Application Form BE Wholesale Barcode

(Filling of all the fields is mandatory and N lank. User should either provide details or to avoid any data fudging jn blank spaces)

For Office use only Applica ate:

Proposal No: Applica No.

Region Sol ld
Lead ld Financial Year
Name & Emp ID of officer sourcing the proposal

PART I : GENERAL DETAILS

Name of Borrower:*

Constitution:* Resident Indian Proprietorship Partnership Private Ltd Public Ltd Others (pl. specify)

Nature of Business Manufacturing Trading (Retail/Wholesale) Service Provider Others (pl. specify)

Bharat Banking / BE W Form / 2024 / Ver 1.0

(Non-Individual):*
Details of Business /
Occupation
(About the Activity):*
Date of Birth/ Date of commencement of Business:*
Incorporation:*
Place of Incorporation:* Country of Incorporation:*
Annual Turnover (in Rs):*

If Individual: Information Technology Professional Service Provider Agriculture Trader Others (pl. specify)

Annual Income (in Rs):* No. of years in business / employment* :

Source of Fund Business Income Equity Investment Donation / Grant From Group Company Others (pl. specify)
(Non Individual)*
Source of Fund Salary Business Income Agriculture Investment Income Others (pl. specify)
(Individual)*
Net Worth (in Rs.) : National Industrial Classificaton Code (NIC) :

Registration No./CIN : (Company/LLP/OPC)

Import Export code CKYC No. Y N (if yes, CKYC No. number)
(if applicable):
Proof of Identity:* Officially valid document(s) in respect of person authorized to transact
Trust Deed

Partnership Deed

PAN*.: UDYAM
Registration No.:
Form 60 (Only if Pan No. is not available) Y N

Whether the MSME unit is ZED rated: Yes No

If yes, the gr y the MSME unit (Tick appropriate one)
Bronze Silver

Aadhar Details: Individual Non Individual* Nationality:

(*Note - Where the client is non-individual, Aadhar number y to transact on its behalf is requir Aadhar details - Part VII for multiple people.)

Certificate of Incorporation / Formation Registration certificate Other document (pls specify)

Registered Office/
Permanent Address:*
Landmark

City State/UT Distance From Branch (km)

District Pin code *Country

Telephone Mobile* 9 1 Fax No

Email ID No. of Years : Ownership Self Owned Rented or Leased Others (pl. specify)......

Correspondence/ Same as above Y N

Communication
address:*

Landmark

City

District State / UT Distance From Branch (km)

Telephone Pin code *Country

Email ID Mobile* 9 1 Fax No

No. of Years : Ownership Self Owned Rented or Leased Others (pl. specify)......

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Address of the
Factory/Principal
Place of Business*
Landmark
City State / UT Distance From Branch (km)

District Pin code *Country

Telephone Mobile* 9 1 Fax No

Email ID No. of Years : Ownership Self Owned Rented or Leased Others (pl. specify)......

GST Details
Whether registered under GST: Y N (If yes following details are mandatory) GST Ex Y N Ex eason if Yes_____
GST Registra Single M (Please fill GST annexure for registr ) Special Economic Zone: Y N
GSTIN

Address registered for GSTIN

Same as Registered office / Permanent Address Same as Correspondence / Communica�on address
Factory / Principal place of business As given below
Line1

Line2

Landmark State:

City Pin code

Districts

10

1) LEI No.:
2) LEI Issuer:
3) LEI Issuance Date:
4) LEI Expiry Date:
10
We will endeavour to obtain the LEI at the earliest and agree to provide the LEI details to Axis Bank once we obtain the same.

I/we confirm that if total banking exposure of our firm/company goes beyond Rs. 5 Crore during the tenure of the loan/credit facility, we will endeavour
to obtain the LEI at the earliest and agree to provide the LEI details to Axis Bank once we obtain the same.

true, correct and up to date in all aspects. Signature

Status regarding Statutory Obligations

Whether complied with (select Yes/No). select NA in case not applicable
1 Registration under Shops and Establishment Act Yes / No / NA
2 Registration under MSME (Provisional/Final) Yes / No / NA
3 Latest GST returns filed Yes / No / NA
4 Latest Income Tax retunes filed Yes / No / NA
5 Any other statutory dues remaining outstanding Yes / No / NA

PART ll : EXISTING BANKING RELATIONSHIP

Exisiting Axis Bank Customer Y N If yes, Customer ID
Deatails of bank A/c and credit facility availed from banks/financial institutions including Axis Bank
Sr. No. Bank & Branch with Address Type of Facility Limit ROI

PART III: Proposal Details

oan Request Details
Sr.no Nature of Facility Amount Requested Tenure Purpose Expected Interest Rate
1.
2.
3.
Mode of Repayment : Cash A/c transfer/Standing Instruction UPI Payment Electronic transfers like RTGS/NEFT/IMPS/ECS/NACH Cheque/DD/PO
City____________________________District______________________________________and Branch________________________________Where loan is required
List of Enclosures
1. KYC Documents: 2. Financial Documents: 3. Bank Statements: 4. Others:
*Expected timelines for disposal of MSE application subject to completion of required documents is within 6 weeks.
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 PART IV: Security Details
1. P rimary Security:
Property Details
Value of the property

2. Collateral Security (Non Agri Property / Liquid collateral only):

A. Immovable property
Name of Registered Owner R with the B orrower
Property Details
Age of property in yrs Value of the property:

B. Liquid collateral security offered :

Type of security offered Value of security

Part V - Interest Rate, Processing Fees & Other Charges

I/We understand and agreed to the following terms pertaining to the facility / loan –
Rate of Interest - The final applicable interest rate as decided by Axis Bank on various parameters as per its policies and procedures shall be communicated to the customer at the time of
sanction/disbursement of each tranche of the facility/loan. The benchmark REPO / MCLR / SOFR / Any other external benchmark rate as prevalent on the date of first disbursement shall be
applicable and would be reset as per the frequency outlined in the sanction letter. The spread would generally remain unchanged during the tenor of the facility/loan. However, credit risk
premium may undergo change when borrower's credit assessment undergoes a substantial change. Overdraft against Fixed Deposit (ODFD) account will attract fixed rate of interest basis fixed
deposit ownership.
Processing Fee - The processing fees applicable on the facility/loan sanctioned by the Bank shall be in accordance with the terms as outlined in the sanction letter.
3) Penal Charges would be levied as follows:
a). Financial Default*: 8% p.a. above applicable interest rate on the overdue amount (subject to the aggregate not exceeding Rs. 1,00,000/- per instance).
b). Non-Financial Default**: 1% p.a. above applicable interest rate / commission from the date of each non-financial default on the outstanding amount of fund-based credit facilities and
non-fund-based facilities (as applicable).
There shall be no capitalisation of Penal Charges. The said Penal Charges will be subject to GST as per applicable law on Goods and Service Tax in India, and GST will be charged separately.
*Financial Default includes all types of payment or financial defaults/irregularities with respect to your Loan Account.
**Non-Financial Default includes breach of any other obligation(s)/covenant(s) with respect to your Loan Account.
4)
communicated to the customer by the Bank. Goods and Services tax (GST) will be charged extra as per the applicable rates, on all the charges and fees (wherever GST is applicable).

5) Prepayment Charges - The prepayment charges applicable on the facility/loan sanctioned by the Bank shall be in accordance with the terms as outlined in the sanction letter. No prepayment
charges are applicable in cases of Micro and Small Enterprises (MSE) customers if : a). Loan amount is up to Rs.50 Lakhs under Fixed rate loans, or b). Floating rate loans (irrespective of the loan
limit).

Signature

Part VI - Customer Request Details

a) A ate my account for Mobile number updates and alerts: Yes / No - Mobile
This subscribes to all alerts including Value added service alerts
b) A ate my account for E –S tatements registr Yes / No - email id:
In case E – S tatements ar ated, physical statements will be disabled
c) New Cheque book request: Number of cheques book/ s required

I have read, understood and agree to the terms and conditions of various products and services. I accept and agree to be bound by the terms and conditions as displayed
on www.axisbank.com. I agree that the bank may debit service charges plus taxes to my account wherever applicable.

Signature

Part VII : Aadhaar Details*

* Note : Where the client is non-individual, Aadhaar number issued to person holding an a�orney to transact on its behalf is required to be submi�ed
1. Aadhaar Number :

2. Aadhaar Number :

3. Aadhaar Number :

4. Aadhaar Number :

Customer Declara
• I/We authorize Axis Bank to verify and authen te my/our Aadhaar number during processing my/our applica or te Business purposes.
• I/We further authorise the B ank to share my Aadhaar related details/informa with regulatory / sta tutory bodies as and when required.

Signature of Authorized signatory Signature of Authorized signatory

Signature of Authorized signatory Signature of Authorized signatory

Part VIII : Customer Declaration of Preferred Language

I confirm my preferred language of communica�on is :
English Hindi Marathi Punjabi Bengali Odia
Gujara� Kannada Malayalam Tamil Telegu
Signature

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3. We agree that in case of non-payment of dues, in case of any facility availed from the Bank and consequently the account is to be classified as NPA, all other loan accounts of the

Bank of India [“RBI”].

and other Credit Grantors or Registered Users, as may be specified by the RBI in this behalf.

10. We understand that all charges pertaining to the loan including the Processing fees, prepayment penalty, etc. are to be borne by us. We further understand that the relevant
as per actuals will be borne by us.

13. I/We undertake that

14. Further, we confirm following: No suit is pending in any court of law against the directors/partners.
• I hereby declare that the details furnished above are true and correct to the best of my/our knowledge and belief and I undertake to inform you of any changes therein,

• My personal / KYC details may be shared with Central KYC Registry

15.
subsidiaries/trustees of mutual funds/venture capital funds.”
16. I/We undertake to inform the Bank in case of any update in the information provided or documents submitted by me/us for the grant of facility/Loan by the Bank at the time of establish-
ment of business relationship / account-based relationship and thereafter, as necessary; I/we shall submit to the Bank the update of such information/documents. I/We agree to
do the aforementioned within 30 days of the update to any such information/documents for the purpose of updating the records at the Banks’ end.
17. I/We agree that Axis Bank reserved the right to retain the documents submitted with application and will not return those tothe applicant even if the facility is rejected.
18. I/We shall furnish at the end of every calendar quarter a ce
rtificate in the form required by the Bank regarding my/our sales turnover and net profit.
19. I/We declare that: (i) I/we am/are competent and fully autho rized to issue such declarations, confirmations, agreements and undertakings and submit this application form for the
purpose of borrowing/availing of the requested facility, and to execute all other documents required by Axis Bank for such purpose. (ii) all such letter(s) of authorities/power(s) of attorney,
if any, executed by me/us in favour of any person/s and which is/are submitted to the Bank, is/are valid, subsisting and has/have not been revoked by me/us.

Yes No

I/We am/are director(s) of Axis Bank Limited and also a director(s) / partner(s), manager(s), managing agent (s), employee (s), or guarantor(s) or holder(s)

I/We am/are director(s) of any other bank or the subsidiaries of any of the banks or trustees of mutual funds / venture capital funds set up by the banks and also

partner(s) or guarantor(s) or major shareholder(s) or in control of the borrower or a major shareholder(s) or in control of the holding or subsidiary company of the borrower.

If any of the above clause is applicable, then please furnish t

Sr. No Name of Director(s)/Senior Officer (s) D R

1
2

1 2 3
Signature of Applicant
Date & Place
Signature of Guarantor
Date & Place

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 Informa roducts and Offerings
From time to time, Axis Bank communicates various new products / special features of existing products / promotional offers which are of significant benefits to its customers. I hereby
provide my consent to receive information / services etc. for marketing purposes through Telephone / Mobile / SMS / E-mails by the Bank / its agents. I understand that I may opt out
by registering in the ‘Provider Customer Preference Register’ as per details provided in the ‘TRAI’ website.

I/We hereby give my consent to and agree and authorize Axis Bank Ltd. to fetch my personal details from UIDAI. I/we hereby state that I/we have no objection in authenticating myself
with Aadhaar based authentication system and I/we voluntarily consent to providing my Aadhaar number / VID number, Biometric information and/or One Time Pin (OTP) data
(and/or any similar authentication data) for the purpose of BE Wholesale loan application. I/we understand that the biometric and/or OTP and/or any other authentication data I/we
may provide for authentication shall be used only for authenticating my identity through the Aadhaar authentication system for the speciific transaction or as per requirement of law
and for no other purposes. I/we confirm that I have been informed about the alternatives to submission of identity information and I/we have agreed to authenticate myself through
Aadhaar based authentication system with full understanding of alternatives to submission of identity information. I/we understand that Axis Bank shall ensure security and
confidentiality of my personal identity data provided for the purpose of Aadhaar based authentication. I/we authorize Axis bank to verify and authenticate my Aadhaar during
processing my BE Wholesale loan. I/we further authorize the Bank to share my Aadhaar related details/information with regulatory / statutory bodies as and when required. I confirm
that the Bank has explained and provided me the above information in my local language before collecting my personal details for the purpose of Aadhaar based authentication

I/we hereby expressly consent to and authorize the bank (whether acting by itself or through any of its service providers, and whether in automated manner or otherwise), to collect,
store and process my application details, personal data and sensitive information about me, information, papers and data relating to know your customer (KYC), credit information, and
any other information about me/pertaining to me or not as may be deemed relevant by the Bank (collectively, "Information") and/we hereby also expressly consent to and authorize
the Bank to download KYC details from the CKYC registry using my CKYC ID for the purpose of BE Wholesale loan application.

I/we expressly consent Bank to share and disclose the Information to service providers, consultants, credit information companies utilities, other banks and finacial institutions, affilliates,
group companies, subsidiaries, regulators, investigating agencien, judicial, quasi-judicial and statutory authorities, or to other persons/institutions/entities as may be necessary, in
connection with the contractual or legal requirements or in the legitimate intersts of the Bank or as per the consent, undertake to process information including by way of storing,
structuring, organizing, reproducing, copying, using, profilling, etc. As may be deemed fit by the Bank and for the purposes od cridit appraisal, fraud detection, anti-money laundering
obligations, for entering into contract.
Yes No
Applicant Signature

Consent

• Email Y N
• SMS text messages Y N
• Telephone Y N Signature of Applicant

* For any grievances please reach out to us at https://www.axisbank.com/contact-us/grievance-redressal/corporate banking

* You can find out more about how we process your personal data, by reading our Customer Privacy Notice, available online at https://www.axisbank.com/privacy-policy

Bharat Banking / BE W Form / 2024 / Ver 1.0

Acknowledgement of Loan applica Bank's Copy
Applica
We acknowledge that we have received an applica dated …………………from Mr. /Ms. ………………………………………………………………….. Resident of .............................................................
for a loan of ……………… under the product.………………

For AXIS Bank Ltd. Date:

(Sign and Stamp) Received the acknowledgment of loan applica (Applicant's Signature)

Documents received: Self-C True Copies Notary I V one:

KYC OVD: Digitally Verified Manually Verified Digital V ef no. …………………………………………………………………..
IN PERSON VERIFICATION CARRIED OUT BY
Emp. Name

Emp. Code

Emp. D

Emp. Or ode

Emp. Branch

Place
(Employee Signature)
Date

------------------------------------------------------------CUT HERE------------------------------------------------------------

Acknowledgement of Loan applica Applicant's Copy

We acknowledge that we have received an applica ted …………………from Mr. /Ms. ………………………………………………………………….. Resident of ......................................
for a loan of ……………… under the product.………………

For AXIS Bank Ltd.

Date:

(Sign and Stamp)

Please Note that:

1. This is only an acknowledgement for having received the and this should not be constructed as an for our acceptance of the proposal, a decision on
which will be taken only a due consider of the proposal on its merit and / or on fulfillment of c if any, that may be by the bank.
2. T will be taken for consider a y be required are received by the bank
3. In case the pr oposal is rejected/not considered the reasons for the same

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 DECLARATION OF BENEFICIAL OWNERSHIP
(NOT APPLICABLE FOR SOLE PROPRIETORSHIP ACCOUNTS)

Name of the Customer/Entity

Registered Number
(Wherever applicable)
Registered Address

The Customer/Entity as stated above hereby confirms and declares that on the below date (Please tick the correct option - option 3 is applicable only for Company)

1. We (Company) __________________________confirm that following natural person(s) (listed in the Table below) directly or indirectly has/have controlling ownership
interest i.e. having ownership/entitlement of more than 10 percent of the shares/capital/profits of the Company, or exercise control over the Company through other means
which includes the right to appoint majority of the directors or to control the management or policy decisions including by virtue of their shareholding or management rights
or shareholders agreements or voting agreements.
OR
We (Partnership firm) __________________________confirm that following natural person(s) (listed in the Table below) directly or indirectly has/have
ownership/entitlement of more than 10 percent of the capital/profits of the partnership, or exercise control over the Partnership firm through other means which includes the
right to control the management or policy decision.
OR
We (Unincorporated association or body of individuals or Society) __________________________confirm that following natural person(s) (listed in the Table below) directly
or indirectly has/have ownership/entitlement of more than 15 percent of the property/capital/profits.
OR
We (Trust) __________________________confirm that following natural person(s) (listed in the Table below) are beneficiaries, settlor, protector (if any), author(s) of the trust,
trustee(s), has/have 10 percent or more interest in the trust or exercise ultimate effective control over the trust through a chain of control or ownership.
OR
2. There is no natural person(s) who exercises control or ultimately have a controlling ownership interest directly or indirectly as stated above, therefore
details of:
All partner(s) (for partnership) /senior managing officials (for unincorporatedbodies/Society) who are natural person(s) are stated in the below Table.
Natural person(s) holding the position of directors/senior management in the Company are given in the below Table.

(*If you have ticked any of the above, please complete the Table below before signing the declaration)

Sr No. Full Name of Beneficial Date of Nationality Address Type of KYC Controlling
owner/controlling natural Birth Documents ownership
person(s) interest
Identity Address (%)

OR
3. The Company is listed on (Name of the Stock Exchange*)
in India or is an entity resident in jurisdiction notified by the Central Government and listed on ___________________ (Name of Stock Exchange*) or it is a subsidiary of

(Name of the listed

Company**)listed on (Name of the Stock Exchange*)

*Stock Exchange recognized in India or in any jurisdiction notified by Central Govt.

**Entity listed on a Stock Exchange in India or an entity resident in jurisdictions notified by the Central Government and listed on stock exchanges in such jurisdictions.

The Customer/Company undertakes that the facts stated above are true and correct. The Customer/Company also undertakes and agrees that it will notify Axis Bank
without delay of any changes in the controlling persons / shareholders, person exercising control or having controlling ownership interest in the Company /
Partnership / LLP / AOP / Society / Trust / Club / University / Institution, as declared in the table above.

For and on behalf of [Name of Company / Partnership / LLP / AOP / Society / Trust / Club / University / Institution]:

Signature of the Authorized Official*:

Full Name of the Authorized Official:

Designation/ Position:

Date D D M M Y Y Y Y

* The declaration should be signed by:

i. An active/designated partner in case of Partnership Firm/LLP, a trustee in case of Trust, a senior managing official in case of AOP, Society, Club and member of the
Managing Committee in case of University and Institution.
ii. The official authorized to sign by the Board Resolution of the Company, in case of a Company.

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 Relationship Details (CIC) Individual Entity
Sr. No . Field Name Input / Select Value Input / Select Value
1 Borrower Cust ID* (Existing customer)
2 Borrower Name*
3 Relationship DUNS Number
� Resident Indian Individual � Resident Indian Individual
4 Related Type* � Foreign/Non-Resident Indian Individual � Foreign/Non-Resident Indian Individual

� Shareholder � Shareholder
� Proprietor � Proprietor
� Partner � Partner
� Trustee � Trustee
� Promoter Director � Promoter Director
� Nominee Director � Nominee Director
5 Relationship* � Independent Director � Independent Director
� Director - Since Resigned � Director - Since Resigned
� Individual Member of SHG � Individual Member of SHG
� Other Director � Other Director
� Karta(HUF) � Karta(HUF)
� Others(Pls specify)____________(Should not be tagged � Others(Pls specify)____________(Should not be tagged
as personal relationships like father, mother etc.) as personal relationships like father, mother etc.)

� Mr � Mr
� Ms � Ms
6 Individual Name Prefix * � Mrs � Mrs
� Dr � Dr
� Mx � Mx
� Other (pls Specify) ___________ _____
� Other (pls Specify) ___________
7 Full Name of Related Party*
8 Gender* � Male; � Female; � Transgender � Male; � Female; � Transgender
9 Date of Birth*
10 PAN*
11 Voter ID
12 Passport Number
13 Driving Licence ID
*Please provide any one of the following : Voter ID/Passport Number/Driving Licence ID
14 UID/Aadhar Card XXXX XXXX __ __ __ __ XXXX XXXX __ __ __ __
15 Ration Card Numbe r

Only when Relationship is: Only when Relationship is:

1 Promoter Director 1 Promoter Director
16 DIN Number 2 Nominee Director 2 Nominee Director
3 Independent Director 3 Independent Director
4 Director - Since Resigned 4 Director - Since Resigned
5 Other Director 5 Other Director
17 Service Tax
18 Other ID
Politically Exposed Person (PEP) Status* Politically Exposed Person (PEP) Status*
Politically Exposed Person (PEP)
Status* (Note: *PEP Politically Exposed
Persons” (PEPs) are individuals who are or
have been entrusted with prominent public PEP Related to PEP Not Applicable PEP Related to PEP Not Applicable
19 functions of a foreign country, including the
Heads of States/ Governments, senior
politicians, senior government or judicial or
military officers, senior executives of state-
owned corporations and important political
party officials)
20 Percentage of Control (If applicable)
21 Address Line 1*
22 Address Line 2*
23 Address Line 3
24 CITY*
25 Pincode*
26 State*
27 Country*
28 Mobile Number*
29 Telephone number
30 Fax number
UDYAM - __ __ - __ __ - __ __ __ __ __ __ __ (First 2 UDYAM - __ __ - __ __ - __ __ __ __ __ __ __ (First 2
31 Udyam Registration Number
character are alphabet, rest 9 are numeric) character are alphabet, rest 9 are numeric)

Signature and Stamp of Borrower

Name:
Designation:

Place:
Date:

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 Relationship Details (CIC) Non - Individual Entity
Sr. No . Field Name Input / Select Value Input / Select Value
1 Borrower Cust ID (Existing customer)*
2 Borrower Name *
3 Relationship DUNS Number

4 Related Type* � Business Entity Registered in India � Business Entity Registered in India
� Business Entity Registered Outside India � Business Entity Registered Outside India

� Holding Company � Holding Company

� Subsidiary Company � Subsidiary Company
� Partner � Partner
5 Relationship*
� Trustee � Trustee
� Shareholder � Shareholder
� Joint Venture � Joint Venture
� Others(Pls specify)___________ � Others(Pls specify)___________
6 Business Entity Name (Related party)*

� MSME � MSME
� SME � SME
� Micro � Micro
7 Business Category*
� Small � Small
� Medium � Medium
� Large � Large
� Others(pls specify)__________ � Others(pls specify)__________

� Manufacturing � Manufacturing
� Distribution � Distribution
� Wholesale � Wholesale
� Trading � Trading
� Broking Commercial � Broking Commercial
8 Business / Industry Type*
� Service Provider � Service Provider
� Importing � Importing
� Exporting � Exporting
� Agriculture � Agriculture
� Dealers � Dealers
� Others(pls specify)__________ � Others(pls specify)__________
_
9 Company Registration Number (if available)
10 Date of Incorporation*
11 PAN*
12 CIN
13 TIN
14 Service Tax
15 Other ID (CKYC No When available)
16 Percentage of Control (When available)
17 Address Line 1*
18 Address Line 2*
19 Address Line 3
21 CITY*
24 District
26 Pincode*
28 State*
29 Country*
30 Mobile Number*(When available)
31 Telephone number
32 Fax number
Udyam Registration (If available) UDYAM - __ __ - __ __ - __ __ __ __ __ __ __ UDYAM - __ __ - __ __ - __ __ __ __ __ __ __
33
Number (First 2 character are alphabet, rest 9 are numeric) (First 2 character are alphabet, rest 9 are numeric)

Signature and Stamp of Borrower

Name:
Designation:

Place:
Date:

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