CITI MORTGAGE APPLICATION FORM FOR NRI CUSTOMERS

VER 14.3/MORTGAGE/MORTGAGE APPLICATION FORM/WPC/10-19

CITI MORTGAGE APPLICATION FORM FOR NRI CUSTOMERS

Name (Same as ID Proof)

Mr./Ms./Mrs./Mx.

:

Maiden Name (If any)

:

Father's/Spouse's Name :

Mother's Name

:

(Please leave one space between each name)

CKYC number (if any):

First Name

Middle Name

Last Name

GST Identification number (Only for Entity):

Others

Citizenship:

Indian

Others ___________________

Residential Status:

Resident Individual

Non Resident Indian

Foreign National

Person of Indian Origin

Other, please specify

Passport Number

Issued at

Issued Date

Proof of Identity:

(any one of them)

A - Passport Number B - Voter ID Card

Passport Expiry Date

C - PAN Card D - Driving Licence

Driving Licence Expiry Date

E - UID (Aadhaar)

F - NREGA (Job Card)

Z - Others (Other Govt ID)

(Please submit all the documents for the ID number ticked in this form).

Address Type for Proof:

Residential

Business

Proof of Address:

Passport

Driving Licence

UID (Aadhaar)

Expiry Date

Voter Identity Card

NREGA Job Card

Others _________________________________________

District: State/UT:

Country:

City/Town/Village: Pin/Post Code:

Mobile No.:

I confirm that the above is my current residential address and I have submitted the address proof documents for the above. In addition, I have/have not submitted a proof of my permanent address as below.

Official E-mail ID

(for verification purposes only)

Signature

(for all correspondence)

District: State/UT:

District: State/UT:

Country: Country:

City/Town/Village: Pin/Post Code:

City/Town/Village: Pin/Post Code:

1

Name of company/ concern: Doing Business As: Designation: Office Address:

District: State/UT: Telephone: Employee No:

Extn.:

No. of years with current employer

City/Town/Village:

Country:

Pin/Post Code:

Fax:

Number of years at previous organisation/s:

Retirement Age

VER 14.3/MORTGAGE/MORTGAGE APPLICATION FORM/WPC/10-19

Name (Same as ID Proof)

Mr./Ms./Mrs./Mx.

:

Maiden Name (If any)

:

Father's/Spouse's Name :

Mother's Name

:

(Please leave one space between each name)

CKYC number (if any):

First Name

Middle Name

Last Name

Others

Citizenship:

Indian

Others ___________________

Residential Status:

Resident Individual

Non Resident Indian

Foreign National

Person of Indian Origin

Other, please specify

Passport Number

Issued at

Issued Date

Proof of Identity:

(any one of them)

A - Passport Number B - Voter ID Card

Passport Expiry Date

C - PAN Card D - Driving Licence

Driving Licence Expiry Date

E - UID (Aadhaar)

F - NREGA (Job Card)

Z - Others (Other Govt ID)

(Please submit all the documents for the ID number ticked in this form).

Address Type for Proof:

Residential

Business

Proof of Address:

Passport

Driving Licence

UID (Aadhaar)

Expiry Date

Voter Identity Card

NREGA Job Card

Others _________________________________________

District:

City/Town/Village: Pin/Post Code:

State/UT:

Country:

Mobile No.:

I confirm that the above is my current residential address and I have submitted the address proof documents for the above. In addition, I have/have not submitted a proof of my permanent address as below.

Signature

2

Official E-mail ID

(for verification purposes only) (for all correspondence)

District: State/UT:

District: State/UT:

Country: Country:

City/Town/Village: Pin/Post Code:

City/Town/Village: Pin/Post Code:

VER 14.3/MORTGAGE/MORTGAGE APPLICATION FORM/WPC/10-19

Name of company/ concern: Doing Business As: Designation: Office Address:

District: State/UT: Telephone: Employee No:

Extn.:

No. of years with current employer

City/Town/Village:

Pin/Post Code:

Country:

Fax:

Number of years at previous organisation/s:

Retirement Age

Address:

District: State/UT: Telephone:

Extn.:

Country:

City/Town/Village: Pin/Post Code:

Fax:

3

Reference Rate: TBLR

: Treasury Bill Benchmark linked Lending Rate (TBLR) which will be the reference rate for variable interest rate loans and is determined based on the 3 month Treasury Bill rate published by Financial Benchmarks India Private Limited (FBIL). The applicable date of TBLR determination will be as detailed in Schedule 1 of the loan agreement

VER 14.3/MORTGAGE/MORTGAGE APPLICATION FORM/WPC/10-19

District: State/UT:

Country:

City/Town/Village: Pin/Post Code:

4

Consent to link Citibank facilities/accounts

I consent to link my Mortgage loan account with my existing Citibank relationships listed above or internally identified by the Bank.

Yes

No

Citibank, N.A.,

VER 14.3/MORTGAGE/MORTGAGE APPLICATION FORM/WPC/10-19

Citibank, N.A.,

Signature / Thumb Impression

Citibank, N.A., 5

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