End use cannot be towards purchase of gold in any form, including primary gold,
gold ..... Terms and conditions as mentioned in the Loan Agreement will apply. ....
You need to pay at least the minimum amount due i.e. ` 250 in this example, by.
Mr./Ms./Mrs./Mx.
Name (Same as ID Proof)
:
Maiden Name (If any)
:
Father’s/Spouse’s Name
:
Mother’s Name
:
First Name
Middle Name
Last Name
(Please leave one space between each name)
CKYC number (if any) : GST Identification number (Only for Entity): Others
Citizenship: Residential Status:
Resident Individual
Non Resident Indian
Indian
Others ___________________
Foreign National
Person of Indian Origin
Other, please specify Proof of Identity: (any one of them)
Passport Expiry Date
A - Passport Number B - Voter ID Card
VER 14.1/MORTGAGE DOMESTIC APPLICATION FORM/06-17
C - PAN Card*
Driving Licence Expiry Date
D - Driving Licence E - UID (Aadhaar*) F - NREGA (Job Card)
Expiry Date
Z - Others (Other Govt ID) (Please submit all the documents for the ID number ticked in this form.) *Mandatory documents.
Address Type for Proof:
Residential
Business
Proof of Address:
Passport
Driving Licence
*Mandatory document.
UID (Aadhaar*)
Voter Identity Card
NREGA Job Card
Others _________________________________________
City/Town/Village: District:
Pin/Post Code: Country:
State/UT:
Mobile No.: I confirm that the above is my current residential address and I have submitted the address proof documents for the above. In addition, I have/have not submitted a proof of my permanent address as below.
Years at current residence
Signature/ Thumb impression
Official E-mail ID: (for verification purposes only) (for all correspondence)
City/Town/Village: District:
Pin/Post Code: Country:
State/UT: Your Current Residence
Owned
Rented
Company Provided
New Property
Permanent Address
1
City/Town/Village: District:
Pin/Post Code: Country:
VER 14.1/MORTGAGE DOMESTIC APPLICATION FORM/06-17
State/UT:
Mr./Ms./Mrs./Mx.
Name (Same as ID Proof)
:
Maiden Name (If any)
:
Father’s/Spouse’s Name
:
Mother’s Name
:
First Name
Middle Name
Last Name
(Please leave one space between each name)
CKYC number (if any) : Others
Citizenship: Residential Status:
Resident Individual
Non Resident Indian
Indian
Others ___________________
Foreign National
Person of Indian Origin
Other, please specify Proof of Identity: (any one of them)
Passport Expiry Date
A - Passport Number B - Voter ID Card C - PAN Card*
Driving Licence Expiry Date
D - Driving Licence E - UID (Aadhaar*) F - NREGA (Job Card)
Expiry Date
Z - Others (Other Govt ID) (Please submit all the documents for the ID number ticked in this form.) *Mandatory documents.
Address Type for Proof:
Residential
Business
Proof of Address:
Passport
Driving Licence
*Mandatory document.
UID (Aadhaar*)
Others _________________________________________ 2
Voter Identity Card
NREGA Job Card
City/Town/Village: District:
Pin/Post Code: Country:
State/UT:
Mobile No.: I confirm that the above is my current residential address and I have submitted the address proof documents for the above. In addition, I have/have not submitted a proof of my permanent address as below.
Years at current residence
Signature/ Thumb impression
Official E-mail ID: (for verification purposes only) (for all correspondence)
City/Town/Village: District:
Pin/Post Code: Country:
State/UT: Owned
Rented
Company Provided
New Property
Permanent Address
VER 14.1/MORTGAGE DOMESTIC APPLICATION FORM/06-17
Your Current Residence
City/Town/Village: District:
Pin/Post Code: Country:
State/UT:
3
VER 14.1/MORTGAGE DOMESTIC APPLICATION FORM/06-17
City/Town/Village: District:
Pin/Post Code: Country:
State/UT:
4
VER 14.1/MORTGAGE DOMESTIC APPLICATION FORM/06-17
• I/We further authorize and give consent to Citibank N.A; and or it's associates/subsidiaries/affiliates to verify any information or otherwise at my/our office/residence and/or contact me and/or my family members and/or my employer/Banker/Credit Bureau/Credit Information Companies (CIC)/Reserve Bank of India (RBI) and/or any third party's they deem necessary and/or to do any such acts as they deem necessary and/or disclose to the RBI or any other authority, including but not limited to, Credit Bureau/Credit Information Companies (CIC) or anyotherthirdperson,thename/identity,creditinformationincludingbutnotlimitedto,currentbalance,paymenthistory,defaults,ifany,etcalongwithdemographicdetails • I/We understand and agree that Citibank N.A; will re-trigger the bureau/Credit Information Companies (CIC) to access my/our latest payment history, current balances if the loan application has crossed more than 60 days from the date of submission of file to Citibank N.A. India
5
VER 14.1/MORTGAGE DOMESTIC APPLICATION FORM/06-17
Signature/ Thumb impression of the Applicant
Signature/Thumb impression
Signature/ Thumb impression of the Co-Applicant
Signature/Thumb impression
6
Place :
For bank use only
Branch/City: _____________________________________
KYC Verification/OSR carried out by Location Citibank employee name
Citibank employee code
Citibank employee designation
Authorised Vendor employee name
Authorised Vendor employee code
Authorised Vendor employee designation
Citibank employee/Authorised Vendor
VER 14.1/MORTGAGE DOMESTIC APPLICATION FORM/06-17
Signature
Institution details: Name: Code: Stamp:
In case of branch / Suvidha / United Sales Force referral please provide Branch Name: Referral RM Employee Code:
RM Referral Name:
This product/service is offered by branches of Citibank N.A. in India. © 2017 Citigroup Inc. Citi and Arc Design are registered service marks of Citigroup Inc. or its affiliates used and registered throughout the world.
7
+
Goods and Service Tax (GST) as applicable will be levied on all the fees and charges. Franking charges applicable during loan booking, if any, as per individual state laws are to be paid by the customer - “Semi Fixed Rate Loan” refers to a loan facility whereby the Rate of interest offered remains Fixed for an initial tenure and becomes variable thereafter, post the completion of the initial tenure becoming directly linked to the MCLR. Legal charges , if any , shall be charged as per actuals applicable to an overdue/delinquent account
MCLR is subject to change at any time. In the event of a change in the MCLR, the interest rate on your loan will be reset as provided in the Loan Agreement.
Schedule of charges applicable on Citibank Mortgage loans ( For latest schedule of charges refer to our website www.citibank.com/india)
VER 12/SOC/WPC/06-17
Credit Information Companies (CIC) and get the applicant’s Credit Information Report.
All information in this communication is correct at the time of printing/publishing (GCG/COMMON APPLICATION MITC VERSION 1.1 /JULY 2017)
(Mandatory document)
UID (Aadhaar) (Mandatory document)
