Customer Information Sheet - Group Loan

1. CIS No. 2.Application Date

3. JC Code/Branch 4. Type of Customer
5. URN 6.Product Code (PHOTO)

7. Application No 8.Jana Group No

9.Loan Amount 10.cKYC No

Information Primary Applicant

1.First Name 2.Last Name

3. Date of Birth (DD-MM-YYYY) 4. Gender
5.Marital Status 6. Education Status
7. Father's Name 8. Spouse's Name
9. Primary Id 10. Primary Id No
11. Secondary Id 12. Secondary Id No
13. Mobile Number 14. Religion
15. Caste 16. Mother Tongue
17. Permanent Address
Door No/Road Village/City/Town
State District
Pincode Landmark
18. Current Address
Door No/Road Village/City/Town
State District
Pincode Landmark
19. Employment Details
Nature of Employment Type of Employment
Occupation Description Type of Industry
Main Products or services Sold
20.NCO Occupation Code/BSR Code 21.Frequency of Income
22.Total no of family members 23.Years in current residence
24.Years in current Village/Town 25. Residence Ownership
26. House Type 27.Insurance Opted
28. Loan Purpose 29.Monthly House hold income
30. End user activity 31.Nationality

Customer Information (Guarantor)

1.Name 2.Date of Birth

3.Gender 4.Mother Tongue
5.Education Status 6.Marital Status (PHOTO)
7.Primary Id 8.Primary Id No.
9.Secondary Id 10.Secondary Id No.

11. Relationship with PC 12.Relationship Proof ID Type

13. Father/Spouse's Name 14. Mobile Number
15. Address Details
Door No/Road Village/City/Town
State District
Pincode Landmark
16. Employment Details
Nature of Employment Type of Industry
Main Products or services Type of Employment
Sold
Occupation Description
17. BSR Code 18. Frequency of income
19.Nationality

Bank Details

1. Bank Name 2. A/c Number

3. Beneficiary Name 4. Bank Branch

Agricultural Acitivity Details

1. Do you have Agri Land 2. Agriculture land holding in acres

3.Category of farmers 4. Agricultural Activities
5.Agriculture land owner 6. Number of Live stock Unit

DECLARATION

1. I/We hereby declare that all the particulars and information (including household income) furnished by me/us in this Application Form to Jana Small
Finance Bank (the “Bank”) are true, correct, complete and up-to-date in all respects. I/We have not withheld any information.
2. I/We further acknowledge the Bank's right to seek any information from any other source in this regard. I/We understand that all of the above-mentioned
information shall form the basis of any facility that the Bank may decide to grant to me/us at its sole discretion.
3. The bank's representative or any of the Bank’s official has not collected any cash or cheque or any amount from me/us via any mode for processing my/our
loan application.
4. I/We also authorize the Bank or it's agents to make references and inquiries related to the information in this Application Form which the Bank considers
necessary.
5. I/We understand that the Bank reserves the right to reject this loan application form submitted and reserves the right to retain the photograph and
documents submitted with the application and shall not returned back. In case the proposal is rejected/not considered the reasons for the same will be
intimated to the applicant.
6. I / We confirm that the funds will be used for the stated purpose only and will not be used for any speculative or any anti-social purposes.
7. We undertake to bear processing, service, documentation charges etc. as stipulated by the Bank from time to time.
8. I/We authorize the Bank to debit my savings bank account with the Bank for any fees, charges, interest etc. as may be applicable.
9. I am/We are aware about the rate of interest charged by the Bank.
10. I/We shall be bound by the terms and conditions of the loans agreement that may be executed between me/us and the Bank.
11. I/We agree and understand that the Bank shall be entitled at its sole discretion to call back, the entire loan/Advance whether due and payable or not at any
time, without assigning any reason and enforce its rights, remedies and securities.
12. I hereby authorize and give consent to the Bank to disclose, without notice to me/ us, information furnished by me/ us in the application form(s)/ related
documents executed/ to be executed in relation to the facilities to be availed by me/ us from the Bank, to the Bank's other branches/ subsidiaries/ affiliates/
Credit Bureaus/ Rating Agencies/Service Providers, banks/ financial institutions, governmental / regulatory authorities or third parties for information
verification, credit risk analysis, or for other related purposes that the Bank may deem fit.
13. I/We agree that I/we have been provided various options by the Bank for establishing my/our identity/address proof for the purpose of account opening
and I/we have voluntarily submitted my/our Aadhaar to the Bank.
14. I/We have no objection in the Bank authenticating the genuineness of the Aadhaar through Quick Response (QR) code or through such other manner as
set out by UIDAI or any other law from time to time.
15. I/We give consent to use/exchange or share the Aadhaar number, Aadhaar/identity information for any purpose with UIDAI, ED, NPCI, CKYC, KRA,
CERSAI and with any other authority or regulatory body or as per requirements of law.
16. I/we undertake to inform the Bank regarding any change in my residence/employment/occupation/registered mobile no. and email ID and to provide any
other information that the Bank may require in this regard. I/We acknowledge that the Bank shall be entitled to assign any activity to any third party agency
at its sole discretion.
17. I/We confirm that the above mentioned mobile number is held by me/my guarantor and is not in use by any other third party. I/We authorize Bank
employees/its authorized partners/associates to contact me/us for verifying the veracity of any transaction, as deemed fit by the bank and for providing
information related to Bank’s products and services through e-mail/SMS/phone calls. This consent overrides any registration for NDC.
18. I/We hereby declare that none of our close relative is a director in Bank or other Bank.
19. In case of default by me/us in repayment of the loan or in the payment of the interest thereon or any of the agreed instalments of the loan on due date(s),
the Bank and / or the RBI shall have an unqualified right to disclose or publish the my/our name/names as defaulters / wilful defaulters in such manner and
through such medium as the Bank or RBI in their absolute discretion may think fit.
20. I/We understand that the claims in relation to the insurance voluntarily opted by me/us shall be done at the sole discretion of the insurance company and
neither the Bank nor its officers are in any way responsible for the same.
21. I/We confirm that I/We have had no insolvency proceedings initiated against us nor I/We have ever been adjudicated insolvent(s).
22. I/We further acknowledge that I/we have read, understood and accepted these terms and conditions governing the JLG loan chosen by me/us.
23. I/We understand that I/we can opt to get myself or my spouse or both of us insured against the sanctioned loan amount for the time period of equal to
the loan tenure. The insurance premium, if opted shall be deducted accordingly (rounded to nearest upper 100 multiple) from the sanctioned amount during
disbursement and the remaining amount shall be handed over to me/us.
24. I/we are aware that the insurance tenor is linked to loan tenor and sum insured covers the entire loan amount.
25. I/we would like to know as well avail the benefits of various the Bank loan offer schemes or loan promotional activities or any other promotional
schemes and hereby authorize the Bank, its employees, agents, representatives and associates to do so. I confirm that laws in relation to the unsolicited
communication referred in “national Do Not Call Registry” as laid down by Telecom Regulatory of India will not be applicable for such communications/
calls/ SMSs received from the Bank, its representatives, agents.
26. I/we authorise the Bank to submit application/other relevant documents submitted by me to CERSAI.
27. I/we hereby provide my consent to receive information from Central KYC Registry through SMS/mail on the above registered number/email address.
28. I/We authorize bank to conduct my/our credit history verification with CIBIL or any other credit rating agency and acknowledge that bank shall have
the right and authority to carry out investigations from the information available in public domain for confirming the information provided by me/us to
_____________.
29. I/We have read and understood the terms and conditions and Schedule of Charges governing the opening of the Account/Term Deposit (Fixed Deposit)
with Jana Small Finance Bank and those relating to various services including, but not limited to ATMs / Debit card / Net banking/ Phone banking/Jana Cash
Wallet mentioned hereunder and more in detail mentioned at www.janabank.com and agreed to be bound by it, if account is opened.
30. I/We understand that in order to process my/our loan application, the Bank may open a Savings Account in my/our name. I/We hereby declare that in
case my/our application is rejected by the Bank for any reason whatsoever, the Bank shall be entitled to close the aforesaid savings account without any
intimation to me/us or further consent from me/us.
31. I hereby declare that I have been explained the entire process of the loan to be given to me and usage of card by the JFSB official, Mr./Mrs
in ................................................................................ (Write name of the language spoken/understood by the customer) language spoken/understood by me
and I am fully informed of the same. I have also understood the terms and conditions of the loan being extended to me and subscribe my signature/Left
Thumb Mark in proof of the same. I hereby authorize Jana small finance Bank to disburse my loan amount through a prepaid card /Cash.
32. "I/we confirm that I/we have been explained about the life insurance product offered by Under a master policy issued to Jana Small Finance Bank
Ltd. for life insurance cover. I/we acknowledge and understand that the insurance cover would commence only on the disbursement of loan amount. I/we
further confirm that no payment towards premium, either in full or in part has been made by me in cash on field. I/we hereby execute the proposal form and
acknowledgement form based the above declaration.
33. Declaration on name/DOB (if any) There is mismatch in my name I DOB in the KYC documents. I declare that my name/DOB mentioned in the
following document is correct and request JSFB to consider the same for loan documents.
1..Primary KYC document / KYC
2.Secondary KYC document/ KYC

Signature/Thumb Borrower

VERNACULAR DECLARATION

I confirm that the Co applicant/Guarantor. (name of illiterate Co applicant/Guarantor) who are deemed to be the co-applicant/Guarantor are illiterate(s)
and have been explained the process of the loan and the amount of loan being distributed to the primary customer and both of them have understood the
transaction/their responsibilities as a borrower and co- applicant/Guarantor to Jana Small Finance Bank Ltd. And her/his LTM is duly attested by me
hereunder. Other literate member(s) has also explained the batch functionality and the loan quantum to the primary customer/co-applicant and the declaration
obtained in this regard is given below.
Name of the Declarant who is batch Member

Signature/Thumb Borrower

Inactive and Dormant Account Activation Request (Only for K2 or L2 customers)

I/We confirm that I/we have not operated my/our above Account no. for the following reason __________________________________. I/We request you
to activate my/our above account.

Signature/Thumb Borrower Guarantor

FATCA- CRS Declarations

Please tick the applicable tax resident declaration (Any one)*
I/We am/are a tax resident of India and not a tax resident of any other country [__] Y [__] N
(If no, Separate FATCA Declaration form need to be filled)
The Central Board of Direct Taxes has notified on 7th August 2015 Rules 114F to 114H, as part of the Income-tax Rules, 1962, which Rules require Indian
financial institutions such as the Bank to seek additional personal, tax and beneficial owner information and certain certifications and documentation from
all our account holders. In relevant cases, information will have to be reported to tax authorities / appointed agencies / withholding agents for the purpose
of ensuring appropriate withholding from the account or any proceeds in relation thereto. Should there be any change in any information provided by you,
please ensure you advise us promptly, i.e. within 30 days. If you have any questions about your tax residency, please contact your tax advisor. If you are a
US citizen or resident or green card holder, please include United States in the foreign country information field along with your US Tax $ Identification
Number. It is mandatory to supply a TIN or functional equivalent if the country in which you are tax resident issues such identifiers. If no TIN is yet
available or has not yet been issued, please provide an explanation and attach this to the form.
I have understood the information requirements of this Form (read along with the FATCA / CRS Instructions and Terms and Conditions) and hereby confirm
that the information provided by me/us on this Form is true, correct, and complete and hereby accept the same.

Date :

Place :

Signature/Thumb Borrower

Nomination (only one individual nominee permitted for account opening)

[__] I wish to nominate [__] I do not wish to nominate

Nomination under Section 45 ZA of the Banking Regulation Act, 1949 and Rule2 (1) of the Banking Companies (Nomination) Rules 1985 in respect of bank
deposits.
I/We (Name) (Address) .nominate the following person to whom in the event of my/our/minor's death the amount of deposit in the above account may
be returned by JANA SMALL FINANCE BANK Name .................................................................................... Address: [__] Same as Primary Applicant
[__] If different from Primary Applicant ................................................................................... ........................................................ Relationship with
depositor, if any........................................................ Age [__] Years Date of Birth of nominee............................. *As nominee is minor I/We appoint
(name)........................................................................Relationship with minor*............................... Address: [__] Same as Primary Applicant [__] If
different................................................................................................................ to receive the amount of deposit on behalf of the nominee in the event of my/
our/ minor's death during the minority of the nominee.
Nominee Mobile Number

Signature/Thumb Borrower Guarantor

Place :
Signature :

*Strike out if nominee is not a minor. ** Where account is opened in the name of a minor, the nomination should be signed by a person
lawfully entitled to act on behalf of the minor. *** In case of thumb impression, nomination to be filled in as an annexure. **** I have
understood the benefits of nomination and still do not wish to nominate.