DHARA MOTOR FINANCE LTD
CLIENT INQUIRY FORM					DATE:
NAME/नाम:		FATHER'S NAME/पिता का नाम:		MOTHER'S NAME/माता का नाम:		CAST/जाति:
ADDRESS-1 (TEMP/CORRESPONDANCE)/पता (अस्थायी):
ADDRESS-2 (PERMANENT)/पता (स्थायी):
PHONE NO./फ़ोन नं.:	HOME/OFFICE/घर का/ऑफिस का :		MOBILE/मोबाइल नं:		WHATSAPP & EMAIL/व्हाट्सएप व ईमेल:
DATE OF BIRTH/जन्मतिथि (PAN CARD/DL/VOTER-ID):				EDUCATIONAL QUALIFICATION/शैक्षिक योग्यता :
BUSINESS PROFILE/कंपनी का नाम:		YEARS/सेवा के वर्ष:	MONTHLY INCOME/मासिक आय/आय का जरिया:		BANK ACCOUNT/बैंक अकाउंट:		MODE OF PAYMENT
							PDCECSSPDCCASH
इनकम टैक्स (अंतिम तीन साल का):		PAN CARD NO.:		VOTER-ID CARD NO.:		AADHAAR CARD NO.:
HOUSING DETAILS/घर का विवरण:	अपना/किराये का	क्षेत्रफल/अनुमानित कीमत	सीमा चिन्ह		घर का प्रकार	गाँव/शहर	कार्यक्षेत्र से दूरी
	OWNEDRENTED				MUD HOUSECEMENTED	VILLCITY
LOAN DETAILS/ऋण का विवरण:	नया/पुराना	MANUFACTURE NAME & TYPE	MAKE & MODEL NAME	YR OF MANUF	गाड़ी का मूल्य(EX SHOWROOM)	ऋण की राशि	TENURE(IN MONTH)
		TWO WHEELER THREE WHEELER FOUR WHEELER LIGHT COMMERCIAL VEHICLE HEAVY COMMERCIAL VEHICLE MACHINE TRACTOR SHOP LOAN BUSINESS LOAN OTHER	&
परिवार के सदस्यों का विवरण	नाम		आयु	व्यवसाय		INCOME
पिता
भाई या अन्य कोई
गारंटर-एक:	नाम	जन्मतिथि	पिता का नाम	पता	मोबाइल	घर अपना/किराये का	PAN NO.
गारंटर एक के व्यवसाय का विवरण व आमदनी (FILL INCOME IN NEXT BOX)
गारंटर-दो:	नाम	जन्मतिथि	पिता का नाम	पता	मोबाइल	घर अपना/किराये का	PAN NO.
गारंटर दो के व्यवसाय का विवरण व आमदनी (FILL INCOME IN NEXT BOX)
विक्रेता/DEALER or Current Owner Details	नाम		पता व फ़ोन नं.		VEHICLE DETAILS(REG.NO./ENG.NO./CHASSIS NO.)
VEHICLE DETAILS (IN CASE OF OLD VEHICLE)
FROM RTO	TRF TO RTO	INS COMPANY NAME	INS TYPE	EXPIRY DATE	HYPOTHECATION	FITNESS UPTO	TAX UPTO
		APOLLO MUNICH INSURANCE BAJAJ ALLIANZ GENERAL INSURANCE BHARTI AXA GENERAL INSURANCE CHOLAMANDALAM MS GENERAL INSURANCE CIGNA TTK HEALTH INSURANCE COMPANY LTD - CIGNA TTK FUTURE GENERALI INDIA INSURANCE COMPANY LTD HDFC ERGO GENERAL INSURANCE IFFCO TOKIO GENERAL INSURANCE COMPANY LIMITED LIBERTY GENERAL INSURANCE MAX BUPA GENERAL INSURANCE NATIONAL INSURANCE COMPANY LIMITED NEW INDIA ASSURANCE ORIENTAL INSURANCE COMPANY RAHEJA QBE GENERAL INSURANCE COMPANY LTD - RAHEJA QBE RELIANCE GENERAL INSURANCE RELIGARE HEALTH INSURANCE ROYAL SUNDARAM GENERAL INSURANCE CO. LIMITED SBI GENERAL INSURANCE COMPANY LTD SHRIRAM GENERAL INSURANCE COMPANY LTD STAR HEALTH AND ALLIED INSURANCE TATA AIG GENERAL INSURANCE UNITED INDIA INSURANCE UNIVERSAL SOMPO GENERAL INSURANCE NONE	PACKAGE POLICY LIABILITY ONLY POLICYNONE
कार्यकारी द्वारा अनुशंसा/RECOMENDATION BY EXECUTIVE
तारीख		कार्यकारी/EXECUTIVE का नाम		COLL. CENTER/BRANCH का नाम	BIJNORHARIDWARMEERUTDELHIKASHIPURANAND_VIHARCHANDPURDHAMPURDEHRADUNRISHIKESHGURUGRAMFARIDABAD	आवेदक/APPLICANT का नाम
CONNECTION:
CONNECTION	EXISTING CUSTOMER (Y/N)	EXISTING GUARANTOR (Y/N)	SURVEY RECORD (Y/N)	CATEGORY	ANY OTHER REFERENCE PLS MENTION FEEDBACK / REMARKS
HIRER CONNECTION	YESNO	YESNO	YESNO
GUARANTOR-1 CONNECTION	YESNO	YESNO	YESNO
GUARANTOR-2 CONNECTION	YESNO	YESNO	YESNO
TEST

Developed By I.T.Department of Dhara Motor Finance Ltd.