APPLICATION FORM

Contract No. 3904823014 POS Code 011260OGT SA Code OpenAPI_User Date 22/06/2019
APPLICANT DETAILS
Name MOHD RAGHIB KHAN Gender Male
Father's Name MOHD HANEEF AHMED Date of Birth 13/03/1992
Occupation Income Rs. 50,000.00 Economical Status Selfemployed

APPLICANT CONTACTS Mobile 9540525884 e-mail address clickadmedia@gmail.com

Secondary mobile

Current Address b 176 old seemapuri, floor 1, old seemapuri

near dilshad garden, seemapuri gol chakkar opposite mohan Dairy, New Delhi, Delhi, Delhi,
Permanent Address b 176 old seemapuri, floor 1, old seemapuri
near dilshad garden, seemapuri gol chakkar opposite mohan Dairy, New Delhi, Delhi, Delhi,

Document Type ID
Photo of Client
PAN Card (OVD) FQUPK8397D
Address Proof Document BANK_STATEMENT

I understand and confirm that the Application Form, photograph and all other documents submitted by me to HCIN shall not be returned to
me and HCIN shall have the right to retain the same. Further, I undertake to inform HCIN within 7 days of any change in any of the details
mentioned herein.
LOAN DISBURSAL DETAILS
I hereby submit the details of my bank account for the purpose of transferring Loan Amount in case the loan application is approved by HCIN.
Bank Account No. 918010011405925 Bank's Branch DILSHAD GARDEN Account Type SA
Bank Name AXIS BANK LTD Account Holder's Name MOHD RAGHIB KHAN
LOAN DETAILS
I declare that I have applied for the loan as per following details which is as per my requirements.
Loan Amount (Rs.) 50,000.00 Flat Interest Rate 29.26 % p.a. Term of the Loan 36 months
EMI (Rs.) 2,608.00 Monthly Customer Care Fee (Rs.) 0 Monthly Instalment (Rs.) 2,608.00
Processing Fee (Rs.) 0.00 Documentation Fee (Rs.) 0 Credit Assessment Fee (Rs.) 0
Number of Monthly Instalment 36 Payment frequency Monthly Date of 1st payment 22/07/2019
Due Date 22nd of every month Date of last payment 22/06/2022
CONSENT FOR AVAILING CONTACT OPTIONS
Yes, I would like to obtain the facility for applying and obtaining Loan from HCIN over the phone, e-mail, sms, HCIN's customer portal (i.e.
Contact Options) as per the terms and conditons of HCIN issued from time to time.

Mobile Number of the Applicant for Contact Option 9540525884

e-mail address of the Applicant for Contact Option clickadmedia@gmail.com

DECLARATION

1. I hereby confirm that I am a citizen of India and competent to submit this Application Form and all other documents for the purpose of availing loan,
and to undertake the obligations arising therform.

2. I confirm that all the particulars and information given by me, are true, correct and complete and no information has been withheld/suppressed. I
confirm that HCIN shall be entitled to reject my application without assigning any reason. The Applicant Form, photograph and all other documents
submitted by me to HCIN shall not be returned to me and HCIN shall have the right to retain the same. Further, I undertake to inform HCIN within 7 days
of any change in any of the details mentioned herein. The details submitted by me can be stored in data centers of HCIN till such time as required by
HCIN.

3. I have no insolvency proceedings against me nor have I ever been adjudicated insolvent. There is no suit for recovery of outstanding dues or monies
whatsoever and/or criminal proceedings have been initiated and/or pending against me, I have never defaulted in repayment of the loan applied for.

4. I will not use Loan amount for any gambling, lottery, or races, or for any purpose prohibited by RBI/ other regulatory body from time to time.

5. I have read and understood the Privacy Policy, Policy on Website Use as well as ‘General Terms and Conditions for obtaining Personal Loan and
POS Loan from Home Credit India Finance Private Limited' (GTC) for availing loan from HCIN. Further, I understand and confirm that all the aforesaid
details provided by me shall be used by HCIN for the purposes, and subject to the conditions, described in aforesaid Privacy Policy, Policy on Website
Use as well as GTC for availing loan from HCIN.

6. I understand that HCIN offers different interest rate to the different borrowers based on loan amount, tenor, down payment, payment history with
HCIN, credit score provided by credit information companies, borrower's age, income, type of documents provided by the borrower and any other
information as may be required for the purpose of credit evaluation. I understand that HCIN offers and charges different rate of interest to different
borrowers based on the aforesaid rationales and I agree to abide by such rationale.HCIN has confirmed that any changes in the rate of interest and fee/
charges shall take effect only prospectively. I further confirm that HCIN shall be entitled to categorise me under High, Low, Medium or any other risk
category based on the aforementioned factors and the loan performance.

I MOHD RAGHIB KHAN confirm that I have applied electronically for loan from HCIN on 22/06/2019