Member Enrollment:

Member Enrollment

Loan details

Purpose of Loan *	:		Select Product *	:
Loan Amount *	:		Registration fees *	:

Referrence details

Referred by/Sponsored by*

Member details

Title *	:		Member First Name	:
Member Last Name	:		Father/ Husband	:

Personal details

Date of Birth *	:	Age *	:
Gender *	:	Religion	:
Mobile *	:	Email ID	:
Occupation	:	Occupational Add	:
Monthly Income	:	PAN	:
Bank Name	:	Branch	:
Account No	:	IFSC Code	:
Land in acres	:	House owned/rental	:
Vehicle name	:	Vehicle no	:
Cattle name	:	Number of cattle	:
Mobile make	:	Android/featured	:
Disease details	:	AlCOHOLIC	:
Previous Loan	:	Loan company	:
Tobacco /paan	:	Bidi/cigarette smoking	:

Spouse name	:	Spouse Age	:
Child1 Name	:	Child1 Age/Sex	:
Child2 Name	:	Child2 Age/Sex	:
Dependant 1	:	Dependant1 Age/Sex	:
Dependant 2	:	Dependant2 Age/Sex	:

Disease name	:	family member	:
Alcoholic y/n	:	/family	:
Tobacco/bidi	:	How long mem taking	:

Communication Address

State *	:	City	:
District *	:	Taluk	:
Centre Name	:	Pin	:
Permanent Add	:

KYC details

Proof of Identity


Passport	:
Voter ID Card	:
PAN Card	:
Driving License	:
Aadhaar Letter / Card	:
NREGA Card	:
Samagra id	:

Proof of Address(of Correspondence Address)

Electricity Bill (not more than 6 months old)	:
Telephone Bill (not more than 3 months old)	:
Bank Account Statement	:
Ration Card	:
Voter ID Card (only if it contains the current address)	:
Lease Deed/Sale Deed	:
LIC /POLICY NO	:

Declaration

I myself declare that above given information is true and authenticated best of my knowledge , I m ready to pay above registration fees from myself income resources. I solemnly declare that will not return demand of my registration fees , because company will pay to this money to insurance company for myself/my family health insurance premium and give to me/us a health cover . I declare that never dispute to company in case denial /rejection the loan/unit /shg loan/health cover/home loan/cattle loan/insurance loan /education loan/marriage loan /others loan /project sanctioned by YL Finance.

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