Co-applicant 1 ( lg&vkosnd 1) Male iq:"k. Female efgyk. Third Gender rhljs fyax. Married fookghr. Single vfookghr. Family Owned. Self Owned Lo;a dk

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1 Application Form for CB icro Home / Business Loan vtz i= CB icro Home Loan hlhch ekbøks xg yksu Employment: jkstxkj% Salaried osruhkksxh Preferred ailing Address: ojh; kd irk% hlhch ekbøks xg CB icro Business Loan hlhch ekbøks O;kikj yksu Self Employed Lojkstxkj Residence vkokl / O;kikj Office dk;kzy; yksu PLEASE FILL IN BLOCK LETTERS ONL (In case of more than 3 co-applicants, please fill up new application form) i;k vaxzsth ds dsoy Nkis v{kjksa esa Hkjsa ¼3 ls vf/kd lg&vkosndksa dh flfkfr esa] i;k u;k vkosnu i= Hkjsa½ Personal etails ( futh fooj.k) Please affix a recent photograph i;k gky esa [khaph xbz QksVks fpidk, Sign across the photo QksVks ij frjnk glrk{kj djsa Application No.: vkosnu la[;k% Application ate: vkosnu dh frffk Applicant ( vkosnd) Co-applicant 1 ( lg&vkosnd 1) Co-applicant 2 ( lg&vkosnd 2) Co-applicant 3 ( lg&vkosnd 3) Name: uke% ate of Birth: tue frffk% Nick Name: miuke% Relation with Applicant vkosnd ds lkfk ukrk Self Lor% Gender: fyax% ale iq:"k Female efgyk ale iq:"k Female efgyk ale iq:"k Female efgyk ale iq:"k Female efgyk Third Gender rhljs fyax Third Gender rhljs fyax Third Gender rhljs fyax Third Gender rhljs fyax arital Status: osokfgd flfkrh% Single vfookghr arried fookghr Single vfookghr arried fookghr Single vfookghr arried fookghr Single vfookghr arried fookghr No. of Children/s: cppk@cppksa dh la[;k% Father s / Spouse Name: firk@ifr dk uke% other s aiden Name: ekrk dk çfke uke% Name of School where the Children/s is/are Studying: ml fo ky; dk uke tgka cpps i<+ jgs gsa% Current Residential Address: (Address, Landmark, City, Pincode, State) orzeku vkoklh; irk% ¼irk] lhekfpà] 'kgj] fiudks] jkt;½ No. of years at current residence: orez ku vkokl ij jgus dk le; ¼o"kZ eas½% Ownership of Residence: vkokl dk LokfeRo vf/kdkj% Self Lo;a dk Rented fdjk, dk Family ifjokj dk Company daiuh dk Self Lo;a dk Rented fdjk, dk Family ifjokj dk Company daiuh dk Self Lo;a dk Rented fdjk, dk Family ifjokj dk Company daiuh dk Self Lo;a dk Rented fdjk, dk Family ifjokj dk Company daiuh dk Permanent Residence Address: (Address, Landmark, City, Pincode, State) LFkk;h vkoklh; irk% ¼irk] lhekfpà] 'kgj] fiudks] jkt;½ etails of Relatives in and around the Village / City: xkao@'kgj vksj vklikl dss fj'rsnkjksadk fooj.k% Name: uke% Relation: laca/k% Address: irk% obile No.: eksckby uacj% 1

2 Applicant ( vkosnd) Co-applicant 1 ( lg&vkosnd 1) Co-applicant 2 ( lg&vkosnd 2) Co-applicant 3 ( lg&vkosnd 3) Telephone (with ST Code): VsyhQksu ¼,lVhh dks ds lkfk½ % obile No.: eksckbzy uacj% I: bzesy vkbzh% Educational Qualification: 'ksf{kd ;ksx;rk% Religion: /kez% Category: Js.kh% General lkeku; OBC vkschlh General lkeku; OBC vkschlh General lkeku; OBC vkschlh General lkeku; OBC vkschlh SC,llh ST,lVh T hvh SC,llh ST,lVh T hvh SC,llh ST,lVh T hvh SC,llh ST,lVh T hvh NT,uVh NT,uVh NT,uVh NT,uVh Permanent Account Number (PAN): LFkk;h [kkrk la[;k ¼ih,,u½% Voter I No.: ernkrk igpku la[;k% Aadhaar Card No.: vk/kkj dkz la[;k% Available Asset: miyc/k ifjlaifùk% Electricity fo qr TV Vhoh LPG,yihth Kitchen jlksbz?kj RCC Construction vkjlhlh dalvª'ku Vehicle okgu Toilet 'kkspky; Fan ia[kk Refrigerator jsfqztjsvj If LPG is available, Name of LPG company: ;fn,yihth miyc/k gks] rks,yihth daiuh dk uke% If LPG is available, Please provide the Gas Consumer Number and Bill copy ;fn,yihth miyc/k gks] rks i;k xsl mihkksäk la[;k vksj fcy dh çfr çnku djsa HP,pih Indane basu Bharat Gas Hkkjr xwl Reliance fjyk;ul Super Gas lqij xwl Other etails of Business / Employment ( O;olk;@jkstxkj dk fooj.k) Source of Income: vk; dk L=ksr% Salaried: osruhkksxh% Nature of Business: O;olk; dh ç fr% Name of the Concern / Employer: fu;ksäk dk uke% esignation: in% Applicant ( vkosnd) Co-applicant 1 ( lg&vkosnd 1) Co-applicant 2 ( lg&vkosnd 2) Co-applicant 3 ( lg&vkosnd 3) Salaried osruhkksxh aily Wages nsfud etnwjh Public Ltd. ifcyd fyfevs PSU ih,l;q NC,e,ulh Self Employed Lojkstxkj Pvt. Ltd. izk;ogsv fyfevs State jkt; }kjk lapkfyr Salaried osruhkksxh aily Wages nsfud etnwjh Public Ltd. ifcyd fyfevs PSU ih,l;q NC,e,ulh Self Employed Lojkstxkj Pvt. Ltd. izk;ogsv fyfevs State jkt; }kjk lapkfyr Salaried osruhkksxh aily Wages nsfud etnwjh Public Ltd. ifcyd fyfevs PSU ih,l;q NC,e,ulh Self Employed Lojkstxkj Pvt. Ltd. izk;ogsv fyfevs State jkt; }kjk lapkfyr Salaried osruhkksxh aily Wages nsfud etnwjh Public Ltd. ifcyd fyfevs PSU ih,l;q NC,e,ulh Self Employed Lojkstxkj Pvt. Ltd. izk;ogsv fyfevs State jkt; }kjk lapkfyr Business / Employment Address: jkstxkj dk irk% Telephone (with ST Code): VsyhQksu ¼,lVhh dks ds lkfk½% No. of years in current Business / Employment: orzeku jkstxkj esa o"kz dh la[;k% No. of employees in Business: OO;olk; esa dezpkfj;ksa dh la[;k% etails of previous business / Employment: finys jkstxkj dk fooj.k% 2

3 Bank Account etails ( c d [kkrk fooj.k) Name of Account Holder [kkrk /kkjd dk uke Bank csad Branch 'kk[kk Account Operated Since [kkrk lapkyu frffk Account No. [kkrk la[;k Account Type (SA / CA / O) [kkrk dk izdkj ¼,l,@lh,@vksh½ Existing Relationship with CB Bank Limited ( hlhch csad fyfevs ds lkfk ekstwnk laca/k) Loan Account No. _.k [kkrk la[;k Savings / Current Account No. pkyw [kkrk la[;k etails of Asset / Income / Expense / Liabilities ( ifjlaifrr@vk;@[kpz@ns;rkvksa dk fooj.k) Income: vk; Gross onthly Income ldy ekfld vk; Net onthly take home?kj dk 'kq) ekfld fdjk;k Other Sources L=ksr Average onthly Expense vkslr ekfld [kpz onthly Installment you can Pay vkids }kjk Hkqxrku dh tkus okyh ekfld fdlr Asset: ifjlaifùk% Property laifùk Agri Land f"k Hkwfe Land Holding (acres) tksrkbz dh Hkwfe ¼,d+½ otor Vehicle eksvj okgu If yes, Please provide Vehicle registration No. ;fn gka] rks i;k okgu iathdj.k la[;k çnku djsa LIC,yvkbZlh Fixed eposits lkof/k tek NSC,u,llh Provident Fund Hkfo"; fu/kh Public Provident Fund yksd Hkfo"; fu/kh Chit Funds / Pygmy Savings fpv Qa@fiXeh cpr Other Securities / Bonds c U Applicant ( vkosnd) Co-applicant 1 ( lg&vkosnd 1) Co-applicant 2 ( lg&vkosnd 2) Co-applicant 3 ( lg&vkosnd 3) Existing Loans ( ekstwnk _.k) If you avail any loan mentioned below: ;k vkius fueu esa ls dksbz _.k fy;k gs% Home Loan vkokl _.k nkslrksa@lacaf/k;ksa ls _.k Please provide the details: i;k fooj.k çnku djsa% Name & address of institution from whom loan has been ml lalfkk dk uke vksj irk tgka ls _.k fy;k x;k gs% Auto Loan fj'kk _.k Unsecured Loans from Friends / Relatives Gold Loan Lo.kZ _.k Business Loan O;olk; _.k Education Loan f'k{kk _.k Loans from oneylender / Societies / Trusts nsunkjksa@lekt@vªlv ls _.k Personal Loan futh _.k Loan from icrofinance Institution ekbøksfqukel lalfkk ls _.k Applicant ( vkosnd) Co-applicant 1 ( lg&vkosnd 1) Co-applicant 2 ( lg&vkosnd 2) Co-applicant 3 ( lg&vkosnd 3) Purpose of Loan: _.k dk mís';% Balance Outstanding (): cdk;k 'ks"k jkf'k (): Balance Term (): 'ks"k vof/k ¼½% Balance Repayment (): 'ks"k jkf'k dh vnk;xh (): Total Liabilities (): dqy ns;rk,a (): 3

4 Property / Security Offered ( izlrkfor laifrr@izfrhkwfr) Property Address: laifùk dk irk% Landmark: lhekfpà% State: jkt;% Area of Land: Hkwfe dk {ks=qy% Property Type: laifùk dk çdkj% Occupancy: vf/khkksx% Approx Value : yxhkx ew; : Residential vkoklh; Self Occupied Lo vf/kdkj Loan etails (_.k fooj.k) Commercial okf.kft;d Rented fdjk, ij Number of family members residing in the same house (Including children/s):,d?kj esa jgus okys ifjokj ds lnl;ksa dh la[;k ¼cPpk@cPps lfgr½% Total onthly Family Income : ifjokj dh dqy ekfld vk; : Total onthly Installment you can Pay : vki dqy fdruh ekfld fdlrksa dk Hkqxrku dj ldrs gsa : City: 'kgj% Industrial vks ksfxd Country: ns'k% Area of House / Flat / Office:?kj@ ysv@dk;kzy; dk {ks=qy% Agri Land f"k Hkwfe Leased Vacant yht ij fjä Free / Encumbered (If encumbered, etails to be given) _.kxzlr ¼;fn _.kxzlr gks] rks fooj.k fn;k tk,½ Open Land [kkyh Hkwfe Under Construction fuekz.kk/khu Ownership Type: LokfeRo dk çdkj% Sole,dy Number of family members in your house sharing same kitchen: vkids?kj esa,d gh jlksbz?kj dk lk>k djus okys ifjokj ds lnl;ksa dh la[;k% Total onthly Family Expenditure : ifjokj dk dqy ekfld O;; : Pin: fiu% Joint la;qä Purpose of Loan: _.k dk mís';% Purchasing Vehicle okgu [kjhnuk Please provide purpose of Loan in detail i;k _.k ds mís'; dk fooj.k folrkj ls nsa Purchase of residential Property for self occupation Lo jkstxkj ds fy, vkoklh; laifùk dh [kjhn arriage of Children cppksa dh 'kknh Education of Children cppksa dh f'k{kk Home Construction xg fuekz.k Purchase of urables fvdkå olrqvksa dh [kjhn Home improvement xg lq/kkj Furnishing of Home?kj dh ltkov Business O;olk; Furnishing of Office dk;kzy; dh ltkov Loan Amount Required : vko';d _.k jkf'k : Loan Tenure: _.k dh vof/k% onths ekg Interest Rate: C;kt nj% Floating yksvhax Fixed and Floating fql vksj yksfvax Reference etails ( lanhkz fooj.k) Name uke Reference 1 ( lanhkz 1) Reference 2 ( lanhkz 2) Relation: laca/k% Address: (Address, Landmark, City, Pincode, State) irk% ¼irk] lhekfpà] 'kgj] fiudks] jkt;½ Telephone (with ST Code): VsyhQksu ¼,lVhh dks ds lkfk½% obile No.: eksckby uacj% 4

5 Processing Fee etails ( çlaldj.k 'kqd fooj.k) Processing Fee (non refundable) : çfø;k 'kqd ¼vçR;kiZ.kh;½ : rawn on ns; Cheque / Number: uacj% I / We agree to open a Savings / Current Account with CB Bank Limited (CB Bank) esa@ge hlhch csad fyfevs ¼hlhch csad½ ds lkfk cpr@djsav [kkrk [kksyus ds fy, lger es gka No ugha ated: frffk% in favour of CB Bank Limited CB Bank Limited ds i{k CB Current and Savings Accounts come with a host of benefits such as Free RTGS / NEFT, Payable at Par Cheque Book, Free Phone / Internet / obile Banking, Free access to VISA ATs, Any Branch Banking and much more. hlhch pkyw vksj cpr [kkrk esa dbz çdkj ds ykhk feyrs gsa tsls fd fu%'kqd ikj psd cwd esa ns;] fu%'kqd Qksu@baVjusV@eksckby csafdax] fotk ds fy, fu%'kqd,lsl,vh,e] fdlh Hkh 'kk[kk esa csafdax vksj cgqr dqna Name uke Signature glrk{kj Applicant vkosnd Co-applicant 1 lg&vkosnd 1 Co-applicant 2 lg&vkosnd 2 Co-applicant 3 lg&vkosnd 3 Services ( lsok, ) SS Banking & Alert Facility:,l,e,l csafdax vksj lpsrd lqfo/kk% Alerts facility enables you to receive alerts on your and / or obile regarding large debit, large credits, Standing Instruction failure, balance below Account Quarterly Balance and balance update. New alerts may be added from time to time. lpsrd lqfo/kk vkidks vius bzesy ;k eksckby ij c+s sfcv] c+s ØsfV] LFkk;h :i ls foqy gksus ij funsz'k] [kkrk =Sekfld 'ks"k jkf'k ls de dh jkf'k vksj 'ks"k jkf'k visv ls lacaf/kr lpsrd çkir djus esa l{ke cukrh gsa le; ij lekpkj lpsrd Hkh tks+s tk ldrs gsaa I / We don t wish to receive any Bank related promotional calls, SS alerts or s. ge csad ls lacaf/kr fokkiu d l],l,e,l lpsrd ;k bzesy çkir ugha djuk pkgrk gsaa CB On The Go (obile Banking) hlhch& vkwu n xks ¼eksckbZy csafdax½ Phone Banking Qksu csafdax Preferred Language Options: ojh; Hkk"kk fodi% English vaxzsth Hindi fganh I / We do not wish to register for CB On The Go (obile Banking). CB On The Go is an opt out service option, CB On The Go facilitates the customer to place Requests, gather Account Information and Fund Transfer to CB / Non CB Accounts. By availing this customer is accepting the terms and conditions related to CB On The Go Instant obile Banking updated on ge hlhch v u n xks ¼eksckby csafdax½ ds iathdj.k djokuk pkgrk gsaa n xks,d v IV vkmv lsok fodi gs] hlhch v u n xks xzkgd dks vuqjks/k djus] [kkrk tkudkjh,d= djus vksj xsj hlhch csad ds [kkrksa esa fuf/k varfjr djus dh lqfo/kk çnku djrk gsa xzkgd bu lqfo/kkvksa dks miyc/k djkdj hlhch v u n xks ls lacaf/kr fu;eksa,oa 'krksaz dks Lohdkj dj ysrs gsa & balvsav eksckby csafdax arathi ejkbh Gujarati xqtjkrh Tamil rfey Telugu rsyqxw Terms and conditions: I / We have read, understood and hereby agree to the Terms and conditions as applicable to my / our account set forth on CB Bank Limited ( CB Bank, the Bank s ) website at I / We understand that access to any changes / updates in terms and conditions applicable to this relationship shall be available on the Bank s website only. I / We do hereby declare that information furnished in this Form is true and correct to the best of my / our knowledge and belief. I / We hereby authorise issuance of AT / ebit Card and provision of Phone Banking, obile Banking Services, Internet Banking and Bill Payment Services. I / We are aware of Charges Applicable for various services offered and I / we affirm, confirm and undertake that I /we have read and understood the Terms and Conditions for usage of the Phone Banking, obile Banking Services, Internet Banking and Bill Payment Services of CB Bank Limited as set forth in the Bank's website and I / we will adhere to all the terms / conditions as applicable from time to time. fu;e,oa 'krsza% geus hlhch csad fyfevs ¼Þhlhch csadß] ÞcSad dkß½ ds osclkbv ij mfyf[kr gekjs [kkrs ds fy, ykxw fu;eksa,oa 'krksaz dks i<+ vksj le> fy;k gs vksj ge blls lger ge le>rk gsa fd bl laca/k ds fy, ykxw fu;eksa,oa 'krksaz esa fdlh Hkh çdkj dk dk,lsl dsoy csad dh osclkbv ij miyc/k jgsxka ge ;g?kks"k.kk djrk gsa fd bl çi= esa çlrqr tkudkjh tkudkjh vksj fo'okl ds vuqlkj lr; gsa ge,vh,e@ sfcv dkz ds fuxzeu] rfkk Qksu csafdx] eksckby csafdax lsok,a] bavjusv csafdax vksj fcy Hkqxrku lsokvksa ds çko/kku ds fy, vf/k r gsaa ge fofhkuu çdkj dh çnùk lsokvksa ij ykxw 'kqd ls voxr gsa vksj ge çfrkku] iqf"v vksj opu nsrk nsrs gsa fd hlhch csad dh osclkbv esa mfyf[kr Qksu csafdax] eksckby csafdax] bavjusv csafdax vksj fcy Hkqxrku lsokvksa ds mi;ksx ds fu;eksa,oa 'krksaz dks i<+ vksj le> fy;k gs vksj ge le; ij ykxw lhkh 'krksaz dk ikyu djsaxsa CB 24-Hour Customer Care customercare@dcbbank.com Call Toll Free Website Please call CB 24-Hour Customer Care to enquire about your account application status vius [kkrk vkosnu dh flfkfr ds ckjs esa tkudkjh ds fy, i;k hlhch ds 24&?kaVs xzkgd lsok ls laidz djsa

6 a eclaration (?kks"k.kk) 1. the basis of any facility CB Bank Limited (the Bank ) may decide to grant me/us. The Bank has the right to reject the application in case any of the information provided in this application form is found to be false / incorrect / misleading. esa@ge?kksf"kr djrk gw fd vkosnu i= esa fn;s x, lhkh C;ksjs vksj tkudkjh lr;] lgh] vksj iw.kz vksj lhkh rjg ls v ru gs vksj esaus@geusa dksbz Hkh tkudkjh fnikbz ugha gsa esa@ge le>rs vksj Lohdkj djrs gsa fd eq>s@gesa fdlh Hkh lqfo/kk dks çnku djus ds fy, facility hlhch csad fyfevs ¼ÞcSadß½ vafre QSlyk ysxka bl vkosnu i= esa nh xbz dksbz Hkh tkudkjh xyr@vlr;@viw.kz ik;h tkus ij csad ds ikl vkosnu jí djus dk vf/kdkj gsa 2. and that I / we have never been adjudicated insolvent or bankrupt by any Court or other authority. esa@ge iqf"v djrk gsa fd esjs@gekjs fo#) fnokfy;kiu dh dksbz dkjzokbz çkjahk ugha dh xbz gs vksj u gh eq>s@gesa fdlh U;k;ky; ;k çkf/kdkjh }kjk fnokfy;k fu.khzr fd;k x;k gs ;k cdk;k jkf'k dh olwyh] laifùk ls lacaf/kr] xahkhj dnkpkj ds fdlh ekeys esa esjk@gekjk dksbz ekeyk U;k;ky; esa yafcr gsa 3. 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, trustee esjs@gekjs f[kykq lekiu] fo?kvu] lapkyu] iquxzbu ;k fdlh çkirdrkz] O;oLFkkid] ç'kklfud çkirdrkz] VªLVh dh fu;qfä ;k U;k;ky; esa esjs@gekjh laifùk ds fy, blh rjq ds dk;kzy; ls lacaf/kr dksbz ekeyk ntz ugha gs u gh fdlh rjg dh dkjzokbz dh xbz gs vksj u gh dksbz dne mbk, x, gsaaaa 4. statutory/regulatory bodies, etc., as the Bank may deem necessary or appropriate as may be required for use of processing of the said information / data by such person(s). esa@ge fcuk 'krz csad dks vius lhkh svk] vkosnu vksj orzeku _.k ;k csadksa] foùkh; lalfkkuksa] ØsfV C;wjks],tsafl;ksa] lkafof/kd@fu;ked fudk;ksa ds iquhkqzxrku@_.k fooj.k br;kfn] ls lacaf/kr nlrkostksa vksj tkudkfj;ksa dks lk>k djus ds fy, çkf/k r djrk gsaa csad,sls O;fä;ksa }kjk mi;qzä tkudkjh@svk ds çlaldj.k ds fy, vko';d tkudkjh ysus ds ckjs esa fopkj dj ldrk gsa 5. I / We understand, agree and acknowledge that the Bank shall have the absolute discretion, without assigning any reasons, to reject my / our application and that I/we reserve no right to appeal against this decision of the Bank. I/we further agree that the Bank 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 consequences, caused by reason of such rejection or any delay in notifying me / us of such rejection, of our application. esa@ge le>rs gsa] bl ckr ls lger vksj Lohdkj djrs fd csad fcuk dksbz dkj.k crk,] esjk gekjk vkosnu jí dj ldrs gsa vksj esa@ge csad ds bl fu.kz; ds f[kykq vihy djus dk dksbz vf/kdkj ugha j[krs gsaa esa@ge vkxs bl ckr ls lger fd,slh fdlh vloh fr ;k eq>s@gesa ;g lwpuk nsus esa fdlh Hkh rjg dh nsjh ;k vkosnu esa gqbz bl nsjh dh otg ls fdlh vfrfjä /ku] gkfu] {kfr ;k [kpz] ;k ifj.kkeksa ds fy, esjs@gekjs fy, csad fdlh Hkh :i esa mùkjnk;h@fteesnkj ugha gksxka 6. The Bank reserves the right to retain the photographs and documents submitted and will not return the same to the applicant and/or co-applicant. csad us tek djkbz xbz rlohjksa vksj nlrkostksa dks vius ikl j[kus ;k vkosnd ;k lg&vkosnd dks iqu% ugha yksvkus dk vf/kdkj vius ikl lqjf{kr j[kk gsa 7. esa@ge u rks csad ds funs'kdksa esa ls fdlh ls lacaf/kr gsa vksj u gh esa@ge mldh@mlds fj'rsnkj gsaa tslk fd daiuh vf/kfu;e] 1956 ds /kkjk 6 vkj@c;w ds rgr ifjhkkf"kr fd;k x;k gsa 8. I / We have been explained the product features of the loan I / we have applied for. I / We have understood the terms and conditions of icrohousing Home Loan/ icrohousing Business Loan product of the Bank and I / we agree to abide by them. esaus@geus ftl _.k ds fy, vkosnu fd;k gs ml _.k ds mrikn fo'ks"krkvksa ds ckjs esa eq>s@gesa le>k;k x;k gsa esaus@geus ekbøksgkmftax xg _.k@ekbøksgkmftax O;kikj _.k ds mriknksa ds fu;e vksj 'krksaz dks le> fy;k gs vksj esa@ge muds }kjk ikyu djus ds fy, lger 9. le; le; ij] csad vius xzkgdksa ds fy, fofhkuu lqfo/kkvksa@mriknksa@fokkiu }kjk NqV çlrqr djrk gsa tks xzkgdksa ds fy, lkfkzd ykhk dh is'kd'k djrh gs ;k,slk is'kd'k nsus ds fy, rrh; i{k,tsafl;ksa dh lgk;rk ysrh gsa ;k vki pkgrs gsa fd ge bl rjg ds ykhk ds ckjs esa vkidks lwfpr djsa \ I / We expressly authorize the Bank to use information or data relating to me / us, for communicating marketing offers as outlined above. esa@ge foi.ku laokn ds :i esa Åij js[kkafdr is'kd'k ds fy, vius@gekjs ls lacaf/kr tkudjh ;k svk ds blrseky ds fy, Li"V :i ls csad dks çkf/k r djrk gsaa I / We do not wish to receive offers as outlined above. esa@ge tslk fd Åij js[kkafdr fd;k x;k gs oslh is'kd'k çkir djus dh bpnk ugha j[krk gsaa 10. I / We understand that Processing Fee and Administrative Fee are non refundable and my / our application being rejected by the Bank for any reason or same being withdrawn by me/us, I / we shall not be entitled to refund of same. esa@ge tkurs gs fd çlaldj.k 'kqd vksj ç'kklfud 'kqd vçr;kiz.kh; gs vksj ;fn csad esjk@gekjk vkosnu fdlh Hkh dkj.k jí dj nsrk gs ;k fdlh dkj.k esa@ge bl jde dks csad ls fudky ysrs gsa rks esa@ge /ku okilh ds gdnkj ugha gksaxsa 11. I / We undertake to guarantee the loan granted by the Bank to me/us. esa@ge csad }kjk eq>s@gesa fn, x, _.k dks pqdkus dh xkjavh ysrk gsaa esa@ge fcuk fdlh 'krz ds csad dks Hkkjrh; fjtoz csad }kjk fu;qä fdlh foùkh; daiuh@csad@øsfv C;wjks@fjtoZ csad v Q baf;k ¼vkjchvkbZ½@,tsalh@,tsafl;ka ls esjs@gekjs _.k fooj.k dh tkudkjh çkir djusds fy, çkf/k r djrk gw A esa@ge bl ckr dh iqf"v djrk gsa fd çkir _.k vo;kogkfjd ;k vlkekftd mís'; dks iwjk djus ds fy, ugha fd;k tk,xka 14. I / We undertake to inform the Bank regarding the change in my/our occupation/employment and to provide any further information and documents that the Bank may require from time to time. esa@ge vius@gekjs O;olk;@jkstxkj esa cnyko ;k le; ij dksbz Hkh tkudkjh ;k nlrkost ftldh csad dks vko';drk gs mls esa@ge csad dks nsus ds fy, ds fy, çfrc) gsaa 15. I / We agree that my/our facility shall be governed by the terms and conditions of the Bank that are in force and may be amended by the Bank at its absolute discretion from time to time. esa@ge blls lger gsa fd esjk@gekjh lkjh lsokvksa dks csad ds fu;eksa vksj 'krksaz }kjk fu;af=r fd;k tk,xk ftls le; ij vius laiw.kz vf/kdkj ds rgr csad }kjk la'kks/ku fd;k tk ldrk gsa 16. I / We have understood, acknowledge and agree that a request and demand for any information and documents by any authority under the law will be mandatorily complied with by the Bank. esa@ge ;g tkurs gsa Lohdkj djrs gsa vksj lger gsa fd dkuwu ds rgr fdlh Hkh vf/kdkjh }kjk fdlh Hkh tkudkjh vksj nlrkost dk vuqjks/k ;k ekax djuk csad ds laiw.kz vf/kdkj {ks= esa vkrk gs ftldk csad }kjk vuqikyu fd;k tk,xka 17. I / We agree as a pre-condition of the facility given to me/us by the Bank and in that case, I/we commit default in the repayment of the facility or in the payment of interest thereon or any of the agreed instalment of the facility on the due date(s), the Bank and/or the Reserve esa@ge csad }kjk nh xbz lqfo/kk ds fy,,d iwoz 'krz ds :i esa lger ftlds rgr] esa@ge ;fn _.k dh vnk;xh ;k fu;r fnukad ij C;kt ugha pwdk ikus ;k igys ls r; fdlr ds Hkqxrku dh vnk;xh ugha djus ij vlefkz gksrs gsa rks Hkkjrh; fjtoz csad ¼vkjchvkbZ½ ds ikl,sls cdk,nkjksa dk esjs@gekjs uke ¼esjs@gekjs QksVksxzkQ lfgr½ [kqyklk ;k çdkf'kr djus dk,d v;ksx; vf/kdkj gksxka,sls cdk,nkj@jksa ;k,slh flfkfr esa lokzf/kdkj vkjchvkbz vksj csad ds ikl lqjf{kr gksxka 18. It will be in order for the Bank to disqualify / deny me/us from receiving any credit facility(ies) from the Bank in case it is proved that the declaration of my/our existing credit facility(ies) made above contains misrepresentation of facts. esjs@gekjs orzeku _.k lqfo/kk dh?kks"k.kk esa rf;ksa dh xyr tkudkjh lkfcr gksus dh flfkfr esa csad fdlh Hkh _.k lqfo/kk çkir djus ls eq>s@gesa budkj@ v;ksx;?kksf"kr dj ldrk gsa Applicant vkosnd Signature glrk{kjh Co-applicant 1 lg&vkosnd 1 Signature glrk{kjh Co-applicant 2 lg&vkosnd 2 Co-applicant 3 lg&vkosnd 3 Sourcing Channel ( lksflzx a psuy) Name and HRS Code of Sourcing Employee: uke v j lksflzx dezpk jh ds HRS dks% Branch Employee name and HRS Code: 'kk[kk dezpk jh dk uke v j HRS dks% For Bank Use Only ( dsoy dk;kzy; ç;ksx ds fy, ) Signature glrk{kjh Signature glrk{kjh Branch: 'kk[kk: Loan Application received on. Processing Fee (cheque / ) received on. Request will be disposed of and acceptance / rejection notification will be mailed within 15 (fifteen) days from the date of the receipt of duly completed application form with all supporting documents, as required by CB Bank Limited. _.k vkosnu dks çkira çfø;k 'kqd ¼psd@hh½ dks çkira vuqjks/k dk fujkdj.k vksj Loh fr@vloh fr dh vf/klwpuk hlhch csad fyfevs }kjk visf{kr lhkh lgk;d nlrkostksa ds lkfk fof/kor :i ls Hkjs gq, vkosnu dh çkfir dh frffk ls 15 ¼iaæg½ fnuksa ds Hkhrj Hkst nh tk,xha ated: frffk: 335-Ver 1.0-Aug 2013 CB Bank Limited (Formerly evelopment Credit Bank Limited) 019 / June 15 / 1.2 Acknowledgement ikorh Loan Application received on. Processing Fee (cheque / ) received on. Application No.: vkosnu la[;k% Request will be disposed of and acceptance / rejection notification will be mailed within 15 (fifteen) days from the date of the receipt of duly completed application form with all supporting documents, as required by CB Bank Limited. _.k vkosnu dks çkira çfø;k 'kqd ¼psd@hh½ dks çkira vuqjks/k dk fujkdj.k vksj Loh vloh fr dh vf/klwpuk hlhch csad fyfevs }kjk visf{kr lhkh lgk;d nlrkostksa ds lkfk fof/kor :i ls Hkjs gq, vkosnu dh çkfir dh frffk ls 15 ¼iaæg½ fnuksa ds Hkhrj Hkst nh tk,xha Authorised Signatory vf/k r glrk{kjh ated: frffk: Authorised Signatory vf/k r glrk{kjh

7 ENROLENT FOR - GROUP PERSONAL ACCIENT INSURANCE (Accidental eath & Permanent Total isablement) *Fields are andatory es, I wish to enrol for Group Personal Accident Insurance Plan CB Bank Account Number / Account Opening Form Number: (For new customers) CB Bank Customer I: (For existing customers) Existing Royal Sundaram GPA Policy Number: Group Personal Accident Insurance Plan (Please tick any one of the below 8 options) Coverage eath + Permanent Total isability eath + Permanent Total isability + ouble benefit for salaried person for accident on duty by Rail / Road / Air es, I wish to enrol for the auto renewal of Group Personal Accident Insurance for additional 3 year 5 years 10 years Plan Plan A Plan G Plan B Plan C Plan F Plan H Plan Plan E Sourcing Staff Name: Sum Insured 5,00,000 10,00,000 15,00,000 25,00,000 30,00,000 10,00,000 15,00,000 25,00,000 Sourcing Staff Name HRS Number: Premium ,826 3,044 3,653 1,350 2,029 3,348 Option Chosen (þ) Incase auto renewal is chosen without specifying tenure, additional 1 year auto renewal will be taken as default. The maximum Sum Insured allowed for any one customer, across one or more policies, should not exceed 30 Lakhs (standard variant only). *Name: r. rs. s. r. Prof. (First Name) (iddle Name) (Last Name) *ate of Birth: Telephone: (with ST Code) *Preferred obile No.: Preferred aximum 32 characters Annual Income: < 50,000 50,000-1,50,000 1,50,001-3,00,000 3,00,001-5,00,000 > 5,00,001 *Occupation: Salaried Business Self Employed House Wife Student Politician Agri Allied Retired / Pensioner Salaried: Proprietorship Partnership Pvt. Ltd. Public Ltd. Public Sector Central / State Government ultinational (Please specify): *Nominee: Nominee Gender: ale Female Third Gender andatory *Nominee Age: ears *Relationship of Nominee with Applicant: *ention Guardian / Appointee Name in case Nominee is a minor: Royal Sundaram Alliance Insurance Company Limited, Sundaram Towers, 45 & 46, Whites Road, Chennai ENROLENT FOR - GROUP PERSONAL ACCIENT INSURANCE PLAN (Accidental eath & Permanent Total isablement) This application is for Group Personal Accident Insurance Cover only. It is not a cover for Life Insurance or ediclaim. A worldwide personal accident cover plan that is specially designed to give comprehensive protection to help you / your family against financial crisis due to Accidental eath or Permanent Total isablement. Key Features: Worldwide Cover No Waiting Period Sum Insured Options: Coverage eath + Permanent Total isability eath + Permanent Total isability + ouble benefit for salaried person for accident on duty by Rail / Road / Air Plan Plan A Plan G Plan B Plan C Plan F Plan H Plan Plan E Sum Insured 5,00,000 10,00,000 15,00,000 25,00,000 30,00,000 10,00,000 15,00,000 25,00,000 Premium ,800 3,000 3,600 1,330 2,000 3,300 The maximum Sum Insured allowed for any one customer, across one or more policies, should not exceed 30 Lakhs (standard variant only). Key Benefits: eath Benefit: In the unfortunate event of a fatal accident, the Sum Insured shall be paid to the nominee of the Insured Person. In the unfortunate event of an accident resulting in Permanent Total isablement, the Insured Person shall be paid the following % of Sum Insured. a) 100% sum insured in case of loss of sight of both eyes, or of the actual loss by physical separation of two entire hands or two entire feet, or of one entire hand and one entire foot, of such loss of sight of one eye and such loss of one entire hand or one entire foot. b) 100% sum insured in case of loss of use of two hands or two feet or of one hand and one foot, or of such loss of sight of one eye and such loss of use of one hand or one foot. c) 50% sum insured in case of loss of sight of one eye, or of the actual loss by physical separation of one entire hand or of one entire foot. d) 50% sum insured in case of total and irrecoverable loss of use of a hand or a foot without physical separation. e) 100% sum insured in case of permanent and total disability which absolutely disables insured person from engaging in any employment or occupation. For those opting for ouble benefit for eath & PT cover: Claim will be paid for salaried persons who are involved in an accident on duty while traveling by Rail / Road / Air. Who can be Insured Person? This insurance is available to persons who are aged between 18 and 70 years at the commencement date of the Policy and are Account holders of CB Bank Limited (Formerly evelopment Credit Bank Limited) (CB Bank). This is an insurance plan underwritten by Royal Sundaram Alliance Insurance Company Ltd. for customers of CB Bank. our participation in this insurance product is purely on a voluntary basis. CB Bank will be the Group anager for this insurance product and will only be responsible for distributing the insurance product to all members of this group. All Claims under the policy will be solely decided upon by Royal Sundaram Alliance Insurance Company Ltd. This application shall be processed and the premium amount as per option chosen by you shall be debited if it is found acceptable by Royal Sundaram Alliance Insurance Company Limited. The insurance cover shall start on 1st day of succeeding month of the premium amount debit in your CB Bank Account ( commencement date ). This insurance cover will be valid for a period of 1 (one) year from the commencement date, provided you continue to remain a CB Bank account holder during this period. This insurance cover will cease to exist in case the CB Bank Account is dormant, freezed or lien marked for any reason whatsoever. The application will not be accepted till the time such account related disputes are resolved and the said CB Bank Account is reactivated. Renewal reminders for this policy will be conveyed through SS alerts and by CB Bank on the obile No. and respectively as indicated by the Applicant in this Application. If for any reason you need to communicate with Royal Sundaram Alliance Insurance Company Limited, it is adequate that you mention the aster Policy number, CB Bank account number and the branch details. Claim intimation can also be made to Royal Sundaram Alliance Insurance Company Ltd, by contacting them on This is only a brief summary of the insurance product. Please refer to aster Policy No. PACB00001 (available on CB Bank s website issued to CB Bank by Royal Sundaram Alliance Insurance Company Limited for complete information on terms, conditions and exclusions. Royal Sundaram Alliance Insurance Company Limited, Sundaram Towers, 45 & 46, Whites Road, Chennai

8 *PLEASE TICK (ü) AGAINST THE APPLICABLE ESCRIPTION, IF OU FALL UNER AN OF THE BELOW LISTE CATEGORIES. IF OU FALL UNER ORE THAN ONE OF THE LISTE TITLES BELOW, PLEASE TICK AGAINST ALL THE APPLICABLE HEAS. Head of State or Central Government Senior Executive of State or Central- Corporation Senior Politician Important Political Party Official Senior Government / Judicial / ilitary Officer Any other Politically Exposed Person List of hazardous occupations which are not covered in Plan: Aircraft pilots and crew, Armed Forces personnel, Artistes engaged in hazardous performances, Aerial crop sprayer, Bookmaker (for gambling), emolition contractor, Explosives users, Fisherman (seagoing), Jockey, arine salvager, iner and other occupations underground, Off-shore oil or gas rig worker, Policeman (Full time), Pop usicians, Professional sports person, Roofing contractors and all construction, maintenance and repair workers at heights in excess of 50 ft. / 15 m, Saw miller, Scaffolder, Scrap metal merchant, Security guard (armed), Steeplejack, Stevedore, Structural steelworker, Tower crane operator, Tree feller, Ship crew, Travel agency business, Air coupon & ticket business. eclaration: I hereby opt to enrol under Group Personal Accident Insurance Plan ( Plan ). The terms and conditions of the Plan have been duly explained by CB Bank Limited (Formerly evelopment Credit Bank Limited) ( CB Bank ) and I have completely understood the same. I authorize CB Bank to debit the above chosen premium amount from my CB Bank Account towards the payment for this Plan. I understand that the insurance cover shall start on 1st day of the succeeding month of the premium amount debit in my CB Bank Account ( commencement date ). This insurance cover will be valid for a period of 1 (one) year from the commencement date, provided I continue to remain a CB Bank account holder during this period. I understand, in case auto renewal is chosen without specifying tenure, policy will be auto renewed for a tenure of 1 (one) year by default and applicable premium amount debited from my CB Bank Account. I also understand that in the event of an admissible claim due to my death, my nominee shall be receiving the claim amount. I understand that CB Bank shall not have any role in the claim process and the claim shall be processed and settled by Royal Sundaram Alliance Insurance Company Limited ( Royal Sundaram ), as per the claim process stipulated by Royal Sundaram, from time to time. I also understand that the claim shall be processed as per the terms and conditions of the aster Policy No.PACB00001 issued to CB Bank by Royal Sundaram. I hereby declare that the statements, answers and/or particulars given by me are true and complete in all respects to the best of my knowledge and belief. I understand that the information provided by me will form the basis of the insurance policy, is subject to the Board approved underwriting policy of Royal Sundaram and that the insurance policy will come into force only after full receipt of the premium chargeable. I further declare that I will notify in writing any change occurring in my occupation or general health after the proposal has been submitted but before communication of the risk acceptance by Royal Sundaram. I declare and consent to Royal Sundaram seeking medical information from any doctor or from a hospital who at anytime has attended me or from any past or present employer concerning anything which affects my physical or mental health and seeking information from any insurance company to which my application for insurance has been made for the purpose of underwriting the proposal and/or claim settlement. I authorize Royal Sundaram to share information pertaining to my proposal including the medical records for the sole purpose of proposal underwriting and/or claims settlement and with any Governmental and/or Regulatory authority. This application is for Group Personal Accident Insurance Cover only. It is not a cover for Life Insurance or ediclaim. *ate: Signature of the Applicant: Section 41 of the Insurance Act, 1938 Prohibition of rebates - 1. No person shall allow or offer to allow, either directly or indirectly, as an inducement to any person to take out or renew or continue an insurance in respect of any kind of risk relating to lives or property in India, any rebate of the whole or part of the commission payable or any rebate of the premium shown on the policy, nor shall any person taking out or renewing or continuing a policy accept any rebate, except such rebate as may be allowed in accordance with the published prospectuses or tables of the insurer. Provided that acceptance by an insurance agent of commission in connection with a policy of life insurance taken out by himself on his own life shall not be deemed to be acceptance of a rebate of premium within the meaning of this sub-section if at the time of such acceptance the insurance agent satisfies the prescribed conditions establishing that he is a bona fide insurance agent employed by the insurer. 2. Any person making default in complying with the provisions of this section shall be punishable with fine which may extend to five hundred rupees. Cancellation charges applicable in Plan: Cancellation & Reversal of premium in the same month of premium debit - NIL Less than 1 month from Policy commencement date - 25% of annual premium amount Between 1 month and less than 3 months from Policy commencement date - 50% of annual premium amount Between 3 months and less than 6 months from Policy commencement date - 75% of annual premium amount 6 months and above from Policy commencement date - Full annual premium amount CB Bank Limited (Formerly evelopment Credit Bank Limited) Name of the Applicant: CB Bank Account Number: ACKNOWLEGENT CB Bank Account Opening Form Number: ate: Instruction received to debit from CB Bank Account towards Group Personal Accident Insurance Premium. (Note: Certificate of Insurance will be couriered at your mailing address / ed on your registered I post issuance of the policy. Insurance cover will start on 1st day of succeeding month of the premium amount debit from your Account with CB Bank) This application is for Group Personal Accident Insurance Cover only. It is not a cover for Life Insurance or ediclaim. Applicant s Signature: Authorised signatory for CB Bank: List of hazardous occupations which are not covered in Plan: Aircraft pilots and crew, Armed Forces personnel, Artistes engaged in hazardous performances, Aerial crop sprayer, Bookmaker (for gambling), emolition contractor, Explosives users, Fisherman (seagoing), Jockey, arine salvager, iner and other occupations underground, Off-shore oil or gas rig worker, Policeman (Full time), Pop usicians, Professional sports person, Roofing contractors and all construction, maintenance and repair workers at heights in excess of 50 ft. / 15 m, Saw miller, Scaffolder, Scrap metal merchant, Security guard (armed), Steeplejack, Stevedore, Structural steelworker, Tower crane operator, Tree feller, Ship crew, Travel agency business, Air coupon & ticket business. Cancellation charges applicable in Plan: Cancellation & Reversal of premium in the same month of premium debit - NIL Less than 1 month from Policy commencement date - 25% of annual premium amount Between 1 month and less than 3 months from Policy commencement date - 50% of annual premium amount Between 3 months and less than 6 months from Policy commencement date - 75% of annual premium amount 6 months and above from Policy commencement date - Full annual premium amount Royal Sundaram Alliance Insurance Co. Ltd. Call Write customer.services@royalsundaram.in Visit CB 24-Hour Customer Care customercare@dcbbank.com Call Toll Free Website CB Bank Limited (Formerly evelopment Credit Bank Limited) 8

9 APPLICATION FOR No. Please mention CB Bank Limited Home Application No. andatory* Customer Information - Part A The proposal form is to be filled in by the applicant. Please answer all questions fully and correctly. Where any question does not apply, please mention clearly that the same is not applicable Loan Account No. (LAN) - mandatory: Customer I: Gender: ale Female Third Gender Status of the Applicant: Loan Applicant Co-applicant Funded Non Funded Occupation: Salaried Self-employed Name of the Applicant (Loan Applicant / Co-applicant to be Insured): r. / rs. / s. ailing Address: Pincode: obile No.: I I I I I I I I I I I I I.: Nominee Name: Relationship of nominee with applicant Type of Loan to be insured: HOE LOAN / LAP Loan Tenure: years Policy Tenure: years ate of Birth: I I I / I I I / I I I I I Loan Amount (Rs.): Premium Amount: Sum Insured Cheque Amount: PAN No. : Cheque No.: Cheque Name: Cheque ate: / / Table of Benefits: Age Group Coverage SI Basis ears ears Benefit A: ajor edical illness & Procedure Benefit B: Personal Accident Benefit C: Loss of Job Benefit A: ajor edical illness & Procedure Benefit B: Personal Accident Benefit C: Loss of Job Group Secure ind - Part B Fixed (Loan Sanction Amount) 3 EI's Reducing (Principal Out-Standing) 3 EI's * Benefit - C: Loss of Job is only available for Salaried employees: In case the proposed individual is not a salaried employee, he/she is eligible for 2% discount Sum Insured under Benefit - A or B cannot exceed loan sanction amount. The Sum Insured basis is fixed for the age group years and Reducing for age group between 46 to 50 years. Please tick appropriate box under the table of illness in case the person applicant for insurance i. has either been diagnosed of or is suffering from or has any symptoms pertaining to, or ii. has undergone any of the below mentioned major medical illness and procedures Table of Illness: yocardial Infarction (Heart Attack) Stroke Coronary Artery Bypass Surgery End stage Renal Failure Cancer ultiple Sclerosis Heart valve Replacement Paralysis ajor Organ Transplant Please provide the name(s) and details about any illness or medical condition that the applicant is currently suffering from or may have suffered in the past or any surgery which he/she may have undergone. eclaration : I hereby declare and confirm that the above statements are true and complete in all respects and that there is no other information which is relevant to my application for insurance for myself or any other person to be insured that has not been disclosed to you. I agree that this application and the declarations shall be the basis of the contract between CB Bank Limited and ICICI Lombard General Insurance Company Ltd and I agree to accept a policy, subject to the conditions prescribed by ICICI Lombard General Insurance Company Ltd. I hereby apply for this Insurance Policy issued to me by ICICI Lombard General Insurance Company Ltd, subject to all terms, conditions and provisions of the policy. I have read, understood & accepted the assignment clause mentioned overleaf and the assignee for this Application Form would be CB Bank Limited I have read and understood the product content and the Terms & conditions as mentioned overleaf and confirm to abide by them. ated : Place : Applicant Signature : Please turn overleaf for Terms & conditions Home Insurance - Part C Loan Account No. (LAN) - mandatory: Property Type: Residential Commercial Nature of Commercial Property: Shop Hotel others (Please Specify) Hypothecated To: Table of Benefits: Type of Cover Home : Structure: Earthquake + Fire Home : Contents: Fire + Earthquake + Burglary *For commercial property type, the policy tenure is 1 ear Coverage Amount Sum Insured 40% of Sum Insured (Jewellery coverage is for maximum Rs. 1 Lakh or 25 % of the sum insured whichever is Lower) Excess Fire-For Act of God perils: first 5% of each and every claim amount subject to minimum of 10,000. Non Act of God perils-10,000 for each and every loss.* *No Excess applicable for Residential Buildings Name of the Applicant to be covered r. / rs. / s. : obile No.: I I I I I I I I I I I I I.: Address of Risk Location: istrict State Pin code Age of the Building (in yrs) No. of the Floors in the Building Loan Tenure: Policy Tenure: Loan Amount (): Burglary - 10,000 for each and every loss or 5% of claim amount which ever is higher eclaration : I hereby declare and warrant that the above statements are true and complete in all respects and that there is no other information which is relevant to my application for insurance for myself or any other person to be insured that has not been disclosed to you. I agree that this application and the declarations shall be the basis of the contract between me and ICICI Lombard General Insurance Company Ltd and I agree to accept a policy, subject to the conditions prescribed by ICICI Lombard General Insurance Company Ltd. I hereby apply for this Insurance Policy issued to me by ICICI Lombard General Insurance Company Ltd, subject to all terms, conditions and provisions of the policy. I have read and understood the product content and the Terms & conditions as mentioned overleaf and confirm to abide by them. ated : Place : Applicant Signature : Please turn overleaf for Terms & conditions No. Section I Part - Group Personal Accident ata Sheet (For age group years only) Coverage Accidental eath / Permanent Total isablement Sum Insured As per mention in Part A Note : a. The maximum liability of insurer is restricted to a maximum of Sum Insured as mentioned above for Section I. b. The above covers would not be applicable for persons occupied in underground mines, explosives and electrical installations on high tension lines. CB Bank Limited. reserves the rights to discontinue the scheme at its option without any intimation. eclaration: I hereby declare and warrant that the above statements are true and complete in all respects and there is no other information which is relevant to my application for insurance for myself that has not been disclosed to you. I agree that this proposal and the declarations shall be the basis on which insurance cover shall be issued to me. I have read and understood the coverage under the policy and the Terms and Conditions governing the same. I agree to accept the policy, subject to the conditions prescribed by ICICI Lombard General Insurance Co. Ltd. I hereby apply for coverage under the I have read and understood the Terms & conditions as mentioned overleaf and the product content and confirm to abide by them. ated: Place: Applicants Signature: Please turn overleaf for indicative Terms & conditions 9

10 Part-B eclaration I understand that the insurance coverage will commence not earlier than the date of disbursal of loan as referred overleaf or the after full premium is received by ICICI Lombard General Insurance Co. Ltd whichever is later subject to underwriting approval by ICICI Lombard General Insurance Company Ltd. Receipt of application form by ICICI Lombard General Insurance Company Ltd shall not be construed as acceptance of my application. The company in its sole discretion reserves the right to accept or reject any proposal without assigning any reason thereof. I understand & agree that no benefit under the policy shall be payable for any major medical illness event or procedure which results due to any pre-existing illness or symptom or which is diagnosed within 90 days of policy inception day. I authorise any physician, nurse, hospital official or employee or any person/institution to disclose to the ICICI Lombard General Insurance Company Ltd all information regarding my medical history and also confirm that the company will have full right to ask for any medicals. I also confirm and agree that the person applied for Insurance will submit to a medical examination by the Company's nominated octor or undergo diagnostic or other medical tests as often as the Company considers necessary, in its sole discretion I agree that the Policy shall become voidable at the option of the Company, in the event of any untrue or incorrect statement, misrepresentation, non-description or non-disclosure in any material particular in the application form/personal statement, declaration and connected documents, or any material information has been withheld by me or anyone acting on my/our behalf to obtain any benefit under this Policy. I have read and understood the policy terms & conditions and agree to abide by them. Terms & Conditions In case of any claim made underthe policy no premium shall be refunded on cancellation of the policy. For applicants applying for insurance policy before commencement of the disbursal of loan : The policy coverage shall commence from the date of the payment or loan disbursal date, whichever is later. The aggregate of Sum Insured opted by the applicants(s) underthe same LAN (loan application number) cannot exceed the loan sanctioned amount. For applicants applying for insurance policy at any time after commencement of the disbursal of loan : The policy shall commence on or after the date of payment. The aggregate of Sum Insured opted by the applicants(s) underthe same LAN (loan application number) cannot exceed the principal outstanding as on the date of last EI due prior to the date of payment. The proposed insurance coverage is subject to realization of full premium amount by the company. For sum Insured opted on reducing balance basis the cover is available for loan tenure or the full pre-payment of the loan which ever is earlier, subject to a maximum of 5 years but not beyond policy end date. In case of cancellation of policy, premium shall be refunded on short premium basis. I/We hereby agree and confirm that if the amount realized by the insurer is less than the premium payable for sum proposed for insurance or scope of cover desired by me/us, the proposal shall be considered for acceptance for a reduced sum appropriate to the premium realized by the insurer and the Policy shall be finalized accordingly. For Sum Insured opted on Fixed Sum Insured basis, the cover is available for loan tenure or the full prepayment of the loan whichever if earlier, subject to a maximum of 5 years but not beyond policy end date. Assignment Clause: It is hereby declared and agreed that: (i) from the Policy Start ate, the monies payable by the Company to the Insured and all rights, title, benefits and interest of the Insured under this Policy stand assigned in favour of CB Bank Limited (ii) upon any monies becoming payable under this Policy the same shall be paid by the Company to the CB Bank Limited without any reference / notice to the Insured, but not exceeding the Principal Outstanding as defined under the Policy. In the event of any monies payable under this Policy exceeding the Principal Outstanding, the Company shall pay such monies as exceeding the Principal Outstanding to the Insured; (iii) the receipt of such monies in the manner aforesaid by the CB Bank Limited Shall completely discharge the Company from all liability under the Policy and shall be binding on the Insured and the heirs, executors, administrators, successors or legal representatives of the Insured, as the case may be. Part-C eclaration I understand that the insurance coverage will commence not earlier than the date of disbursal of loan as referred overleaf or after the full premium is received by ICICI Lombard General Insurance Co. Ltd whichever is later subject to underwriting approval by ICICI Lombard General Insurance Company Ltd. Receipt of proposal form by ICICI Lombard General Insurance Company Ltd shall not be construed as acceptance of my proposal. The company in its sole discretion reserves the rightto accept or reject any proposal without assigning any reason thereof. I also confirm and declare that the persons whose details have been mentioned in this proposal for coverage are the applicant(s) of the loan whose details have been mentioned in the proposal form. I confirm that I have voluntarily participated for this policy and am aware that the Bank Products are available without this policy as well. I authorize the Company and their agents to exchange, share or part with all the information provided to other Agencies/ Statutory Bodies as may be required and I/We will not hold the Company and their agents liable for use of this information. I agree that the Policy shall become voidable at the option of the Company, in the event of any untrue or incorrect statement, misrepresentation, non-description or non-disclosure in any material particular in the proposal form/personal statement, declaration and connected documents, or any material information has been withheld by me or anyone acting on my/our behalf to obtain any benefit under this Policy. Terms & Conditions For commercial loans, the cover is available only for one year Warrantthat hazardous goods not stored Structure cover is applicable only for completed construction. For properties under construction, the cover gets activated on completion of construction for Contents cover, the coverage amount is 40% of the sum insured (Jewellery coverage is for ax. Rs. 1,00,000/- or 25% of the sum insured which ever is lower), This cover will not be applicable for commercial loans In case of any claim made under the policy no premium shall be refunded on cancellation of the policy. In case of cancellation of policy, premium shall be refunded on Pro-Rata basis. I/We hereby agree and confirm that if the amount realized by the insurer is less than the premium payable for sum proposed for insurance or scope of cover desired by me/us, the proposal shall be considered for acceptance for a reduced sum appropriate to the premium realized bythe insurerandthe Policy shall be finalised accordingly. For proposers applying for insurance policy before commencement of the disbursal of loan : The policy coverage shall commence from the date of the payment or loan disbursal date, whichever is later. The aggregate of Sum Insured opted bythe applicants(s) underthe same LAN (loan application number) cannot exceed the loan sanctioned amount. For proposers applying for insurance policy at my time after commencement of the disbursal of loan : The policy shall commence on or after the date of payment. The aggregate of Sum Insured opted by the applicants(s) underthe same LAN (loan application number) cannot exceed the principal outstanding as on the date of last EI due prior to the date of payment. The proposed insurance coverage is subject to realization of full premium amount bythe company, subject to agreed bank clause ain Exclusions Any loss arising out of any act of Terrorism, Losses arising out of Theft, Any loss due to direct or indirect involvement of Insured, Any loss due to Electrical/mechanical breakdown. Cash, oney and onetary instruments excluded from covers in the policy. Intentional self-injury, suicide or attempted suicide, any loss whilst underthe influence of intoxicating drugs or liquor, war, nuclear war, any loss arising from an act made in breach of law with or without criminal intent. Part eclaration I/We, the undersigned hereby declare that the above statements and particulars are true, accurate and complete and I/We declare and agree that this declaration and the answers given above shall be held to be promissory and shall be the basis of the contract between me/us and the Company. I/We authorize the Company and their agents to exchange, share or part with a II the information provided toother Agencies/Statutory Bodies as maybe required and I/We will not hold the Company and their agents liable for use of this information Terms & conditions In case of any claim made underthe policy no premium shall be refunded on cancellation of the policy. For proposers applying for insurance policy before commencement of the disbursal of loan : The policy coverage shall commence from the date of the payment or loan disbursal date, whichever is later. For proposers applying for insurance policy at any time after commencement of the disbursal of loan : The policy shall commence on or after the date of payment. The aggregate of Sum Insured opted bythe applicants(s) underthe same LAN (loan application number) cannot exceed the principal outstanding as on the date of last EI due prior to the date of Payment. I agree that the Policy shall become voidable at the option of the Company, in the event of any untrue or incorrect statement, misrepresentation, non-description or non disclosure in any material particular in the proposal form/personal statement, declaration and connected documents, or any material information has been withheld by me or anyone acting on my/our behalf to obtain any benefit under this Policy. ain Exclusions Intentional self-injury, suicide or attempted suicide, any loss whilst under the influence of intoxicating drugs or liquor, war, nuclear war, any loss arising from an act made in breach of law with or without criminal intent. I/ we hereby agree and confirm that if the amount realised by the insurer is less than the premium payable for sum proposed for insurance or scope of cover desired by me/us, the application shall be considered for acceptance for a reduced sum appropriate to the premium realised bythe insurerandthe policy shall be finalised accordingly. Assignment Clause It is hereby declared and agreed that: (i) from the Policy Start ate, the monies payable bythe Company to the Insured and all rights, benefits and interest of the Insured under this Policy stand assigned in Favour of CB Bank Limited. (ii) Upon any monies becoming payable under this Policy the same shall be paid by the Company to the CB Bank Limited without any reference/notice to the Insured, but not exceeding the Principal Outstanding as defined under the Policy. In the event of any monies payable under this Policy exceeding the Principal outstanding, the Company shall pay such monies as exceeding the Principal outstanding to the Insured; (iii) the receipt of such monies in the manner aforesaid by the CB Bank Limited Shall completely discharge the Company from a II liability underthe Policy and shall be binding on the Insured and the heirs, executors, administrators, successors or legal representatives of the Insured, as the case may be. STATUTOR WARNING: PROHIBITION OF REBATES (Under Section 41 of Insurance Act 1938) 1) No person shall allow or offer to allow, either directly or indirectly as an inducement to any person to take out or renew or continue an insurance in respect of any kind of risk relating to lives or property, in India, any rebate of the whole or part of the commission payable or any rebate of the premium shown on the policy, nor shall any person taking out or renewing or continuing a Policy accept any rebate, except such rebate as may be allowed in accordance with the published prospectuses or tables of the Insurer. 2) Any person making default in complying with the provisions of this section shall be punishable with fine, which may extend to five hundred rupees. Registered Office : ICICI Lombard General Insurance Company Limited, ICICI Bank Towers, Bandra Kurla Complex, umbai ailing Address: ICICI Lombard General Insurance Company Limited, Zenith House, Keshavrao Khadye arg, Opp. Race Course, ahalaxmi, umbai Visit us at ail us at customersupport@icicilombard.com Now One Number for all your Insurance needs: (Toll Free also accessible from your mobile phone) Insurance underwritten by ICICI Lombard General Insurance Co. Ltd. Insurance is the subject matter of the solicitation. isc 17, isc 13, isc 65, isc 05. IRA Reg. No.115 For complete details on coverage's, terms & conditions & exclusions, Please refer to policy wordings (available on request) I hereby authorize CB Bank Limited struct ICICI Lombard to cancel my policy/policies and receive the premium refunded by ICICI Lombard thereof on my behalf. I further agree and understand that all such refunds shall be made subject to the terms and conditions of policy/policies and refund of premium by ICICI Lombard to CB Bank Limited, Shall absolve ICICI Lombard from any and all liabilities arising out of the said policy/policies Signature of Proposer 10