CUSTOMER APPLICATIONSeamless Solutions, Effortless Form Fill: Your Information, Our Expertise Borrower DetailsMarital StatusSingleMarriedSelect GenderMaleFemaleServices available in only Buxar, Bhojpur and Rohtas DistrictStateBiharCountryIndiaDocument UploadAadhar Front *Choose FileNo file chosenDelete uploaded fileAadhar Back *Choose FileNo file chosenDelete uploaded filePAN *Choose FileNo file chosenDelete uploaded fileShop Picture *Choose FileNo file chosenDelete uploaded fileBank Statement *Choose FileNo file chosenDelete uploaded fileIf Bank Statement Password Protected, Please enter Password belowBank DetailsBank NameAxis BankBank of BarodaBank of IndiaBandhan BankCanara BankCentral Bank of IndiaHDFC BankIndian BankState Bank of IndiaUCO BankLoan DetailsSelect Loan Duration *Select Loan Duration24 Biweekly (1 Year)36 Biweekly (1.5 Year)48 Biweekly (2 Year)Loan Purpose *Loan PurposeMobile ShopGeneral StoreMedical ShopStationary ShopCloth ShopSalonBike Repairing ShopCosmatic ShopBeauty ParlourHardware ShopElectronic ShopCycle shopSweet shopOtherApplied Loan Amount *Applied Loan AmountRs. 10,000Rs. 20,000Rs. 30,000Rs. 40,000Rs. 50,000Rs. 60,000Rs. 70,000Rs. 80,000Rs. 90,000Rs. 1,00,000Rs. 1,10,000Rs. 1,20,000Rs. 1,30,000Rs. 1,40,000Rs. 1,50,000Co- Borrower DetailsMarital StatusSingleMarriedSelect GenderMaleFemaleCo-Borrower relation with BorrowerSonFatherHusbandMotherBrotherWifeStateBiharUttar PradeshCountryIndiaDocument UploadAadhar Front *Choose FileNo file chosenDelete uploaded fileAadhar Back *Choose FileNo file chosenDelete uploaded filePAN *Choose FileNo file chosenDelete uploaded fileConsent Clauses *I hereby give my consent to and agree and authorize Ahilya Gramin Livelihood Foundation to fetch my personal details from UlDAl. I hereby state that I have no objection in authenticating myself with Aadhaar based authentication system and voluntarily consent to providing my Aadhaar number/VlD number. Biometric information and/or One Time Pin (OTP) data (and/or any similar authentication data) for the purpose of personal loan application. I understand that the biometric and/or OTP and/or any other authentication data may provide for authentication shall be used only for authenticating my identity through the Aadhaar authentication system for the specific transaction as per requirement of law and for no other purposes. I confirm that I have been informed about the alternatives to submission of identity information and I have agreed to authenticate myself through Aadhaar based authentication system with full understanding of alternatives to submission of identity information. I understand that Ahilya Gramin shall ensure security and confidentiality of my personal identity data provided for the purpose of Aadhaar based authentication. I authorize Ahilya Gramin to verify and authenticate my Aadhaar during processing my personal loan. I further authorize the company to share my Aadhaar related details/information with regulatory/statutory bodies as and when required.Customer Declaration *I/We declare that the particulars and information given in the application form are true, correct, complete and up to date in all respects and I/we have not withheld any information. I/We confirm that I/We have no insolvency proceeding indicated against me/us nor have I/We ever been adjudicated insolvent. I/We have read the application form and am/are aware of all terms and conditions of availing finance from Ahilya Gramin Livelihood Foundation. I/We authorize Ahilya Gramin Livelihood Foundation to make reference and inquiries relating to information in this Customer Declaration application which the company considers necessary. I/We authorize the company to exchange, part/share with all information relating to my/our loan details and repayment history to other banks/financial institutions etc. as may be required and shall not hold the company liable for use of this information. I/We under take to inform the company regarding change in my residence/employment and to provide any further information that the company may require. I/We agree that my/our loan shall be governed by the rules of the company which may be in force from time to time. I/We understand that the company has the right to reject my/our application without providing any reason thereof. The borrower(s)/guarantor(s) agree(s) to have given his/their express consent to the company to disclose all information and data furnished by them to Credit information companies (CIC's) or any other credit bureau permitted to operate in India. The borrower(s)/guarantor(s) further agree(s) that they shall execute such additional documents as may be necessary for the purpose. I/We confirm that I/We have received a copy of the "Code of Company's commitment to Customers". I/We have been explained the content of the same and also understand that it is available on-line at the Company's website, "www.ahilyagramin.in".SubmitPlease do not fill in this field.
