GSTIN - 23AATCA1843R1Z3

BLOCK LETTERS specified

Licence
 Applicant-Co-applicant Signature

Form No.60/61 [see provision to clause (a) of rule 144BC(1)]

From of declaration to be Made by a person who does not have other a Permanent From of declaration to be Made by a person who has agriculture income and is not in
Account Number or General Index Register Number who makes payment in cash in receipt of any other income changeable to income tax in respect of transaction
respect of transaction specified in clauses (a) to (b) rule 144BC. specified in clauses (a) to (h) of rule 114BC.
Full name and address of the declarant Full name and address of the declarant
.......................................................................... ..........................................................................
..................................................................... .....................................................................
................................................................ ................................................................
particulars of transaction particulars of transaction
.................................................................. ..................................................................
Account of transaction Account of transaction
..................................................................... .....................................................................
Are you assessed to tax?Yes/No(if/Yes) Details of the document being produced in support of address in column (1) (I here by
Details of word/Circle/Range where the last return of income was fitted (?) having declare that my source of income is from agriculture and I am not requested to put
Permanent Account Number/General Index Register Number.Detailsof the documents income tax in any other income of any)
being in support of address column in (1) Date:
Date: Place:
Place: ......................................................
Signature of the Declarant

VERIFICATION
I ..................................do hereby declare that the above furnished details are true to the best of my knowledge and belief
verified today,the.........................day of.........................20.....................
Date:...................
Time:...................
...................................................................
Signature of verifying officer
OFFICE USE ONLY

All enclose documents are verified from original and are found satisfactory.Permission is hereby granted to open account.

Loan Account opening Date Loan/Term Deposit Account No. Pigmy/RD/Saving account

First Receipt No. Passbook No./Certificate No.

This Form Checked by

From A To Z NIDHI LIMITED sr.No. A TO Z NIDHI LIMITED sr. No Name.................
Employee Code.............. Seal
Signature................

Page-3
 BLOCK LETTERS specified

Licence

(To be lled in by AToZ Nidhi Limited)

 Guarantor Signature

Applicant-Co-applicant Signature
 I/We and that all the particulars and information given in the application form true, Correct and complete and that they
shall from the basis of any loan, ATOZ NIDHI LIMITED may decide to grant me/us.

I/we undertaking inform ATOZ NIDHI LIMITED regarding change in my/our occupation /employment I residential
address and to provide any other information that the financial company acquire.
I/We confirm that I/We do not avail any other credit-facilities with any bank finance company other than mentioned
above .I/we confirm that if I/We avail any credit facility from any bank financial company in future then I/We furnish
details to financial company immediately. Funds will not be used for speculative purpose. I/We confirm.
I/We also understand that the sanction of the loan is subject to the execution of documents are per financial company
requirements. I/We agree that financial company ATOZ NIDHI LIMITED has right to make any enquiries regarding
me as they think fit.
In view of above it is requested that kindly sanction me loan after due verification of me and my guarantor records by
your verification officer(legal)
Minimum loan amount will be Rs.5000/- and Maximum Rs. 10,00,000/- in case of personal loan etc.
Interest will be charged at rate of4% to 36% P.A. (Flat}.
Repayment of loan will be on monthly installment basis along with flat interest.
Tenure of loan Repayment will be minimum one year and maximum five years.
Loan would provide to government employee working at all place in India.
Loan would be provide Central/State govt. Department except employee of few departments.
If the loss is repaid before the stipulated period the discount would be provided in interest.
File charge and expenditure regarding property verification, mortgage deed, registration, verification, guarantee deed
registration, guarantor verification, agent commission etc. Will be borne by the applicant.
After considering all the facts and able of the loan application, applicant will be lntimated in due course of time
regarding after later of loan by the financial firm/company.
After submitting all papers and completing all formalities as firm/company's requirement by the applicant the financial
firm/company will disburse the loan after verification through cheque or bank draft.
Agent's responsibility will be to work as a mediator till the loan is approved and collect all the papers related to loan,
guarantor's paper etc. And submit the same to financial firm/company. Moreover, the agent has no author or disbursing
of the loan any applicant.
If the applicant is unable to submit necessary spares(related to loan), guarantor bond (to be prepared by the guarantor)
within the stipulated period of time, papers found false or incomplete, guarantor or guarantor's H.O.D.I salary incharge
refuse the official undertaking then financial firm/company will assume that the applicant has failed to fulfil all
formalities of the financial firm/company will assume that the applicant has failed to fulfil all formalities of the financial
firm/company. In this circumstances financial firm/company will have a total right to reject the loan case of this
particular applicant.
In the event of rejected loan case, the applicant no right to ask/claim for the refund of deposited processing fees etc.
(Processing fees etc is non refundable to applicant.)
I (applicant) have read the loan applicable form and understand each and every fact. In my full conscious,
without any pressure and without taking any type of alcoholic/intoxicated. Hence, do accept the written conditions
of application form as the application form carries only the primary conditions related to load. So any other conditions
applicable related to loan after verification will be acceptable to me.
Processing fee will accepted through bank draft only.
Any disputes that will arise under the jurisdiction of MANASA civil court only.

Applicant-Co-applicant Signture

Page-6
 SIGNATURE VERIFICATION

ATOZ NIDHI LIMITED

/Mrs

/Mrs
ATOZ NIDHI LIMITED

Theorem

Affix
Revenue
Stamp

Affix
Revenue
Stamp
 ATOZ Nidhi Limited

is due from me under

the captioned Loan-Cum-Hypothecation Agreement executed by me.I hereby acknowledge and admit
my liability to pay the same to you on demand.

B15
ATOZ NIDHI LIMITED
No Objec on Cer ficate

I...........................son/Daughter/Wife of .......................................aged about........................years,residing

at.................................(hereinafter referred to as the Borrower which expression shall include his/her heir(s),
executor(s), administrator(s), successor(s) and permitted assign(s))

OR

...................................................a company incorporated under the provisions of the Companies Act, 2013 and
having its registered office at ................................................ acting through it’s director S/o .................................
R/o .................................................... authorized by the board resolution (here in after referred to as the Borrower
which expression shall include its successor (s) and permitted assign(s))

OR

M/s.......................................................................... a partnership firm having its principal place of business at .........................

...........................................................acting through its duly authorized partner.......................S/o .......................................
R/o............................................ ( here in after referred or as the Borrower which expression shall deemed to mean and include
all the partner's and their respective heir(s), executor(s) , administrator (s) and its successor (s) and permitted assign(s)

Being insured in terms of the insurance policy bearing no................,...................dated................( the Insurance Policy) availed
from ...................................................................................... to secure the hypothecated vehicle purchased against the loan of
Rs. ......................./ ( Rupees..................................../only) taken vide Agreement- cum- Guarantee, dated......................................
( the Agreement ) ( from ATOZ Nidhi Limited, no Non-Banking Finance Company within the meaning of the RBI Act, 1934, having
its registered office Shop No. 8,Janpad Panchayat, Court Area, Manasa Dist Neemuch ( here in after referred to as the company) ,
have no objection to the Company receiving the insurance claim/benefit under the insurance Policy in the name of the Company.
The Borrower hereby confirms that any money /claim payable to the Borrower in terms of the Insurance Policy shall be payable to
the company ( in the name of the company ) as long as the vehicle in hypothecated with the company and only upon receipt of
such money / claim by the company shall be fully and finally discharged in respect of such payment. This no objection certificate
shall not be valid for any purpose other than for obtaining the payment of the insurance claim in respect of the insurance policy by
the Company in its own name.

Dated :- Signature of Borrower..................................

Place :- ( Name of Borrower) ....................................

In the presence of WITNESSES

Name ( Witness) Address Signature

Borrower ................................ Co- Borrower ........................... Guarantor ................................

Page - 11
FIELD INVESTIGATION REPORT ATOZ NIDHI LIMITED
ATOZ Nidhi Applica on Form Number Reference
FI Officer Name : Field Visit Date:
Purpose of Loan Loan Amount in Rs.
Par culars Applicant Co - applicant Guarantor
Name
Address of Visit ( Same As applica on form) Yes No Yes No Yes No
If No then please men on the address
Rela onship with Applicant
Accommoda on Type Pucca Kuccha Bungalow Pucca Kuccha Bungalow Pucca Kuccha Bungalow

Residence Ownership Self Joint Parent Rent Self Joint Parent Rent Self Joint Parent Rent
If rented,Rent Rs. p.m.
Area Of Sq.
No. of Year at Address
Distance From ‘ATOZ Nidhi ltd.office’(kms)
Nega ve area(Yes/No)
Residence class Lower Middle Upper Lower Middle Upper Lower Middle Upper
BORROWER’S BANKING DETAILS
Bank Name Type of Account
Account Number Account in Use ( No. of Years
Limit Bank Statement Provided ( In Months)
Assets found at the me of visit for applicant
Accessories : Electricity Connec on TV Fridge Telephone cell phone
Equipments : Pump sets Thresher Harvester Compressor Rig
Livestock : Cows Buffaloes Goats Poultry
Implements : Plough Cul vator SeedDrill
Vehicles owned Details :
Vehicle type ( Tractor /CV/ Car Year Model Financier/Free Loan Amount Tenure Completed Tenure Market Value
2 wheeler / other vehicles )

Land Details
Applicant/Co-applicant/ Survey No. Loca on Land Holding (in Acres) Irriga on Source Free/ Encumbered Market Value
Guarantor

Gram Panchayat Name:

Closest Chowk / Circle Village Mee ng Point:

Details of Neighbours
S.No. Name Father Name Address Contact No.
1
2
3
 Geographical Details – MAP

Profile of the Borrower

Declara on
I hereby declare that I have personally met the Applicant, Co - applicant & Guarantor and physically verified the house ,
land and documentary records .I further declare that I have checked the references and found them to be sa sfactory and
that the informa on given above is true to the best of my knowledge. I am aware that any false or incorrect informa on,
misrepresenta on or omission or facts called for in this FIR may result in immediate termina on of my service with
company without any no ce as well as legal ac on against me as per the applicable laws.

Date-------------Borrower Name --------- - Mobile No. ---------------- Borrower Signature ------------------

Telephone number called Tele – Verifica on Report

How long has been using the mobile
Reference number( at least 2 with names)
Proposed of Loan
Finance amount
Rate of interest
No. of Installments & Tenure
Repayment type- Monthly /Quarterly etc.
ODC Charges at 36 % on each installment in rupees per day
1 st Installment Date
Whether FI Person visited the Customer
Assets owned by Customer & Value
No. of Dependents
Source of other income , if any
Other Income Amount
Date of Tele FI
Recommenda ons:-

Signature of FIELD OFFICER ------------ Name ----------- STAFF CODE-------

 o Z
Something a New Every Day
Tick(√)
UMRN
Sponsor Bank Code
I/We hereby authorize
Utility Code
to debit(tick√ )
Date

ATOZ NIDHI LIMITED SB/CA/CC/SB-NRE/SB-NRO/Other

CREATE √
MODIFY Bank a/c number
CANCEL
with Bank IFSC or MICR
an amount of Rupees
FREQUENCY √ Mthly x Qtly x H-Yrly x Yrly x As & when presented DEBIT TYPE x Fixed Amount √ Maximum Amount
Reference 1 Phone No.
Reference 2 Email ID.
I agree for the debit of mandate processing charges by the bank whom I am authorizing to debit my account as per latest schedule of charges of the bank.
PERIOD
From Signature Primary Account Holder Signature Primary Account Holder Signature Primary Account Holder

To
1. Name as in bank records 2. Name as in bank records 3. Name as in bank records
Or √ Until Cancelled
This ACH Mandate shall be valid & binding on me/us for all the agreements/ loan account with ATOZ Nidhi ltd. This is to confirm that the declaration has been carefully read,understood &
made by me/us. I am authorizing the user entity/corporate to debit my account,based on the instructions as agreed and signed by me. I have understood that I am authorized to cancel /
amend this mandate by appropriately communicating the cancellation / amendment request to the user entity/ corporate or the bank where I have authorized the debit.

o Z
Something a New Every Day
Tick(√)
UMRN
Sponsor Bank Code
I/We hereby authorize
Utility Code
to debit(tick√ )
Date

ATOZ NIDHI LIMITED SB/CA/CC/SB-NRE/SB-NRO/Other

CREATE √
MODIFY Bank a/c number
CANCEL
with Bank IFSC or MICR
an amount of Rupees
FREQUENCY √ Mthly x Qtly x H-Yrly x Yrly x As & when presented DEBIT TYPE x Fixed Amount √ Maximum Amount
Reference 1 Phone No.
Reference 2 Email ID.
I agree for the debit of mandate processing charges by the bank whom I am authorizing to debit my account as per latest schedule of charges of the bank.
PERIOD
From Signature Primary Account Holder Signature Primary Account Holder Signature Primary Account Holder

To
1. Name as in bank records 2. Name as in bank records 3. Name as in bank records
Or √ Until Cancelled
This ACH Mandate shall be valid & binding on me/us for all the agreements/ loan account with ATOZ Nidhi ltd. This is to confirm that the declaration has been carefully read,understood &
made by me/us. I am authorizing the user entity/corporate to debit my account,based on the instructions as agreed and signed by me. I have understood that I am authorized to cancel /
amend this mandate by appropriately communicating the cancellation / amendment request to the user entity/ corporate or the bank where I have authorized the debit.

o Z
Something a New Every Day
Tick(√)
UMRN
Sponsor Bank Code
I/We hereby authorize
Utility Code
to debit(tick√ )
Date

ATOZ NIDHI LIMITED SB/CA/CC/SB-NRE/SB-NRO/Other

CREATE √
MODIFY Bank a/c number
CANCEL
with Bank IFSC or MICR
an amount of Rupees
FREQUENCY √ Mthly x Qtly x H-Yrly x Yrly x As & when presented DEBIT TYPE x Fixed Amount √ Maximum Amount
Reference 1 Phone No.
Reference 2 Email ID.
I agree for the debit of mandate processing charges by the bank whom I am authorizing to debit my account as per latest schedule of charges of the bank.
PERIOD
From Signature Primary Account Holder Signature Primary Account Holder Signature Primary Account Holder

To
1. Name as in bank records 2. Name as in bank records 3. Name as in bank records
Or √ Until Cancelled
This ACH Mandate shall be valid & binding on me/us for all the agreements/ loan account with ATOZ Nidhi ltd. This is to confirm that the declaration has been carefully read,understood &
made by me/us. I am authorizing the user entity/corporate to debit my account,based on the instructions as agreed and signed by me. I have understood that I am authorized to cancel /
amend this mandate by appropriately communicating the cancellation / amendment request to the user entity/ corporate or the bank where I have authorized the debit.