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

Customer Details

1) First Name
2) Middle Name
3) Last Name
4) Qualification(s)
5) Date of Birth
6) Marital Status
7) PAN
(Permanent Account Number)
Employment Details
8) Employment Details
9) Employment Type
10) Monthly Income
11) Family Income
12) Name of the Organisation
13) Designation
14) Address
Residence Details
15) Residence Details
16) Correspondence Address
17) Nearest Landmark
18) Pincode
19) Telephone Number
20) Permanent Address
Loan Details
21) Loan Amount
22) Source Name
Documents Required:

Photo, Pancard, Ration Card/Aadhar Card, Electricity Bill, 3 month Salary Slip/ 2 yr ITR, 6 month Bank Statement.

Declaration

I/We declare that I/we am/are citizen(s) of India. All the particulars and information given in the application form are true, correct and complete in every respect. No information, likely to affect the acceptance of this proposal, has been withheld. I/we confirm that I/we have had no insolvency proceedings against me/us nor have ever been adjudicated insolvent. I/we agree that APHELION FINANCE PVT. LTD. may take up such references and make such enquiries in respect of this application as may deem necessary, I/we hold myself/ourselves liable for any misstatement(s) that may be discovered hereafter. I we/ undertake not to alienate, alter or change any of the above articles without your prior written consent. I/we further agree that my/our hire purchase/ loan shall be governed by the rules of APHELION FINANCE PVT. LTD., which may be in force from time to time. APHELION FINANCE PVT.LTD. reserves the right to reject my application without providing reason. I/we agree to notify to you in writing about any changes in my/our position (including changes in address, telephone numbers, occupation etc) within seven days of such change, taking place. I/we agree to accept the hire purchase/auto loan agreement(s), promissory note(s) and such other documents as may be necessary and required by APHELION FINANCE PVT. LTD. in this behalf.