| The Chief Manager / Manager
United Bank of India
-------------------------- Branch.
Dear Sir,
I, on behalf of my family , hereby apply for a UGSCC for a
limit of
Rs. ______(Rupees___________________________ only).
General Information :
1. Full Name of the applicant / Key person
Age Sex
Father’s / Husband’s Name
------------------------------------------ -----
-----
-----
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2. Full Address :-
Village/Town
Post Office P.S.
District
------------------------
------------
------
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3. Name of other earning members Relationship with key person
i)
ii)
iii)
iv)
4. Whether belongs to Scheduled Castes/ Tribe/ Backward Class
(as per definition in the State)
..........................................
5. Particulars of Identity documents :-
(Ration Card/ Voter I.D. Card/ Panchayat or Municipal Tax Receipts/ of
the applicant key person)
6. Particulars of existing liability, if any, of the
applicant / Key person :-
7. Income details of the family
Name of the earning Members
Source
Amt.
i) ---------------------------------
--------- ----------
ii) ---------------------------------
---------
----------
iii) --------------------------------
--------- ----------
Total income of the family :
-----------------------
I hereby declare that the particulars given
above are true and correct to the best of my knowledge and belief.
I also hereby undertake to take Personal
Accident Risk Insurance Coverage & authorize to debit my OD a/c for the premium amt.
I hereby authorize the Bank to disclose all
or any particular or detail or information relating to my loan account with the bank to
any other financial institution, Government or any agency as may be considered necessary
or desirable by the Bank.
It will be in order for the Bank to
disqualify me from receiving of any credit facility from the Bank in case it is proved
that the declarations made above contain misrepresentation of facts.
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( Applicant’s Signature )
|
