172.16.21.

18 2022-10-20 21:11:14
R I B1 3 6 3 5 0 4 0 1

Please use CAPITAL LETTERS only Please Tick wherever Applicable All fields are mandatory

FOR BANK USE ONLY

✔
Application Type: New Update | KYC Number (Mandatory for KYC update request)
✔
Account Type: Normal Simplified (for low risk customers)
PERSONAL DETAILS

Title Mr. Mrs. Miss ✔ Others_________ ✔ APPLICANT CO-APPLICANT

Name A J I T A S H O K S A W A N T
Maiden Name
Father's Name
Mother's Name
Date of birth 0 1 1 1 1 9 9 1 Gender: ✔ Male Female Transgender | Religion:
Customer Category ✔ General SC ST OBC Other _________________| Marital Status: Married Single Others_____________
Residence Address 4 9 , N A V J I V A N S O C I E T Y , S K B H A Y E R D ,
N R F O R T W O R L I K O L I W A D A
City/Town/Village District
Nearest Landmark
State Code PIN 4 0 0 0 3 0 Tel ( R ) -
Residence is Self Owned Rented (Monthly rent _______________) Company provided Other __________________
Residence Type Bunglow(B) Row House(R ) Flat(F) Other(O) __________________
No. of years at above residence Yrs Months Tick, if Permanent Address is same as the Residence Address
Permanent Address

City/Town/Village District
Landmark State code PIN
Tel ( R ) - Location Category Rural Semi Urban Urban Metro
Additional Address
District
City/Town/Village State code PIN
Nearest Landmark Tel ( R ) -

Mobile No. 8 8 9 8 2 3 2 5 8 5 Email ID AJITSAWANT16@GMAIL.COM

Gross Income (per annum) PAN No. C X T P S 0 8 3 3 F
Citizenship ✔ IN-Indian Others(ISO 3166 Country Code) No. of Dependents
Residential Status ✔ Resident Individual Non-resident Individual Person of Indian Origin Foreign National

DETAILS OF FACILITY REQUIRED*

Credit Facility Amount 60000.0 Tenure 36

M M Months

Purpose of Facility Education Travel Occasion in Family Purchase of Household/ Electronic Goods
Home Renovation / Extension ✔ Others ___________________
*Subject to Approval

OCCUPATIONAL DETAILS
Private Sector Public Sector Government Sector
Occupation ✔ Salaried Other ____________________

Company / Employer Name Q U E S S C O R P L T D

Official Email ID
 BANK DETAILS
Primary Bank
A. Name of Bank I C I C I BANK L I M I T E D Branch
A/C. No. 0 5 5 5 0 1 5 5 2 4 5 8 UPI/VPA

END USE OF DECLARATION

I hereby represent, warrant and confirm that the loan has been taken for a valid purpose and is not speculative or illegal in any manner. I also declare that funds under
the facility will not be used towards purchase of gold in any form, including primary gold, gold bullion, gold jewellery, gold coins, units of gold exchange traded funds(ETF)
and units of gold, mutual funds etc.
The facility either in part or full will not be used for investment in capital market, land acquisition, acquiring equity shares of Indian company/ ies, buyback of shares of
Indian company, funding of promoters contribution in the project or any other purpose, which is prohibited or any illegal activity.
I further agree, confirm and undertake that the purpose of use of funds under the loan shall not be changed in any manner during the tenor of loan, or that such change
in purpose shall take place only with the prior written permission of ICICI Bank.
I agree that any breach or default in complying with all or any of the aforesaid undertaking(s) will constitute an event of default under the facility documents.
DECLARATION
I/We have no objection to ICICI Bank Limited, its group companies, agents/representatives to provide me/us information on various products, offers and services provided
by ICICI Bank Limited/ its group companies through any mode (including without limitation through telephone calls/ SMSs/emails) and authorize ICICI Bank Limited, Its
group companies, agents I representatives for the above purpose. Please tick Yes or No, as acceptable· Yes ✔ No

COMMON DECLARATIONS
1. I/We declare that all the particulars and information and details given/filled 8. II / We authorize ICICI Bank Limited (ICICI Bank) and their agents to
in this application form are true, correct, complete and up-to-date in all exchange, share or part with all information and data maintained with ICICI
respects and that I/We have not withheld any information whatsoever. Bank relating to my/ our existing account related information including
2. I hereby declare that the details furnished above are true and correct to the existing or prior loans and repayment history to other ICICI group
best of my knowledge and belief and I undertake to inform you of any companies, banks, financial institutions, credit bureau, agencies, mobile
changes therein, immediately. In case any of the above information is found network operators directly or indirectly, statutory bodies and other service
to be false or untrue or misleading or misrepresenting. Iam aware that I providers of ICICI Bank as may be required and I/We shall not hold ICICI
may be held liable for it. Bank (or any of its group companies) liable for sharing such information.
3. I hereby consent to receiving information from Central KYC Registry through I/We further authorize ICICI Bank to submit/disclose the ‘financial
SMS / Email on the above registered number/ email address. information’ as defined in Section 3(13) of the Insolvency and Bankruptcy
4. I/ We confirm that no insolvency proceedings or suits for recovery of Code, 2016 (“IBC”) (including all amendments and replacements made
outstanding dues or monies whatsoever and/ or any criminal proceedings thereto and all rules and regulations framed thereunder) in relation of the
have been initiated and/ or are pending against me/us and that I / we have loan facility availed by me/us to an Information Utility as defined in Section
been never adjudicated insolvent by any court or other authority. 3(21) of IBC. I/We further agree to promptly authenticate and verify the
5. No action nor other steps have been taken or legal proceedings started by ‘financial information’ submitted by ICICI Bank, as and when requested by
or against me/us in any court of law / other authorities for Winding up, Information Utilities
dissolution, administration or reorganization or for the appointment of a 9. I/We understand and acknowledge that ICICI Bank shall have the absolute
receiver, administrator, administrative receiver, trustee or similar officer or discretion, without assigning any reasons (unless required by applicable
for my/our assets. law), to reject our application and that ICICI Bank shall not be responsible/
6. I/We declare that I/we have not made any payment in cash, bearer cheque liable in any manner whatsoever to me/us for such rejection or any delay in
or kind along with or in connection with this application to the executive notifying me/us of such rejection and any costs, losses, damages or
collecting my/our application. I/We shall not hold ICICI Bank liable for any expenses, or other consequences, caused by reason of such rejection, or
such payment made by us to the executive collecting this application. any delay in notifying me/us of such rejection, of our application.
7. l/We understand and confirm that the Application Form and all other 10. Except to the extent disclosed to ICICI Bank herein, no Chairman /
documents submitted by me/us to ICICI Bank shall not be returned to me/us Managing Director or director or a relative/near relation, , of a Chairman /
and ICICI Bank shall have the right to retain the same. Managing Director or director of a banking company (including ICICI Bank
and its subsidiaries) or mutual funds/venture capital funds or a relative/near
relation, , of a senior officer of ICICI Bank, as specified by RBI, is: a partner
of our concern, or a trustee, member, director, manager, employee of our
concern, or of our subsidiary, or our holding company, or a guarantor on
my/our behalf, or holds substantial interest in our concern or my/our
subsidiary or holding company.
For the purpose of this clause the terms “relative”, “near relation” & “senior
officer” shall have the same meaning ascribed to them under the RBI
master circular on Loans and Advances dated July 1, 2015, para 2.2.1.8
and shall include any amendments made thereto.
Details of any such relation as referred to above
_________________________
A J I T ASHOK SAWANT
172.16.21.18
2022-10-20 21:11:14
172.16.21.18 2022-10-20 21:11:14

For Bank Use Only

✔
Personal Loan Facility Application No.: R I B1 3 6 3 5 0 4 0 1
Business Installment Loan Date: 2 0 1 0 2 0 2 2

CREDIT FACILITY APPLICATION FORM

(To be Filled by applicant only)
1. INTRODUCTION
1. ICICI Bank Limited (“ICICI Bank”) – Branch / Office address: ..............................................................................................................................
2. All applicants and co-applicants [collectively, “the Applicant(s)”, which expression shall, as the subject or context may admit or require, mean
any or each of the Applicant/s]- whether individuals, proprietary concerns, partnerships, Hindu Joint Family, societies, trusts or private/public
companies or any other bodies or associations (whether incorporated or not), who wish to either avail of financial assistance detailed below
(the “Facility”) from ICICI Bank for any purpose specified below in this Application Form (the “Purpose”) are required to fully fill-in and submit
this Application Form (and along with all other necessary details and documents) to ICICI Bank for applying for the same.
3. ICICI Bank shall be entitled at its sole and absolute discretion to reject/approve any Application Form submitted by the Applicant(s).
4. Upon consideration of the Application Form and all other additional documents necessary or required for consideration of the Application Form,
submitted by the Applicant(s), and if the same is to the satisfaction of ICICI Bank, ICICI Bank shall disburse the requested Facility to the
Applicant(s).
5. The Applicant(s)'s request for the Facility vide this Application Form, and the sanction of the same by ICICI Bank and/or disbursement of the
Facility, shall be subject to and governed by “ICICI Bank Limited's (All-India) Standard Terms & Conditions Governing Unsecured Loans (Regular
and Pre-Qualified Loans)” registered on Registered on April 15, 2009 with the Sub-Registrar-VII, New Delhi/Delhi vide Registration No. 266 in
additional Book No.4 Vol No. 1,402 on page 165 to 173 (hereinafter referred to as the “Standard Terms”), a copy of which has been handed
over to the Applicant, as well as the terms and conditions specified/referred to herein.
6. All capitalised terms used but not specifically defined in this Application Form shall have the respective meanings ascribed to them under the
Standard Terms.
IIA DETAILS OF THE APPLICANT
A J I T A S H O K S AWA N T
Name of Applicant :........................................................................................ Father's Name:..................................................................................................................
4 9 , N A V J I V A N S O C I E T Y , S K B H A Y E R D ,
Residence Address :..................................................................................................................................................................................................................................
4 0 0 0 3 0 Landmark:..............................................................................................................................................................
Pin:.............................................................................
8 8 9 8 2 3 2 5 8 5
STD Code:....................................................Tel.:...................................................Fax...................................................Mobile:...............................................................
A J I T S A W A N T 1 6 @ G M A I L . C O M
Email ID:....................................................................................................................................................................................................................................................
Address of communication ✔ Residence Office address as stated above (please select)

Facility in the nature of : Rupee Loan

60000.0
Facility amount: Not exceeding:............................................. sixty thousand
in Words......................................................................................................................................... only.
15.0
Rate of interest:............................................. fifteen point zero
% per annum in Words......................................................................................................................................... only.
(plus applicable interest tax or other statutory levies ) payable on the date(s) specified in Sectiobelow in relation to the repayment of the Facility.
Tenure: 36
1180.0
Processing Fee: Rs ............................................. one thousand one hundred eighty
(in words)......................................................................................................................................... only
(plus applicable taxes or other statutory levies, if any. )
Note: The processing fee is one time fee and is collected by ICICI Bank for the purpose of appraising the application for the
facilty and the same is independent of the outcome/ result of such appraisal.
Purpose of Facility:........................................................................................................................................
Facility is to be disbursed to:
A J I T A S H O K S A W A N T
Name:........................................................................................................................................................................................................................................................
Disbursement Mode :
Direct credit to ac no. 0 5 5 5 0 1 5 5 2 4 5 8

Note: Fees / charges paid by deducting the facility, then ICICI Bank shall disburse an amount reduced by the amount of fees/ charges; however
the Applicant shall be liable for the Entire Facility amount.

Repayment
2093.0
Amount of each Installment: ...................................................in two thousand ninety three
Words........................................................................................................................................only
36
No. of installments ............................................ 5th
Due dates(s) :............................................ day of each successive month

05/12/2022
First Due Date : ...................................... 05/11/2025
......Date ............................................
Last Due

Note: The Facility and applicable interest shall be payable/ repayable by the Applicants(s) to ICICI Bank as per aforementioned schedule notwithstanding the
dates(s) of disbursement by ICICI Bank to the person(s) mentioned above.
Mode of payment/ repayment of the Installments
by direct debit from the applicant/'s bank account with the ICICI Bank (“ Direct Debit method/ Reduction against Salary “)

Prepayment Charges
Prepayment charges: 3%+GST on the outstanding amount.

Charges per EMI Bounce Rs 400, ( Plus applicable taxes or statutory levies, if any.)
Repayment mode swap charges Rs 500, ( Plus applicable taxes or statutory levies, if any.)
Penal interest (applicable on payment defaults) 24% p.a., ( Plus applicable taxes or statutory levies, if any.)
Check Pick-up charges Rs 150, ( Plus applicable taxes or statutory levies, if any.)
Charges for EMI paid in Cash Rs 100, ( Plus applicable taxes or statutory levies, if any.)
Note:
(i) The charges / interest rate(s) specified in this Application Form and / or the other Transaction Documents in relation to the Facility are non- refundable in
nature and the rates are changeable, at the discretion of ICICI Bank, from time to time. ICICI Bank shall endeavour to give notice of such changes.
(ii) The charges for missed due date shall be payable by the Applicant/s to ICICI Bank under the Direct Debit method, or every instance that Installment/s is/
are not paid to/received by ICICI Bank in accordance with the repayment schedule specified above (irrespective of the reasons for such non-payment/
non-receipt).
(iii) The cheque re-presentation charges shall be payable in each instance that any post-dated cheque is dishonoured (under any of the payment modes) and
consequently represented OR in each instance that a post-dated cheque is presented when any Installment/s is/are not received by ICICI Bank by/upon
issue of debit instructions under the Direct Debit method selected by the Applicant/s for any reasons whatsoever.
(iv) GST an all other applicable taxes/ statutory levies, if any will be charged additionally.
(v) Part prepayment facility is not available in Personal Loan.
(vi) Zero FC after 12 EMIs & closure within 12 months will be 3% of the outstanding POS plus GST.

DECLARATIONS BY THE APPLICANT(S)

1. I/We declare that all the particulars and information and details given/filled in 5. Except to the extent disclosed to ICICI Bank herein, no Chairman / Managing
this Application Form are true, correct, complete and up-to-date in all respects Director or director or a relative/near relation of a Chairman / Managing Director
and that I/We have not withheld any information whatsoever. or director of a banking company (including ICICI Bank and its subsidiaries) or mutual
2. In addition to the representations, declarations, warranties and confirmations funds/venture capital funds or a relative/near relation of a senior officer of ICICI Bank,
given by me/us in this Application Form, I/we do hereby represent, warrant, as specified by RBI, is: a partner of our concern, or a trustee, member, director,
make and confirm to ICICI Bank each of the representations, declarations, manager, employee of our concern, or of our subsidiary, or our holding company, or a
warranties and confirmations set out in the Standard Terms (as defined guarantor on my/our behalf, or holds substantial interest in our concern or my/our
below) and do hereby further represent, warrant and confirm to ICICI Bank subsidiary or holding company.
that each of such representations, declarations, warranties and confirmations For the purpose of this clause the terms “relative”, “near relation” & “senior officer”
are, true, correct, valid and subsisting in every respect as of the date of this shall have the same meaning ascribed to them under the RBI master circular on
Application Form, and all such representations, declarations, warranties and Loans and Advances dated July 1, 2015, para 2.2.1.8 and shall include any
agreements shall survive the execution and delivery of this Application Form, amendments made thereto.”
the provision of the Facility pursuant to this Application Form and the Details of any such relation as referred to above________________________.
repayment/payment in full of the Facility and all monies in respect thereof. 6. I/We undertake to inform ICICI Bank regarding any changes whatsoever in my/our
3. I/We confirm that no insolvency proceedings or suits for recovery of addresses as specified here in above or my employment/profession and to promptly
outstanding dues or monies whatsoever or properties and/or any criminal provide such further information that ICICI Bank (or its designated group companies
proceedings have been initiated and/or are impending against me/us and that or agents or representatives) may require.
I/we have never been adjudicated insolvent by any court or other authority. I/ 7. I / We authorize ICICI Bank and their agents to exchange, share or part with all
we have not taken any action and no other steps have been taken or legal information and data maintained with ICICI Bank relating to my/ our existing account
proceedings started by or against me/us in any court of law / other authorities related information including existing or prior loans and repayment
for the appointment of a receiver, administrator, administrative receiver, history to other ICICI group companies, banks, financial institutions, credit
trustee or similar officer or for my/our assets. bureau, agencies, mobile network operators directly or indirectly, statutory bodies
4. I/We confirm that I/we shall not use the Facility (or any part thereof) for any and other service providers of ICICI Bank as may be required and I/We shall not hold
improper/illegal/unlawful/ speculative/ capital market related activities and ICICI Bank (or any of its group companies) liable for sharing such information
shall apply the Facility (or any part thereof) only for the limited purposes 8. I/We have fully read and understood the Standard Terms copy of which has been
specified herein. The Applicant shall use the proceeds of the Facility for the been provided to me/us.
Purpose and shall, if the Bank so desires, furnish a certificate and/ or such 9. I /We acknowledge and agree that the grant of the Facility by ICICI Bank to me / us
other valid proofs (including without limitation valid invoices, bills, receipts, shall be subject to compliance by me / us of the Standard Terms and the terms and
acknowledgments, etc.) to the satisfaction of the Bank, in the format and conditions set out under this Application.
manner acceptable to the Bank, affirming that the Facility has been utilized for
the Purpose. If for any reason the Borrower finds itself unable to comply with
this condition, it shall immediately inform ICICI Bank in writing of the same
and the reasons there for and shall, unless otherwise agreed to by ICICI Bank,
repay forthwith the outstanding balance of the Facility together with interest
and all other monies payable in respect thereof.

I/We further authorize ICICI Bank to submit/disclose the ‘financial information’ as defined in Section 3(13) of the Insolvency and Bankruptcy Code, 2016 (“IBC”)
(including all amendments and replacements made thereto and all rules and regulations framed thereunder) in relation of the loan facility availed by me/us to an
Information Utility as defined in Section 3(21) of IBC. I/We further agree to promptly authenticate and verify the ‘financial information’ submitted by ICICI Bank, as and
when requested by Information Utilities.
Following term stands amended as follows- “Transaction Documents” include all writings and other documents executed or entered into, or to be executed or entered into, by
the Borrower(s) or any other person or any other document executed or issued by ICICI Bank/Bank in relation, or pertaining, to the Facility and each such Transaction
Documents as amended from time to time.

ADDITIONAL DECLARATION:
I/ We have read and understood the concepts and illustrations in relation to due dates, classification of borrowal accounts as SMA (special mention account), NPA
(nonperforming asset) as detailed in Annexure[1]. I/ We further understand that the clarifications/examples mentioned in Annexure are only illustrative in nature covering
common scenarios and the norms and clarifications provided by Reserve Bank of India from time to time will prevail.

Execution/Signature/Affixation of thumb print by/of the Applicant and Co-Applicant

172.16.21.18
AJ I T A S HOK S AWA N T
2022-10-20 21:11:14
 172.16.21.18 2022-10-20 21:11:14

KEY FACT STATEMENT AND MOST IMPORTANT INFORMATION

RIB136350401
I/ We refer to final application form No............................................................................... 2022-10-20 submitted by me/ us to ICICI
dated..................................
Bank Limited. I/ We have been provided the following information & have accordingly filled up the aforesaid.

Loan Details Rates and Charges

60000.0 Fixed ROI p.a (Monthly Reducing Balance):..................................%

15.0
Loan Amount : ...................................................................................

36
Tenure :................................................................................... Months 1180
* Processing Fees(Non Refundable)...............% Amount .......................

36
Number of EMIs: ................................................................................... *Penalty for Delayed Repayment : 24% p.a.

**EMI Amount: 2093

................................................................................... *Cheque Bounce Charges : 400

EMI Start Date 05 / 12 / 2022

............................................
*Repayment Mode Swap Charges: 500

5th
EMI Due Date............................... Day of each Month * Loan Cancellation Charges : 3000
*Cheque Pick-up Charges: 150
Date on which Annual Outstanding Balance
Statement will be issued: On Request *Charges of EMI paid in Cash: 100

* Prepayment Charges: 3%+GST on the outstanding amount.

.
Repayment Mode ✔ Direct Debit Mandate
1. *Plus Applicable Taxes and other Statutory Levies if any.
2. The security mandate collected would be sent to your bank for registration. Please note that the security mandate shall
be banked only in case of default in your loan repayment.
3. Instances wherein Disbursement is delayed the EMI amount may change accordingly as the EMI amount varies basis the gap between
disbursement date and the first EMI date.
4. Part Prepayment facility is not available in Personal Loan.
5. Zero FC after 12 EMIs & closure within 12 months will be 3% of the outstanding POS plus GST.

I/We acknowledge that:

I/We have not made any payment in cash, bearer cheque or kind along with or in connection
with this application to the executive collecting my/our application form

✔ The sanction under the Facility, if and when sanctioned, shall be governed by the terms and conditions
applicable there to and it shall be my/our responsibility to obtain the copy and read the same

✔ ICICI Bank follows defined installment dates. Accounting reconciliation would be suitably depicted at
the time of payment of last EMI and surplus amount, if any, would be refunded to the applicant

Please read carefully

I hereby confirm that I have received a copy of duly filled Key Fact Statement & Most Important Information as above.
..........................................................
...................................................................
...................................................................
Name of Applicant(s) A J I T A S H O K S A W A N T
 ICICI BANK DIRECT DEBIT EMI & SECURITY MANDATE FORM
DATE 2022-10-20

FROM
Customer Name AJIT ASHOK SAWANT
Customer Address 49,NAVJIVAN SOCIETY,S K BHAYE RD,
NR FORT WORLI KOLIWADA

TO
ICICI Bank Limited.,
---------, Branch, _______
MUMBAI , City.

Ref: Account No.: 0 5 5 5 0 1 5 5 2 4 5 8

Dear Sir,
I/We would like to inform you that we have taken a Personal Loan Division pursuant to the Credit
Facility Application Form (No. _____
RIB136350401 dated ____
20-10-2022 _ (the "Application Form") OR
Facility/ Loan Agreement dated ________
20-10-2022 (the "Facility Agreement"), submitted to
ICICI Bank Ltd. You are hereby authorized to debit the above mentioned account and credit ICICI
Bank Ltd. -loan account number ________ on receiving instructions from ICICI
Bank Limited Personal Loan Division towards: (i) the repayment of the Facility, the Equated Monthly
Instalment, instalment(s), Pre EMI interest, all interest and other charges payable by me or to you
over the entire tenure of Facility ("EMI Mandate") and/ or (ii) any default committed by me in
repayment of dues ("Security Mandate"). The abovementioned account will be debited with the
amount Rs__________
2093 � er month for repayment of dues (Rupees
only) and/or with the amount ----------------------
two thousand ninety three
Rs. _____ (Rupees __________________only) for
default in repayment of dues, as the case may be, w.e.f. 05-12-2022 over the entire
tenure of the Facility.
In the event of the above account getting closed/transferred for any reason, I/We will intimate to
the bank the new account opened with the bank to debit the loan repayment amounts. Further,
I/We undertake to submit the fresh set of Mandate for such new account, in lieu of existing
instructions.
We are requesting and hereby authorizing ICICI Bank Limited Personal Loan Division to forward this
to you after affixing the signatures of their authorized person(s) to signify their approval for the
above instructions and agreement to give effect to the above.
Please note that the Security Mandate will be invoked & banked only in specific circumstances
such as customer failing under default, exceeding overdue limit, etc. In case of default, outstanding
amount including overdue interest, bounces and other charges, if applicable, will be debited.

Thanking you,
yours truly,
AJIT ASHOK SAWANT

Customer Name :
(Account Holder/s)