Bank Name

EMI (Rs)

Loan Tenure (Months)

Designation Designation

Designation

Nature of Profession, if Self Employed

Professional

Nature of Business (if self employed)

Proprietorship Govt/PSU

Partnership Partnership

Proprietorship Govt/PSU

Employment Nature / Occupation Type

Service: Private Sector Public Sector Government Sector

Other ____

Others: Professional Self Employed

Retired Housewife Student

Occupation

Service: Private Sector Public Sector Other ____Government Sector

Others: Professional Self Employed

Retired Housewife Student

Service Provider Other ________________ Service Provider Other ________________

Public Company LLP If other:(please Specify)

Whether registered under GST (If yes, following details are mandatory) GST Exemption Exemption Reason(If Yes) Y N Y N3.

4. *GSTIN DETAILS

5.

*GST Registration * (Please fill GST Annexure for multiple GST Registration) Single Multiple

Y N

GSTIN ( Default)

Address registered for GSTIN Same as residence /communication address Same as Permanent address Others (Use GST Annexure)

Exemption Valid Till (if Yes)

GSTIN Registration Date

Special Economic Zone Code (if Y)*Special Economic Zone

Email ID:

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Farm Credit & Allied activities Farm Credit

PRIORITY SECTOR CATEGORY / MSME DETAILS

Upto Rs. 10 lakh (Micro) Above Rs. 10 lakh upto Rs. 2 crore ( Small)

Above 2 crore upto 5 crore (Medium)

Upto Rs. 25 lakh ( Micro) Above Rs. 25 lakh upto Rs. 5 crore ( Small)

Above 5 crore upto 10 crore ( Medium)

Upto 2.5 Acres Between 2.5 to 5 Acres

Above 5 Acres (1Acre - 0.40 Hectare)

Declaration:

I/We hereby declare / confirm that the vehicle purchased / to be purchased by me /us shall be used for: Purchase of Business Farm Credit and Allied Activities and/or assist the transport of agricultural input and farm products

I/We are aware that is on the faith of this representation, declaration and confirmation that you have agreed to consider my loan application for financial assistance under category of Priority sector Advances.

I/We shall indemnify the bank to make the loss good in event of any loss damage that may arise on account of false/incorrect declaration by me/us.

PIN Landmark

APPLICANT REFERENCE DETAILS (TO BE FILLED BY THE APPLICANT) One reference has to be non-relative / non colleague

Additional details required for NRI Applicant

Country Name: ____________________________________________ Country code:_______________________________________________

If applicant resident for tax purposes in Jurisdiction outside India: Yes No

Jurisdiction of residence: _____________________________________________________________________________________________________

Tax Identification Number or equivalent (If issued by jurisdiction):_____________________________________________________________________

Country of Birth: ____________________________ City/Place of Birth:_______________________________________________________________

If address in jurisdiction where application is resident is same as Current/ Permanent/ Overseas or Correspondence/ Local address details: Yes No

Address in Jurisdiction: ___________________City / Town / Village:_________________________State:________________________________________

Country: ZIP/Post Code:__________________________________

ISO 3166 Country Code

Landmark

Tel.

Tel.

Fax:

Fax:

Agriculture Export (Please Select)

(Please Select)

Existing Vehicle Details

6.

7.

8.

9.

10.

11.

(b)

Aadhaar Number*

Aadhaar Number*

*Note - Where the client is non-individual, Aadhaar numbers issued to person holding an attorney to transact on its behalf is required to be submitted.

Name of the reference

Phone (STD/ISD/Tel Off.)

Email ID (if any)

Yes No

I am a director of Axis Bank or we are a firm in which any director of Axis Bank is interested as a partner/manager/employee/ guarantor or we are a company in which any of the directors of Axis Bank is interested as a managing agent, manager, employee or as a guarantor or holds substantial interest.

I am a director of any other bank or we are a firm in which any director of other bank is interested as partner/ guarantor or we are a company in which any of the directors of other bank holds substantial interest or is interested as a director or as a guarantor.

I/we am/are a relative of director of Axis Bank/other bank/senior officer of Axis Bank or we are a firm (Partnership / Hindu Undivided Family) in which any relative of director of Axis Bank / other Bank is interested as a partner/ guarantor or we are a company in which any relative of the director of Axis Bank / Other Bank hold substantial interest or is interested as a director or guarantor.

If yes, mention the details below.

Relationship of the applicant Yes No

If yes, mention the name of other bank

Customer declaration in respect of relationship with Director/ Senior Officer of the Bank/any other bank

In the event that the Applicant / Co-applicant are related to any of Director of Axis Bank/ Director of other bank/ Senior officer(s) of Axis Bank:

I/We declare(s) that the I/we am/are related to the director(s) and / or Senior Officer(s) of Axis Bank or of any other bank as specified hereto*:

If the above declaration is found to be false then the Bank will be entitled to revoke and/or recall the credit facility.

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*including directors of Scheduled Co-operative Banks, directors of subsidiaries/trustees of mutual funds/venture capital fun

I/We hereby confirm that I/we am/are in favour of receiving communication/ information / loan document/ other collaterals from bank pertaining to the loan account via email/ net banking from time to time.

Enrollment under Max Life Group Credit Life Secure Plan Yes No

Please note: Axis Bank has tied-up with Max Life Insurance Company Ltd. for “Max Life Group Credit Life Secure” policy that offers protection to 2W Loan customers of Axis Bank against loan liability in case of an eventuality. Coverage is voluntary for all eligible members of the scheme and by signing this Application you agree to enroll yourself within the Group Policy. Coverage is not active while this application is under process. Insurance cover shall commence only on issuance of Certificate of Insurance by Max Life.Declaration: I/We authorize Max Life to appropriately adjust the amount of sum insured and/or coverage tenure depending upon the final premium amount remitted to Max Life by the Master Policyholder. I understand that the final coverage terms will be as per COI issued by Max Life. I hereby authorize Max Life Insurance Company Limited (“Max Life”) to pay the outstanding loan balance as provided in the Credit Account Statement (to be provided by the Master Policyholder) to Axis Bank Limited ("Master Policyholder"), in respect of the loan availed of by me from the Master Policyholder (the application number of which is mentioned herein), by deducting the same from the claim proceeds payable to [my nominee/beneficiary] under this group policy on the happening of the insured event. "I further give my consent to and authorized Max Life to pay other processed, if any, in favour of Master Policy Holder."

Nominee/Beneficiary Details:

Name of Beneficiary:

Relationship:

Date of Birth:

Gender:

In case beneficiary is minor:

Name of Appointee:

Relationship with Beneficiary:

DOB of Appointee:

Gender of Appointee:

Third GenderMale Female Others

Third GenderMale Female Others

* Axis Bank Limited may request for additional documents other than requested above in connection with the Two-wheeler Loan application

Two-Wheeler Loan Documents Submitted

Pls. tick () boxes where appropriate and write N.A if not applicable

GENERAL Proforma Invoice

INDIVIDUAL BORROWER

Salaried Self - Employed

Office / Business Proof NA

Application Form

Application form with photograph duly signed by all applicant

Identity & Address Proof

Income Proof

Bank Statement

Age Proof

Sign Verification Proof

Employment / Business

Continuity Proof

NON INDIVIDUAL BORROWER

Partnership Firm / Trust / Society

Application form with photograph duly signed by all applicant :

Identity Proof

Address Proof

Income Proof

Bank Statement

Employment / Business

Continuity Proof

Additional Documents

Latest Salary Slip & Latest Form 16

Latest 3 Months Bank Statement

Audited Balance Sheet P&L Account & ITR for latest 2 years Others (Pls. specify) ____________________

Telephone Bill Electricity Bill Utility Bill Shop & Establishment Act Certificate SSI or MSME Certificate Sales Tax or VAT Certificate

Current A/c Statement Registered Lease with utility bill

PAN Cards Authority letter by all partners & Board

Resolution for Trust / Society

Shop & Establishment Act Certificate SSI or MSME Registration Certificate Sales Tax or VAT Certificate

Current A/c Statement Others (Pls. specify) ________________________

Latest 3 Months Bank Statement

Others (Pls. specify) ________________________

Copy of Partnership Deed Trust Deed Society Deed

Passport PAN Card Banker's Verification

Others (Pls. specify) ______________________Passport Driving License PAN Card Birth Certificate

Shop & Establishment Act Certificate SSI or MSME Registration Certificate Sales Tax or VAT Certificate Current A/c Statement

Private Limited / Limited Companies

Copy of Latest MOA/AOA

Others (Pls. specify) ________________________

List of Directors & Shareholding Pattern PAN Card

Certificate of Commencement of Business for Ltd. Co.

Certificate of Incorporation

Latest ITR

SSI or MSME Registration Certificate Sales Tax or VAT Certificate Telephone Bill Electricity Bill Shop & Establishment Act Certificate

Passport Voter's ID

Yes No

Yes No

Driving License PAN Card (only as ID Proof) Aadhar Card Others (Pls. specify) ______________

Documents required

Documents required

Current A/c Statement Regd. Lease with utility bill

Copy of appointment Letter Date of joining mentioned on salary slip or Form 16 ITR or Form 16 of completed 1 year WorkExperience Certificate Releiving Letter

Any Other document (please specify) Address Proof ______________________ ID Proof ______________________________

Others (Pls. specify) ______________________

Others (Pls. specify) _________________________________________

Others (Pls. specify) _________________________________________

Board Resolution

Others ____________

FOR BANK USE ONLY

Documents Received : Self-Certified True Copies NotaryIdentity Verification Done :

IN PERSON VERIFICATION CARRIED OUT BYEmp. Name :_______________________________________Emp. Code :_______________________________________Emp. Designation :_______________________________________Emp. Organisation & Code :_______________________________________ Emp. Branch :_______________________________________Place :_______________________________________D D M M Y Y Y Y

(Employee Signature)

9. My personal / KYC details may be shared with Central KYC Registry

10. I hereby consent to receiving information from Central KYC Registry through SMS/Email on the above registered number/email address

11. I/We further authorise the Bank to share my Aadhaar related details/information with regulatory / statutory bodies as and when required.

12. I/We authorize Axis Bank to verify and authenticate my/our Aadhaar number during processing my/our application for legitimate Business purposes.

13. I hereby declare that the details furnished above are true and correct to the best of my/our knowledge and belief and I undertake to inform you of any changes therein, immediately.

In case any of the above information is found to be false or untrue or misleading or misrepresenting, I/We am/are aware that I/we may be held liable for it

2. The bank may at its sole discretion sanction or decline the application. The bank shall convey, the reasons, which in its opinion after due consideration, have led to rejection of the application.

3. The bank will decide and assign the loan limit and no commitment has been given to me/ us for the same.

4. The DSA/ DST has not collected any commission/ brokerage or ant other fee by way of cash or cheque other than the cheque no. _____________ towards _______________in favour of Axis Bank Ltd.

5. Prepayment options are available. The details of the prepayment charges are given below.

6. Prepayment clause _________________________________________________________

________________________________________________________________________________

7. Processing fees of Rs. _______________ will not be refunded in case of rejection/ withdrawal of the case.

8. Axis Bank Ltd. reserves the right to retain the photographs and documents submitted with this applications and will not return the same to the applicant.

Please sign across

the photograph

Please sign across

the photograph

Axis Bank will convey its decision (within 2 weeks for credit limit up to Rs. 5 lakh and within 3 weeks for credit limit above Rs. 5 lakh and up to Rs. 25 lakh for Micro & Small enterprises borrowers) and (within 30 working days for other borrowers) from the date of receipt of the application provided the application is complete in all respects and is submitted along with all the documents as per 'check list' provided in the application for loan and/or any additional documents as may be required by the bank for proper appraisal of the application. The computation of timelines shall starts from the day on which

1.

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Loan Variant / Type :

Loan Amount (Rs.): Tenor (Month):

Processing Fee (Rs.): Repayment Mode : SI NACH Mandate PDC

Documentation Charges - Rs. 1500/-

Location (Name of the ASC) :

0-12 months - 10% of outstanding

Part Payment charges: Not Allowed

*Goods and Services tax (GST) will be charged extra as per the applicable rates, on all the charges and fees (wherever GST is applicable)

*Part payment will be allowed twice in a loan calendar year and once in a loan calendar month.

*The minimum amount accepted for part payment will be equal to one EMI and maximum amount will be 25% of the balance principal in one year.

Dealer Cross Sell Direct Digital Insta Sanctions

AL _LNAUL_BRE AL_PREAPPROVED_BRE UC_LNUCL_BRE AU_CORP_BRE

Others ____________

Repayment Mode details :

For SI Cases: 03 undated EMI cheques & 01 undated cheque for entire loan amount to be provided

Channel Code :

Total on - road price

is EMIs in Advance, number of Advance of EMIs

Bank Bazaar Other ___________

Phone BankingSource Code ATM SMS Website Outbound Mobile App Email

Ex-show-room price

Registration cost

Motor Insurance

Octroi / other taxes, if any

Discount

Promotion Code

Net Banking CIBIL Others ________________

Axis Bank will convey its decision (within 2 weeks for credit limit up to Rs. 5 lakh and within 3 weeks for credit limit above Rs. 5 lakh and up to Rs. 25 lakh for Micro & Small enterprises borrowers) and (within 30 working days for other borrowers) from the date of receipt of the application provided the application is complete in all respects and is submitted along with all the documents as per 'check list' provided in the application for loan and/or any additional documents as may be required by the bank for proper appraisal of the application. The computation of timelines

TW_LAA

Balance Transfer

Credit Life Insurance (Rs)

R O

DME Code

DSA Code:

Team Leader Name

Referrer Name:

18604195555/18605005555 (Local charges applicable) OR contact us online at www.axisbank.com/support OR visit www.axisbank.com/loanappstatus

Dealer Sales Executive / Account Officer Name & Code:

For NACH Cases: 01 EMI Cheque for 1st EMI banking, 03 undated EMI cheques , 01 undated cheque for entire loan amount & 01 cancelled cheque along with 2 NACH

Mandate to be provided.

Note:

1 undated cheque with full loan amount “Not exceeding Amount <<Sanction Loan Amount>> to be written on cheque.

3 Undated Security cheques equivalent to EMI amount. Amount to be filled in words & figures.

Cheques to be drawn in favor of Axis Bank Ltd Loan A/C <<Customer Name>>

On backside of all cheques customer’s Loan account number to be mentioned

All cheques to be A/c Payee only.

2500

PDD Collection charges - Rs 500/-

Penal Interest

>12 months - 5% of outstanding

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