1. Count of Products being financed*
Color TV Desktop / Laptop
Fitness Equipment
If Others (Please specify)
LCD / LED / Home Theatre
Furniture
Luxury Watches
Product Details4
Consumer Durables
Lifestyle Products
AC FurnitureWashing Machine / Refrigerator / Oven
Camera
Applied Loan Amount *
LTV * <=67% 68-70% 71-75% 76-83% 84-90% >90%
Marital Status* Gender* Male FemaleMarried Unmarried
F I R S T M I D D L E L A S T
Personal Details
Name*
Date of Birth* D D M M Y Y Y Y
1
Identification Document
(Tick Any One)
Corresponding ID No.
Phone 2
Mobile No.*
Bajaj Finance Limited
Corporate Office: 4th Floor, Bajaj Finserv Corporate Office, Off Pune-Ahmednagar Road, Viman Nagar, Pune – 411 014, Maharashtra, INDIA
Registered Office: Mumbai - Pune Road, Akurdi, Pune - 411 035. Maharashtra, INDIA
Tel +91 20 3040 5060 Fax +91 20 3040 5020 www.bajajfinservlending.in
Yes NoPreferred Mailing Address* Residence Address Residence-cum Office*Office Address
City*
Pin Code*
Residence Address*
Area/ Locality*
State*
Email ID
Contact Details2
Residence is* Owned Rented Co. Provided Parental Bachelor Acco/ Sharing/ PG
Landmark*
Extension No.Office Phone
Employment/Business Details3
Employee ID
Designation Department
City*
Pin Code
Office/Business Address
Area/Locality*
State*
Landmark
Employment Type* Self-Employed Salaried Housewife Student Pensioner
Name of the Company/ Business*
(Please provide your e-mail id in Block letters since the Loan Summary Letter would be mailed on the same)
Gross Tenor* months No. of Advance EMIs* months
Consumer Finance
Application Form
Dealer Code*
Executive Mobile No.*
Sourcing Details
Case ID
Date D D M M Y Y Y Y
Executive Name*
Promotion Case*
Sourcing Surrogate Info 1* Sourcing Surrogate Info 2*
Sourcing Surrogate Info 3*
Please fill in all the required details in BLOCK LETTER. Tick boxes as applicable. * Mandatory Fields
Dealer Name*
Credit Program Code*Yes No
Case Referral Type* WOW WOW Lite WOW Extension Normal DDF
Passport Driving LicensePAN Card Voter ID Ration CardCredit Card
Residing Since* Years Months
Constitution of the Company* Proprietorship Partnership Pvt. Ltd. Public Ltd. MNC Others
(Please turnover for surrogate details)
Sales Representative Name
ACKNOWLEDGMENT
CASE ID
We acknowledge the receipt of your application for a loan from Bajaj Finance Ltd. Please furnish documents mentioned overleaf
for approval of your loan application. Please write to us at the given mail id for your queries and suggestions :
wecare@bajajfinserv.in
Note: Credit at the sole discretion of Bajaj Finance Ltd.
This is a preprinted acknowledgement and does not require any signature.
Please quote the Case ID no. in future reference
Applicant Name
Loan Amount Applied: Sales Representative Mobile No.
Date D D M M Y Y Y Y
www.bajajfinservlending.in
I/We hereby apply for a Finance facility for the Consumer Durable & Lifestyle Products Loan mentioned in this application.
I/We declare that all the particulars and information and details given/filled in this Application Form are true, correct, complete and up-to-
date in all respects and that I/We have not withheld any information whatsoever.
I, would like to know through telephonic calls, or SMS on my mobile number mentioned in the Application Form as well as in this
undertaking, or through any other communication mode, various BFL loan offer schemes or loan promotional schemes or any other
promotional schemes and hereby authorize M/s Bajaj Finance Limited, (BFL) it's employee, agent, associate to do so. I confirm that laws in
relation to the unsolicited communication referred in “National Do Not Call Registry” (the “NDNC Registry”) as laid down by TELECOM
REGULATORY AUTHORITY OF INDIA will not be applicable for such communication/calls/ SMSs received from BFL, its employees, agents
and/or associates.
5 Undertaking
Signature of the Applicant
Mobile No.
DNC Yes No
Asset Category*
WOW Plus
Home Improvement
Digital Lifestyle Products If Others (Please specify)
Processing Fee: Rs. . Interest Rate : % Annum. Bounce Charges: Rs 350/EMI/Loan.
Late payment penalty will be charged 2% pm on an amount of EMI outstanding as on that date.
Please not each product will be treated as different loan. No foreclosure or pre payment charges
Processing time of loan will be upto 15 days

2. Bajaj Finance Limited
Corporate Office: 4th Floor, Bajaj Finserv Corporate Office, Off Pune-Ahmednagar Road, Viman Nagar, Pune – 411 014, Maharashtra, INDIA
Registered Office: Mumbai - Pune Road, Akurdi, Pune - 411 035. Maharashtra, INDIA
Tel +91 20 3040 5060 Fax +91 20 3040 5020 www.bajajfinservlending.in
DECLARATION
I/We hereby apply for a Finance facility for the Consumer Durable & Lifestyle Products Loan mentioned in this application.
I/We declare that all the particulars and information and details given/filled in this Application Form are true, correct, complete and up-to-date in all respects and are true to my/our
knowledge and that I/We have not withheld any information from Bajaj Finance Ltd. whatsoever.
I/We confirm that no insolvency proceedings or suits for recovery of outstanding dues or monies whatsoever or properties and/or any criminal proceedings have been initiated
and/or are impending against me/us and that I/we have never been adjudicated insolvent by any court or other authority. I/we have not taken any action and no other steps have
been taken or legal proceedings started by or against me/us in any court of law / other authorities for the appointment of a receiver, administrator, administrative receiver, trustee or
similar officer or for my/our assets.
I/ We declare that I/ We have not made any payment in cash, bearers cheques or of any other kind along with or in connection with this Application Form to the person collecting
my/our Application Form. I/ We shall not hold Bajaj Finance Ltd liable for any such payment made by us to the person collecting this Application Form.
I We authorize Bajaj Finance Ltd. and all its group companies and their agents to exchange, share or part with all the information and details relating to my/our existing loans and/or
repayment history to other Bajaj group companies, banks, financial institutions, credit bureaus, agencies, statutory bodies etc. as may be required or as they may deem fit and shall
not hold BFL (or any of its group companies or its/their agents/representatives) liable for use/sharing of this information.
I/We understand and acknowledge that Bajaj Finance Ltd shall have the absolute discretion, without assigning any reasons (unless required by applicable law), to reject my/our
application and that Bajaj Finance Ltd shall not be responsible/liable in any manner whatsoever to me 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 my/our application.
Place
Date D D M M Y Y Y Y
Signature of ApplicantNote: BFL shall be entitled at its sole and absolute discretion to reject / approve Application Form Submitted by the applicant/s.
Sourcing Surrogate Details (Only for Office Use)
Credit Program Sourcing Surrogate Info 1 Sourcing Surrogate Info 2 Sourcing Surrogate Info 3
Credit Card Credit Card Issuer/ Bank Credit Card Type Credit Card No.
Employed in 2000 companies Designation Total Work Experience (in years) Net Monthly Salary
With Passenger Car Ownership Make of Car Model of Car Car is New/ Used & Purchase Year
Repayment Track Record (RTR) - External Name of Financier Type of Loan Loan Amount
Repayment Track Record (RTR) - BFL None None None
Salary Income Proof Program Designation Total Work Experience (in years) Net Monthly Salary
Banking Surrogate Bank Account Type Account Since (approximate number of years) Average Monthly Balance
Individual With OD/ CC Account OD/ CC Limit (in Rs.) Limit Utilization (in %) (as told by customer) Using the Account Since
Own Property (House/ Business) House Type House Owned by Supporting Documents Submitted
Instant Connection is Landline/ Postpaid Monthly Average Bill Amount Connection Since
Debit Card Debit Card issuer/ Bank name Debit Card type Account since (age of account)
Self Employed - Self Traders Type of Business Office Premise is Owned/ Rented Average Monthly Turnover
*Documents requirement might vary according to Credit Program chosen.
Documents Checklist
Photo Identity Proof* Passport, PAN Card, Voters ID Card, Driving License, Photo Credit Card
Address Proof*
Yourapplicationwillbeassessedquicklyafterreceivingtherequireddocuments.Pleasequotetheapplicationnumbermentionedinthisslipforanyenquiries.
Minimum Loan Amount 7 0 0 0 Maximum Loan Amount 5 0 0 0 0 0 Maximum Tenor 3 6 Months
Ration Card, Driving License, Voter ID card, Passport, Sale Deed / Property purchase agreement (for owned properties)
Have you travelled abroad in the last one year? Yes No
Rs. 50001 - 75000 >Rs. 75000
Type of Internet Access at Home Broadband Dial Up Wireless Data Card Do not own
Which of the following do you own? Cooking RangeMicrowave Electric Chimney Printer
DesktopLaptop Vacuum Cleaner
Please tell us about your refridgerator Greater than 280 L280 L or less Do not own
Please tell us about your TV Normal-Flat TVNormal TV LCD/LED Plasma
Size of the TV Between 21 to 30 inch21 inch or less 30 inch or more
Please tell us about your washing machine Fully AutomaticSemi Automatic Do not own
Please tell us about your car Used CarNew Car Do not own
Please tell us the price of your car
Month and Year of Purchase M M Y Y Y Y
What type of Credit Card do you have Platinum/Titanium Gold Silver Others Do not have
What type of Insurance do you have Life Motor Medical Property Plant & Machinery
Others Do not own
What is the no. of cars that you own?
< 5 Lakhs 5-10 Lakhs 10 - 15 Lakhs >15 Lakhs
Consumer Durables
What is your gross monthly salary ?
Help us know you better6
For cheque swapping, bounce, penal and other charges please refer to www.bajajfinservlending.in
What is your Net Monthly Income? < Rs. 15000 Rs. 15000 - 25000 Rs. 25001 - 50000
Minimum Loan Amount 2 0 0 0 0 Maximum Loan Amount 3 0 0 0 0 0 Maximum Tenor 3 6 Months
Lifestyle Products
Your Preferred Language 1) 2)