CAPITAL LIMITED

For Office use only

APPLICATION FORM Sales Manager Code ________________CRE
737024 Code __________________
91004053
Business Loan BL OD Branch Name _______________________Spoke Code__________________
BHOKARDAN
• All fields are Compulsory to be filled DSA Code ________________________ Referrer Code _______________
• Please fill all the details in CAPITAL LETTERS only Scheme Code _____________________
PPPAOTF Norms No.__________________
Date: 23 / 08 / 2024 CKYC No.____________________________________________________
Purpose of Loan: Business Any other, please specify______________________________________
APPLICANT INFORMATION CKYC No.
1. Applicant Name : PRABHAKAR BHAGWAN TALEKAR
2. Borrower Entity Type: Self Employed Individual / Proprietorship Firm Public Ltd Co. Private Ltd Co.
Partnership Firm/LLP HUF NPO* Trust Society Others, please specify ____________________
*NPO should be selected under the constitution type if the entity or organisation is registered as a trust or a society or a company registered under Section 8 of the
Companies Act, 2013 and is constituted for religious or charitable purposes referred to in clause (15) of section 2 of the Income-tax Act, 1961)
3. Principal office address / Place of Business: SHREE POULTRY AND HATCHERIES
SHREE POULTRY AND HATCHERIES BHOKARDAN NEAR PERJAPUR ROAD JALNA MAHARASHTRA 431114
Jalna Maharashtra
City State PIN Code 431114
Ownership Status: Rented Owned No. of years in principal office _______________
Telephone (office): E-mail Address: prabhakartalekar70@gmail.com

4. Factory Address / Other Office Address

City State PIN Code

Ownership Status: Rented Owned
Telephone (office): E-mail Address:
5. Date of Commencement of Business / / Date of incorporation of Business: / /
6. Registration No./ CIN Place of incorporation: ______________
Whether GST Registered: Yes No
AHKPT8785C
GST No.: PAN: TAN:
Darpan ID.:
7. Nature of Business: Manufacturing Retail Trading Wholesale Trading Service Sector Others
8. Non Professional Professional
If Professional, then please tick Doctor CA/CS/CWA Architect Engineers Lawyer
Others, please specify _________________
9. Contact Person Name:
Designation: Phone Number:
10. Preferred mode of Communication: Mail Phone
AUTHORIZED SIGNATORY DETAILS CKYC No.
1. Name: (as per PAN Card) :- Mr./ Mrs./Ms.
2. Gender : Male Female Transgender 3. Date of Birth: / /
4. Designation/Relation with Company: _______________________
5. PAN: Passport No.: Exp. Date / /
Driving Lic No.: Exp. Date / / Voter ID Card No.
Aadhaar Virtual ID NREGA Job Card No. Others_________

PERSONAL DETAILS APPLICANT CO-APPLICANT CKYC No.

1. Name of Applicant: (as per PAN Card) :- Mr./ Mrs./Ms.
Father /Husband’s Name:- Mr.
(Father’s name is mandatory if PAN no. not provided)
Spouse Name:- Mr./ Mrs.
Mother Name:- Mrs. CHANDRABHABAI
04
2. Gender : M Male Female Transgender 3. Marital Status: Single Married 4. Date of Birth: / 06 / 1985
5. Education: Under-Graduate Graduate Post-Graduate Any Other, Please specify ___________________
6. Residential Premises is: Self Owned Rented
Residential Address: WARD NO 4 TALEKAR WADI POST OFFICE JAVAL MEAN ROAD ROKDA NEAR HANUMAN MANDIR PARISAR BHOKARDAN BHOKARDAN JALN

431114
City PIN State
Landline No.: Mobile No. 9860259205

7. Permanent Address:
Affix Latest
Photograph
City PIN State duly sign across
Landline No.: Mobile No.
8. PAN: AHKPT8785C Passport No.: Exp. Date / /
Driving Lic No.: Exp. Date / / Voter ID Card No.
Aadhaar Virtual ID NREGA Job Card No. Others________
___________________
PRABHAKAR BHAGWAN TALEKAR ___________________ ___________________
Applicant Co - Applicant Co - Applicant

IP Address:182.70.118.152:55912 Date & Time: 23-08-2024 13:52:55

 PERSONAL DETAILS CO-APPLICANT CKYC No.

1. Name of Applicant: (as per PAN Card) :- Mr./ Mrs./Ms.

Father /Husband’s Name:- Mr.
(Father’s name is mandatory if PAN no. not provided)
Spouse Name:- Mr./ Mrs.
Mother Name:- Mrs.
2. Gender : Male Female Transgender 3. Marital Status: Single Married
4. Date of Birth: / /
5. Education: Under-Graduate Graduate Post-Graduate Any Other, Please specify ___________________
6. Residential Premises is: Self Owned Rented
Residential Address:

City PIN State

Landline No.: Mobile No.
Affix Latest
7. Permanent Address: Photograph
duly sign across

City PIN State

Landline No.: Mobile No.
8. PAN: Passport No.: Exp. Date / /
Driving Lic No.: Exp. Date / / Voter ID Card No.
Aadhaar Virtual ID NREGA Job Card No. Others________

PARTNERS/DIRECTORS DETAILS (FOR PARTNERSHIP FIRM/LLP/ PVT LTD CO./PUB LTD CO.)
Name Address Profit Sharing% Total Experience

LOAN FACILITY

Loan Amount Requested Rs. 425000.0

__________________________ Tenure: /
48 Months Repayment Mode ECS Others
Disbursement in favour of: 1) _________________________________________________________ Amount __________________________
2) _________________________________________________________ Amount __________________________

LOAN DETAILS

1. Existing Relationship with TCL / TCHFL Yes No

2. Previous Loan Details (Any loan)
(I) (II) (III)
1) Financier Name
2) Type of Loan
3) Loan Amount 425000.0

4) EMI

BANK DETAILS
Name of Bank: ________________________________________________________
HDFC BANK Branch: ________________________________________
BHOKARDAN

A/c No.:
50100358133662 Account Type: ✔
Saving Current Others No. of Years: /
Name of Bank: ________________________________________________________ Branch: ________________________________________
A/c No.: Account Type: Saving Current Others No. of Years: /

CREDIT CARD DETAILS

Bank ______________________________________ Card No.: Expiry /

Bank ______________________________________ Card No.: Expiry /

PRABHAKAR BHAGWAN TALEKAR
___________________ ___________________ ___________________
Applicant Co - Applicant Co - Applicant

IP Address:182.70.118.152:55912 Date & Time: 23-08-2024 13:52:55

 PERSONAL REFERENCES (Both Relatives)
1. Name TALEKAR SUNITA 2. Name SURADKAR DILIP
WARD
WARD NO 04 TALEKAR WADI POST OFFICE JAVAL MEAN ROAD ROKDA NEAR NO 4 TALEKAR
HANUMAN WADI POST
MANDIR PARISAR OFFICE JAVAL
BHOKARDAN MEAN ROAD
BHOKARDAN ROKDA
JALNA NEAR
431114 MA
Address Address

Jalna 431114 Jalna 431114

City PIN City PIN
Maharashtra Maharashtra
State Tel.: State Tel.:
STD Code Mobile STD Code Mobile
Relation with Applicant _____________________________________ Relation with Applicant _____________________________________

TRADE REFERENCES
1. Name:
Mobile No. E-mail ID:
Relation with Applicant: _____________________________
2. Name:
Mobile No. E-mail ID:
Relation with Applicant: _____________________________

TERMS AND CONDITIONS

1. This application is not for citizens, residents, persons or entities accessing from the European Union and no services shall be provided to any person or entity in the
European Union.
2. This Application Form shall not be construed to imply automatic approval of your loan / facility by Tata Capital Limited(“the Company”).
3. The Loan facility shall be disbursed by the Company to the applicant/s and/or such other person as instructed by the applicant and the amount disbursed by the Company to
such person shall be valid binding and effectual discharge from the applicant/s
4. Payment of non-refundable processing fee is a pre requisite together with this loan application form.
5. Wherever PAN is not available, Form 60 to be provided.
6. The Terms and Conditions mentioned above are an indicative list of terms and conditions of our loan products. These Terms and Conditions are further described in other
financing documents (such as Specific Agreements, Master Terms and Conditions, other loan documents) under relevant sections / schedules and therefore should be read in
conjunction with such financing documents. Please also visit the Company’s website www.tatacapital.com for the Fair Practices Code and Policy for determination of Interest
Rates, Processing and other charges adopted by the Company.
UNDERTAKING / DECLARATION
1. I /We/applicant understand that this application is not for citizens, residents, persons or entities accessing from the European Union and no services shall be provided to any person
or entity in the European Union.
2. I /We understand that my application for loan via this journey shall not be construed to imply automatic approval of your loan / facility by Tata Capital Limited (“the Company”).
3. I/We confirm that my/our annual household income is more than Rs.3 lakhs, and therefore, my borrowing under the Loan Facility does not qualify to be treated as a microfinance loan.
4. I /We understand that the loan facility shall be disbursed by the Company to the applicant/s and/or such other person as instructed by the applicant and the amount disbursed by the
Company to such person shall be valid binding and effectual discharge from the applicant/s
5. I /We understand that the payment of non-refundable processing fee if any, is a pre-requisite together with this loan application.
6. I /We understand that wherever PAN is not available, Form 60 is to be provided.
7. I/We hereby represent that the Company can contact the references provided by me/us for my/ our reference check or in case the I/We or any of us is/are not reachable/contactable
for any reason and that the references have consented to the same
8. I /We understand that these Terms and Conditions are an indicative list of terms and conditions of our loan products. These Terms and Conditions are further described in other financing
documents (such as Specific Agreements, Master Terms and Conditions, other loan documents) under relevant sections / schedules and therefore should be read in conjunction with
such financing documents. Please also visit the Company’s website www.tatacapital.com for the Fair Practices Code and Policy for determination of Interest Rates, Processing and
other charges adopted by the Company.
9. I/ We am / are aware of the Fair Practices Code and Policy for determination of Interest Rates, Processing and other charges adopted by the Company which are placed on the
Caompany’s website www.tatacapital.com.
10. I/We declare that I / We am / are not citizens, residents, persons or entities accessing from the European Union.
11. I/We declare that all the details furnished in this application form are true, correct and up to-date in all respects and that I/We have not withheld any information whatsoever.
I / We undertake to inform the Company 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 may be held liable for it.
12. I/We hereby understand that TCL may, if required, seek information or documents in addition to what is mentioned in its KYC-PMLA Policy and I/We hereby consent to the same and
agree to provide such information or documents.
13. I/We hereby confirm that no insolvency proceeding or suits for recovery of outstanding dues or monies whatsoever or for attachment of my/ our assets or properties, and/ or any
criminal proceedings have been initiated and/ or are pending against me/ us and that I/We have never been adjudicated insolvent by any court or other authority nor has any receiver,
administrator, administrative receiver, trustees or similar officer been appointed for my/our assets and that no action nor other steps have been taken or legal proceedings started by
or against me/us in any court of law/other authorities for winding up, dissolution, administration or re-organization or for the appointment of a receiver, administrator, administrative
receiver, trustees or similar officer or for my/our assets.
14. I/We understand and acknowledge that the Company shall have the absolute discretion, without assigning any reasons (unless required by applicable law), to reject my/ our application
and that the Company shall not be responsible/liable in any manner whatsoever to me/us for such rejection or any delay in notifying me/us of such rejection and any costs, losses,
damages or expenses, or other consequence caused by reason of such rejection, or any delay in notifying me/us of such rejection of our application.
15. I / We understand and am aware that the charges paid to the Company towards out of pocket expenses and / or log-in / processing fees are non-refundable to me / us and upon the
application being withdrawn by us or being rejected by the Company for any reason whatsoever, we will not be entitled for refund either in part or in full.
16. I / We hereby confirm and duly undertake that the loan is being taken for purpose as stated in the application. I / We also confirm that I / We shall not use the loan for any improper/
illegal or unlawful purpose/ activities.
17. I / We hereby consent to the Company to carry out the KYC and other requisite checks by such processes as may be permissible under law including verification of documents or
details submitted for KYC purpose, accessing and procuring data from databases maintained by statutory or other authorities constituted by law, for the purpose of granting the loan
facility referred in the journey.
18. I / We expressly authorize/consent to the Company, its group companies and other companies within the Tata group, its various service providers or agents, to contact me / us, through
e-mails, telephones, messages, SMS, Whatsapp or other applications or otherwise even if my / our names appear in the Do Not Call or Do Not Disturb Register to inform me / us
about the marketing schemes, promotional schemes, various financial and other products and/or offerings of other services, loyalty programs or any other aspect offered by them. I
/ We agree to the use of e-mails, messages, SMS, Whatsapp and/or other applications for communication or sharing of information or documents, agree to abide by the terms and
conditions of such applications and agree to the risks associated with such applications or sharing of information through them. I / We agree that this consent shall continue to be valid
even if the loan applied for has been rejected or closed.
19. I/We authorize the Company and all its group companies, their agents and service providers to exchange, share or part with all the information and details (including personal sensitive
data or information and any information that requires a consent under the Information Technology Act, 2008 and/or any other statute) relating to my/our existing loans and/or repayment
history to other group companies, bank, financial institutions, credit bureaus, information utilities, agencies, statutory bodies etc. as may be required or as they may deem fit and shall
not hold the Company or any of its group companies or its agent/representatives liable for use/sharing of this information.

TATA CAPITAL LIMITED

Registered Office: 11th Floor, Tower A, Peninsula Business Park,
Ganpatrao Kadam Marg, Lower Parel, Mumbai - 400013

If you have any queries or require any assistance, you can reach us through
our call centre number 1860 267 6060 or email us at customercare@tatacapital.com

IP Address:182.70.118.152:55912 Date & Time: 23-08-2024 13:52:55

20. I/ We hereby consent to receiving information from Central KYC Registry through SMS/Email on the above registered number/Email address.
21. I/We hereby provide our consent to the Company to obtain and / or submit my / our information from / to Credit Information Company and/or information utility and/or such institution
set up under the provisions of law from time to time, as and when required.
22. The Company has adopted the Tata Code of Conduct (“TCoC”) and all our employees and representatives are bound by the same. A copy of the TCoC is available on www.tatacapital.
com. In case you notice any violation or potential violation of the TCoC by any of our employees or representatives, you may write to us at ethics@ tatacapital.com intimating us of
the same.
23. The Company /its group companies reserve the right to retain the photographs and documents submitted with the application and will not return the same to me / us.
24. I / We hereby consent to voluntarily submit to the Company at my / our own discretion, the physical copy of Aadhaar card / physical e-Aadhaar / offline electronic adhaar xml as issued
by the Unique Identification Authority of India (“UIDAI”) after masking the Aadhaar number for the purpose of establishing my / our identity / address proof in line with the Directions
/ guidelines issued by the Regulatory and Statutory bodies from time to time. I / We further give my / our consent to the Company for verification of my / our Aadhaar to establish the
genuineness in such manner as permitted by UIDAI or under any law from time to time. The consent and purpose of collecting Aadhaar has been explained to me / us in local language.
25. The Company has informed me / us that my / our Aadhaar submitted to the Company shall not be used for any other purpose other than as per the requirements of law.
26. I/We hereby expressly authorize the company to send me/us communication regarding third party products including insurance products of the company through any of the modes
of communication referred above.
27. I/We do not want to receive any communication regarding third party products/Insurance.
28. I/ We hereby consent to the Company to carry out the KYC and other requisite checks by such processes as may be permissible under law including verification of documents or
details submitted for KYC purpose, accessing and procuring data from databases maintained by statutory or other authorities constituted by law, for the purpose of granting the loan
facility referred in this journey.
29. More particularly, I/ We hereby consent to the Company updating/furnishing my/our KYC data on the Centralised KYC Registry (CKYCR) or such other database or repository as may
be prescribed from time to time as also access, download and procure data therefrom and rely upon the same for the purpose of KYC checks and it shall be my/our responsibility
to ensure that the data is correct and updated and to immediately intimate in writing in case of any changes to the data.The Company may also verify the data in such manner as it
deems fit and seek additional information or perform enhanced due diligence. I consent to receive information/intimation from the Company/CKYCR through SMS/Email on the above
registered number/Email address notwithstanding my/our names and / or numbers appearing in the Do Not Call or Do Not Disturb registry.
30. I /We hereby declare that the mobile number as submitted by me/us in this application is the same as the one available and registered with the Unique Identification Authority of
India (“UIDAI”). I / We undertake to inform the Company 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 may be held liable for it.
31. I/We hereby declare that I/We have read, understood and agree to the terms given above.

___________________ ___________________ ___________________

Applicant Co - Applicant Co - Applicant
MOST IMPORTANT DOCUMENT
Enclosing Self Attested Pre sanction documents Tick Tick
Application Form AOA / MOA & Certificate of Incorporation
Photograph (signed across) Partnership Deed
Latest 6 months Bank Statement Post Sanction Documents
Payment Instrument Loan Agreement
Last 2 years ITR with computation of income/certified financials ECS / Payment Instrument
Proof of Turnover (Latest sales / Service Tax returns) Other Documents
Proof of Indentity (Specify)
Proof of Address (Specify)
Signature Verification
Board Resolution / Partnership
Authority Letter
Other confirmations which are forming part of the Loan App form:
I/ We CONFIRM THAT THE EXECUTIVE COLLECTING MY APPLICATION / DOCUMENTS HAS:
• Informed me that a Processing fee (non-refundable) (of Rs. _______________)
15045.00 will be charged towards loan application.
• Not received any payment in cash, bearer cheque or kind along with or in connection with this loan application from me/us.
• Informed me/us that taxes as may be applicable will be charged in connection with the loan.
• Informed me/us that the quantum of the loan will be finally decided by TATA CAPITAL LIMITED (“the Company”) and has not made commitments to me/us regarding the same.
• The Company may request for additional documents other than those collected in connection with the application.
• That all Payment Instruments are to be issued favoring TATA CAPITAL LIMITED only
Relationship Declaration (if any with Director/ Senior Officer of TCL)*
Relationship of the Applicant Yes No
I am a Director/relative of a Director of TCL or we are a firm in which any Director/relative of a Director of TCL is interested as a partner/manager/employee/
guarantor or we are a company in which any Director/relative of a Director of TCL is interested as a major shareholder, director, manager, employee or guarantor. ✔

I/we am/are a senior officer(s)/relative of a senior officer of TCL. ✔

Note: A director or relative shall be deemed to be interested in a company, being the subsidiary or holding company, if he/she
is a major shareholder or is in control of the respective holding or subsidiary company
In the event that the Applicant / Co-applicant are related to any of Director/senior officer(s) of TCL:
S.No. Name of Director(s)/senior officer (s) Designation Nature of Relationship with director/
senior officer

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

___________________ ___________________ ___________________

Applicant Co - Applicant Co - Applicant

ACKNOWLEDGEMENT OF LOAN APPLICATION FORM (OFFICE COPY)

Dear Sir/Madam,
Dated ______________
This to acknowledge receipt of your Loan Application Form ( ________________________________________________ Dated _____________)along with the “Most Important
Document”. Our representatives will be touch with you in connection with the same.
Any additional document required
1) _______________________________________________________________
2) _______________________________________________________________
EMP Name _______________________________________ EMP Code _______________________EMP Stamp _____________________

CAPITAL LIMITED CUSTOMER COPY
ACKNOWLEDGEMENT OF LOAN APPLICATON FORM
November 23 : Version 1

Dear Sir/Madam, Dated ___________________

This to acknowledge receipt of your loan Application Form (_____________________________which will be processed with-in next 15 days. Our representatives have
collected your importanant documents and will get in touch if any additional documents will be required.
1) _______________________________________________________________
2) _______________________________________________________________
EMP Name _______________________________________ EMP Code _______________________EMP Stamp _____________________

IP Address:182.70.118.152:55912 Date & Time: 23-08-2024 13:52:55