Contacted By _________________ Contact No __________________ SUBSCRIBER INFORMATION CUM APPLICATION FORM PERSONAL INFORMATION Name of the subscriber Father / Husband Name Telephone Numbers E-mail Permanent Address (PI. provide proof of address) Mailing Address (PI. provide proof of address) Name of Spouse Names of Children No of Dependents Nature of Business Your Vehicle Your House Name Address Partners / Directors / Employer Incase of Partnership Firm & Company PAN number (P). provide copy of PAN Card Mr./Mrs.Dr D D 1 3 6 2 5 7 Date Anniversary OWN CAR : TWO WHEELER : FINANCED COMPANY PROVIDED COMPANY PROVIDED COMPANY PROVIDED FINANCED FINANCED OWN OWN D M R O O B B D D M M M M Y Y Y Y Y Y Y Y
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Contacted By _________________
Contact No __________________
SUBSCRIBER INFORMATION CUM APPLICATION FORM
PERSONAL INFORMATION
Name of the subscriber
Father / Husband Name
Telephone Numbers
E-mail
Permanent Address (PI. provide proof of address)
Mailing Address (PI. provide proof of address)
Name of Spouse
Names of Children
No of Dependents
Nature of Business
Your Vehicle
Your House
Name Address
Partners / Directors / Employer
Incase of Partnership Firm & Company
PAN number (P). provide copy of PAN Card
Mr./Mrs.Dr
D
D
1
3
6
2
5
7
DateAnniversary
OWNCAR :
TWO WHEELER :
FINANCED COMPANY PROVIDED
COMPANY PROVIDED
COMPANY PROVIDED
FINANCED
FINANCED
OWN
OWN
D
MR
O
O
B
B
D
D
M
M
M
M
Y
Y
Y
Y
Y
Y
Y
Y
INFORMATION
Nominee Details
If nominee is a minor then provide Name & address of guardian
Name Relationship Date Of Birth Percentage
PROFESSIONAL DETAILS
You are (Pl. tick the appropriate)
If self employed (Pl. tick the appropriate)
Your Profession (PI. indicate the nature of activity if others is ticked) BUSINESS DETAILS
FINANCIAL DETAILS
Date of Establishment
No. of employees
Name and Address of the Firm/Company
PAN/TAN Number
Annual Turnover
Monthly Income
Immovable Properties (PI. furnish details of the properties) Location & Address
Pl. provide copy of latest financial statement
If salaried - employed in(Pl. tick the appropriate group)
1
1
3
2
2
4
5
SALARIED
GOVT
PROPRIETOR
CHARTERED ACCOUNTANT
BANKER BULIDER OTHERS
(Pl. indicate the nature of activity if others is ticked)
PUBLIC - SECTOR
PARTNER
DOCTOR ENGINEER LAWYER
DIRECTOR OTHERS
PUBLIC - LTD - CO
SELF - EMPLOYED RETIRED PENSIONER
PVT LTD MNC
Are You Member of any chits group in Our Company?
Are You Member of any Other Chits Company?
Name Of Company
DECLARATION
Place :
Date : Signature of Introducer Signature of Subscriber
Of the above encumbered properties,if any (Pl. indicate the serial number from the above list and inform to whom it is encumbered)
Refrence
1
1
3
3
2
2
4
4
5
5
YES
YES
NO
NO
IF YES GROUP ID
IF YES GROUP ID
IF YES GROUP ID
IF YES GROUP ID
MONTHLY SUBSCRIPTION AMOUNT
MONTHLY SUBSCRIPTION AMOUNT
VALUE OF CHIT
VALUE OF CHIT
TERMINATION DATE
TERMINATION DATE
1.I/We hereby confirm and declare that the above mentioned particulars are correct.
2.Rules and regulations relating to the chit has been read/translated and I/We have understood the same. I/We agree to be bound and abide by the terms and conditions of Mahathej Chit Funds PVT LTD I wish to join the proposed Chit group as subscriber.
3.I/We understand that I/We have to give security to the extent of future liabilities (installments) when I/ We bid the chit. I/We here by agree to give security acceptable to the company to the extent of up to 150% of the future liability in the form of moveable or immovable properties.
4.Please allot me a chit of value Rs----------------- with a monthly subscription of Rs------------------------- I am remitting Rs--------------------(Rupees --------------------------------------------------------------------only) By cash/cheque/DD/NEFT/RTGS No-------------------- date ------------- Drawn on --------------- being the payment of first installment
1. In case of partnership firm the authorized signatory/signatories as per the partnership deed should sign the form2. In the case of Companies and Trusts, a resolution to join the chit is to be attached.
OFFICE USE ONLY
INSTRUCTIONS OF FILLING THE FORM
Receipt Number
Customer ID
Introducer / Name
Verified By / Name
Group Details
Branch Name
Group Details
Authorised / Signature
Signature
Admitted / Not AdmittedSignature
1. Please fill in all the columns in capital letters.2. Ensure entering only one alphabet in each block wherever the columns are divided into blocks.3. Wherever indicated please provide copies of the necessary documents as proof.4. Acceptable documents --- both original and copy to be produced. Original will be returned after verification.
Passport Passport
Driving License Driving License
Voter’s ID Card Voter’s ID Card
Latest Telephone Bills
Employer’s Certificate
Rental Agreement
Aadhar Card
ID Card issued by Government authorities
ID Card issued by Employer Acceptable to us
Proof of Identity Proof of Address
5.If space is not sufficient please use attachment s and provide the column reference in the attachment.(Example: if space is not sufficient for address of various properties, then provide the same in a separate sheet and write “Immovable Properties” on the sheet and Pl. see the attachment list in the column).
6.Wherever “Yes” is retained and “No” is scored off, Pl. furnish the required details.