I, the undersigned hereby apply for financial assistance under your Gold Loan Financing Scheme and hereby submit the following information as required by you :

Customer Details

1) First Name
2) Middle Name
3) Last Name
4) Existing Customer
(PL/TL/GL No.)
5) PAN
(Permanent Account Number)
6) Marital Status
7) Date of Birth
8) Address
9) Telephone Number
10) Email ID
11) Nominee Name
12) Permanent Address
13) Relationship
Employment Details
14) Present Annual Income
15) Employment Details
16) Employment Type
17) Employer Details
18) Name of Organisation
19) Designation
20) Address
21) Industry Type
Bank Details
22)Bank A/c No.
23) IFSC Code
24) Bank Name
25) Bank Branch Name
26) Documents Submitted
Id Proof
Pan Card
Address Proof
Elect Bill
Updated Bank Passbook
Driving License
27) Purpose of Loan

I agree that all the details mentioned above are true to the best of my knowledge.I am aware that the disbursal of loan is at the sole discretion of APHELION FINANCE PVT. LTD. & I authorise APHELION FINANCE PVT. LTD. to call or sms me as regards my loan application.