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Rate of interest per annum valid up to Rs. 5 crore (w.e.f. 10th July 2017)
Date:
Tenor in Non-cumulative
Cumulative
months Monthly Quarterly Half Yearly Annual Application Form No.:
12 – 23 7.60% 7.35% 7.39% 7.46% 7.60% Sourcing Channel:
24 – 35 7.80% 7.53% 7.58% 7.65% 7.80%
36 – 60 7.85% 7.58% 7.63% 7.70% 7.85% Broker Code:
# Rates for above Rs. 5 crore may vary from the published card rate
Sub Broker Code:
# Minimum deposit size Rs. 25,000
Scheme Code:
PLEASE FILL IN BLOCK LETTERS AND TICK WHERE REQUIRED
Investment Details
Investment New Renewal If renewal, existing FD No. Renew Principal Renew Principal and Interest Partial renewal
(only for cumulative) (cumulative up to P+I and
Deposit Payable to First Holder Either or Survivor non-cumulative up to only P)
Deposit Amount Numeric Words
Deposit Term in Months Deposit Option Cumulative Non-cumulative
Interest Payout Frequency (Mandatory for Non-cumulative option) Monthly Quarterly Half Yearly Annually
Maturity Instruction: Renew Principal and Interest* (only for cumulative) Renew Principal* Payout on Maturity
City/Town/Village State/U.T.
Pin Code Is Current/Correspondence Address same as Permanent Address? Yes No
Email ID
(Mobile no. or Email ID S T D Code Landline Mobile Number
is mandatory)
Annual Income Up to Rs. 15 lakh Rs. 15 lakh-Rs. 50 lakh Rs. 50 lakh+ Occupation Self employed Salaried Retired
Father’s/Spouse’s Name Mr. Ms. Mrs.
First Middle Last
Mother’s Name
First Middle Last
Guardian’s Name
PAN
Constitution Resident Individual Resident Non-Individual (Please tick any one of the below)
HUF Statutory Board Local Authority Partnership Proprietorship Public Ltd. Co. Private Ltd. Co. Others
Please tick (✓) If the following is additionally applicable to you: Politically Exposed Person (PEP) Relative of PEP
Special Category
Refer Point no. 1 in Terms and Conditions for details
Senior Citizen BFL Existing Customer Please provide your BFL LAN/Customer ID
Please mention if you are a Bajaj Finance Limited shareholder Yes No If yes, please mention your Folio No.
*Tenor, option & interest payout frequency to be same as per original deposit
Page 1 of 12
KYC Details of First Applicant
ID Proof Passport PAN Driving Licence Voter ID Aadhaar Card NREGA Job Card ID Proof No._________________________
Address Proof (Any one of the following) Passport Driving Licence Voter ID UID/Aadhaar Card Utility Bills
Property or Municipal Tax Receipt Bank account or Post Office savings bank account statement
Letter of allotment of accommodation from employer issued by State or Central Government departments, statutory or regulatory bodies,
public sector undertakings, scheduled commercial banks, financial institutions and listed companies
‘Only above mentioned options are valid/acceptable as address proof’
In case of Non-Individual category, enclose a certified true copy of the following documents:
1. Certificate of Registration/Incorporation issued by the Registrar of Companies. Please mention your Registration No.
2. Memorandum & Articles of Association/Partnership Deed
3. Resolution of the Board of Directors to open an account and identification of those who have authority to operate the account
4. Power of Attorney granted to its managers, officers or employees to transact business on its behalf
Email ID Gender
Please tick (✓) If the following is additionally applicable to you: Politically Exposed Person (PEP) Relative of PEP
Email ID Gender
Please tick (✓) If the following is additionally applicable to you: Politically Exposed Person (PEP) Relative of PEP
Loan against Fixed Deposit available. For details, refer to point No.5 in the Terms and Conditions.
Page 2 of 12
Nomination to Deposit: Form DA 1: U/S 45 QB of RBI Act 1934
I/We, above named Depositors at above address, nominate the following person to whom in the event of my/our/minor's death the amount of this deposit
may be returned by the Company:
1. Name and Address of Nominee
2. As the nominee is a minor on this date, I/we appoint (Name, Address and Age)
to receive the amount of the said deposit on behalf of the nominee in event of my/our/minor's death during the minority of the nominee.
(*Strike out if not applicable)
*Date of Birth (if nominee is a minor)
*Place & Date:
Two Witnesses’ Name & Signature 1) ___________________ 2) ___________________ Signature(s) of Depositor
Payment Details
UTR No. (Applicable for deposit amount electronically transferred through RTGS)
(In case of RTGS mode of deposit or interest and maturity amount repayment desired in a separate account, please enclose a signed cancelled
cheque of the same account with a valid IFS code)
*15G/H form for tax exemption is attached with this deposit form. Kindly fill in the same. Incomplete or incorrect forms will result in tax deductions
Declaration
The deposit amount together with interest is payable by online banking payment to the bank account specified by me/us in this Application Form or such other bank account intimated by me/us in writing to the
Company from time to time. I/We also note that the fixed deposit receipt when issued will not be transferable. I/We declare that the amount mentioned herein is not being deposited out of the funds acquired by
me/us by borrowing or accepting deposits from any other person. I/We have gone through the financials and other declarations furnished by the Company and after careful consideration, I/we am/are making the
deposit with the Company at my/our own risk and volition. I/We declare that the first named Depositor mentioned in this application is the beneficial owner of this deposit and as such he/she should be treated as
the payee for the purpose of deduction of tax, if applicable, under Section 194A of the Income Tax Act, 1961. The other names have been added merely for the sake of convenience. I/We declare that the first named
Depositor under this application does not hold, alone or as first named holder in any deposit(s) of the fixed deposit schemes of the Company, other than the deposits the particulars of which are indicated by me/us
herein above. I/We also declare that whatever is stated in this application is true and correct. I declare that I/we have read and understood the Terms and Conditions mentioned in this form. I/We hereby authorise
the Company to pay the interest and amount of deposit on maturity by online banking payment to my/our aforesaid bank account, details of which are provided by me/us in this form.
Page 3 of 12
Terms and Conditions
13 In the event of death of sole depositor and/or all the joint depositors, all payment on account of principal and/or HOW TO APPLY:
interest will be made to the Nominee appointed by the depositor (s) on production of proof of identity and on 1. Depositor(s) are requested to go through the terms and conditions printed above
execution of such other documents as BFL may deem fit for the same.
2. The attached Application Form should be filled in fully and signed by the Depositor(s)
14 In any other case, it will be necessary for the legal representative of the deceased depositor to produce Succession 3. The amount should be deposited only by cheque made payable to ‘BAJAJ FINANCE LTD – ACCOUNT NUMBER
Certificate/Letter of Administration/Probate of the Will to the satisfaction of BFL. 00070350006738’ and crossed ‘Account Payee only’
15 Any change in address, email ID, bank account etc mentioned in the application form may be effected by BFL only on 4. The cheques should be payable at par and CTS compliant
the basis on written instruction signed by the sole/joint deposit holder(s) as per their signature on the application
5. Application Form along with the necessary remittance should be sent to the distributors to the Fixed Deposit
form.
Schemes of BFL or be submitted in any of BFL’s branches
16 FIXED DEPOSIT RECEIPTS:
6. Depositor(s) can also apply online by visiting www.bajajfinserv.in=>Investment=>Fixed Deposit. Bajaj Finance Ltd
Fixed Deposit Receipts will be forwarded by Speed Post to the Depositors within a period of three weeks from the customers can also apply on customer portal Experia
date of deposit. Fixed Deposit Receipts will not be transferable. BFL will not accept or recognise any lien or assignment
OTHER REQUIRED INFORMATION
on the deposit and/or interest thereon.
1. In case of non-repayment of the deposit or part thereof as per the terms and conditions of such deposit, the
17 INTEREST: depositor may approach the Western Bench of Company Law Board at:
Interest will be calculated from the date of realisation of the cheque towards the deposit. The Bench Officer, Company Law Board, 2nd Floor N.T.C House, 15 Narottam Morarjee Marg, Ballard Estate,
The dates for interest payments are as follows: Mumbai - 400038
2. In case of any deficiency of the BFL in servicing its deposit, the depositor may approach the District Level
Consumer Redressal Forum, the State Level Consumer Redressal Forum or the National Consumer Redressal
Forum for relief
*This Provisional Receipt is valid only till the issuance of the Fixed Deposit Receipt Page 4 of 12
BAJAJ FINANCE LIMITED
Registered Office: Akurdi, Pune 411 035
Corporate Office: 4th Floor, Bajaj Finserv Corporate Office, Off Pune-Ahmednagar Road, Viman Nagar, Pune 411 014
Fixed Deposit Schemes ‘FAAA/Stable’ Rating by CRISIL | ‘MAAA (Stable)’ Rating by ICRA
‘FAAA/Stable’ Rating by CRISIL and ‘MAAA (Stable)’ Rating by ICRA indicate the highest degree of safety with regard to timely payment of interest and principal on the instrument.
The above text of advertisement has been issued on the authority and in the name of the Board of Directors and has been approved by the Board of Directors at its meeting held on 19th July 2017 and copy
of the same signed by the majority of Directors has been delivered to the Reserve Bank of India for registration.
By order of the Board of Directors
for Bajaj Finance Limited
Pune (Rahul Bajaj)
20th July 2017 Chairman
HOW TO INVEST:
The amount should be deposited only by cheque made payable to ‘BAJAJ FINANCE LTD – ACCOUNT NUMBER 00070350006738’ and crossed ‘Account Payee only’. The cheques should be payable at par and CTS
compliant. Application Form along with the necessary remittance should be sent to the Distributors of the Fixed Deposit Schemes of BFL or be submitted at any of the BFL branches.
Write to us at fd@bajajfinserv.in or call us on 020 71124281
Page 5 of 12
Customer ID: ‘FORM NO. 15G’
PART I
1. Name of Assessee (Declarant)
2. PAN of the Assessee
First Middle Last
3. Status 4. Previous year (P.Y.) 5. Residential Status
(for which declaration is being made)
6. Flat/Door/Block No. 7. Name of Premises
8. Road/Street/Lane 9. Area/Locality
17. Estimated total income of the P.Y. in which income mentioned in column 16 to be included
18. Details of Form No. 15G other than this form filed during the previous year, if any
Total no. of Form No. 15G filed Aggregate amount of income for which Form No. 15G filed
Sr. no. Identification number of relevant Nature of income Section under which Amount of income
investment/account, etc. tax is deductible
20. Declaration/Verification
Signature of the Declarant
*I/We ………………………………………………………………………………………. do hereby declare that to the best of *my/our knowledge and belief what is stated above is correct,
complete and is truly stated. *I/We declare that the incomes referred to in this form are not includible in the total income of any other person under sections 60 to 64 of the
Income- tax Act, 1961. *I/We further declare that the tax *on my/our estimated total income including *income/incomes referred to in column 16 *and aggregate amount of
*income/incomes referred to in column 18 computed in accordance with the provisions of the
Income-tax Act, 1961, for the previous year ending on 31.03……………. relevant to the assessment year 20……-20…….. will be nil. *I/We also declare that *my/our *income/in-
comes referred to in column 16 *and the aggregate amount of *income/incomes referred to in column 18 for the previous year ending on 31.03………………. relevant to the
assessment year 20……-20…….. will not exceed the maximum amount which is not chargeable to income-tax.
Place
Page 6 of 12
PART II
[To be filled by the person responsible for paying the income referred to in column 16 of Part I]
Complete Address: 4TH FLOOR, BAJAJ FINSERV CORPORATE OFFICE, OFF PUNE AHMEDNAGAR ROAD, VIMAN NAGAR, PUNE - 411014
Email ID Telephone No. (with STD Code) and Mobile No. 020-30405060 Amount of income paid Gross Interest for FY
Date on which Declaration is received Date on which the income has been paid/credited (DD/MM/YYYY)
Place
As per provisions of section 206AA(2), the declaration under section 197A(1) or 197A(1A) shall be invalid if the declarant fails to furnish his valid Permanent
Account Number (PAN). Declaration can be furnished by an individual under section 197A(1) and a person (other than a company or a firm) under section
197A(1A).
1. Enter the name of the declarant
2. Enter the PAN of the declarant
3. Tick whichever status is applicable
4. The financial year to which the income pertains.
5. Please mention the residential status as per the provisions of section 6 of the Income-tax Act, 1961.
6-14. Enter residential address and contact details
15. Please mention ‘Yes’ if assessed to tax under the provisions of Income-tax Act, 1961 for any of the assessment year out of six assessment years
preceding the year in which the declaration is filed.
16. Please mention the amount of estimated total income of the previous year for which the declaration is filed including the amount of income for which
this declaration is made.
17. Enter income from all sources, including income filled in 16. above
18. In case any declaration(s) in Form No. 15G is filed before filing this declaration during the previous year, mention the total number of such Form No. 15G
filed along with the aggregate amount of income for which said declaration(s) have been filed.
19. Mention the distinctive number of shares, account number of term deposit, recurring deposit, National Savings Schemes, life insurance policy number,
employee code, etc.
20. Indicate the capacity in which the declaration is furnished on behalf of a HUF, AOP, etc.
Before signing the declaration/verification, the declarant should satisfy himself that the information furnished in this form is true, correct and complete in all
respects. Any person making a false statement in the declaration shall be liable to prosecution under section 277 of the Income-tax Act, 1961 and on
conviction be punishable-
a. In a case where tax sought to be evaded exceeds twenty-five lakh rupees, with rigorous imprisonment which shall not be less than six months but
which may extend to seven years and with fine;
b. In any other case, with rigorous imprisonment which shall not be less than three months but which may extend to two years and with fine.
The person responsible for paying the income referred to in column 16 of Part I shall allot a unique identification number to all the Form No. 15G received
by him during a quarter of the financial year and report this reference number along with the particulars prescribed in rule 31A(4)(vii) of the Income-tax
Rules, 1962 in the TDS statement furnished for the same quarter. In case the person has also received Form No.15H during the same quarter, please allot
separate series of serial number for Form No. 15G and Form No. 15H.
The person responsible for paying the income referred to in column 16 of Part I shall not accept the declaration where the amount of income of the
nature referred to in sub-section (1) or sub-section (1A) of section 197A or the aggregate of the amounts of such income credited or paid or likely to be
credited or paid during the previous year in which such income is to be included exceeds the maximum amount which is not chargeable to tax. For
deciding the eligibility, he is required to verify income or the aggregate amount of incomes, as the case may be, reported by the declarant in columns 16
and 18.
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Customer ID: ‘FORM NO. 15H’
PART I
1. Name of Assessee (Declarant)
2. PAN of the Assessee
First Middle Last
3. Date of Birth 4. Previous year (P.Y.) 5. Flat/Door/Block No.
(for which declaration is being made)
6. Name of Premises
7. Road/Street/Lane 8. Area/Locality
16. Estimated total income of the P.Y. in which income mentioned in column 15 to be included
17. Details of Form No. 15H other than this form filed for the previous year, if any
Total No. of Form No. 15H filed Aggregate amount of income for which Form No. 15H filed
Sr. no. Identification number of relevant Nature of income Section under which Amount of income
investment/account, etc.8 tax is deductible
Declaration/Verification
Signature of the Declarant
*I/We ………………………………………………………………………………………. do hereby declare that to the best of *my/our knowledge and belief what is stated above is correct,
complete and is truly stated. *I/We declare that the incomes referred to in this form are not includible in the total income of any other person under sections 60 to 64 of the
Income- tax Act, 1961. *I/We further declare that the tax *on my/our estimated total income including *income/incomes referred to in column 16 *and aggregate amount of
*income/incomes referred to in column 18 computed in accordance with the provisions of the Income-tax Act, 1961, for the previous year ending on 31.03……………. relevant to
the assessment year 20……-20…….. will be nil. *I/We also declare that *my/our *income/incomes referred to in column 16 *and the aggregate amount of *income/incomes
referred to in column 18 for the previous year ending on 31.03………………. relevant to the assessment year 20……-20…….. will not exceed the maximum amount which is not
chargeable to income-tax.
Place
Page 8 of 12
PART II
[To be filled by the person responsible for paying the income referred to in column 16 of Part I]
Complete Address: 4TH FLOOR, BAJAJ FINSERV CORPORATE OFFICE, OFF PUNE AHMEDNAGAR ROAD, VIMAN NAGAR, PUNE - 411014
Email Telephone No. (with STD Code) and Mobile No. 020-30405060 Amount of income paid Gross Interest for FY
Date on which Declaration is received Date on which the income has been paid/credited (DD/MM/YYYY)
Place
As per provisions of section 206AA(2), the declaration under section 197A(1C) shall be invalid if the declarant fails to furnish his valid Permanent Account
Number (PAN). Declaration can be furnished by a resident individual who is of the age of 60 years or more at any time during the previous year.
1. Enter the name of the declarant
2. Enter the PAN of the declarant
3. Enter the date of birth of the declarant
4. The financial year to which the income pertains.
5-13. Enter residential address and contact details
14. Please mention ‘Yes’ if assessed to tax under the provisions of Income-tax Act, 1961 for any of the assessment year out of six assessment years
preceding the year in which the declaration is filed.
15. Please mention the amount of estimated total income of the previous year for which the declaration is filed including the amount of income for which
this declaration is made.
16. Enter income from all sources, including income filled in 15. above
17. In case any declaration(s) in Form No. 15H is filed before filing this declaration during the previous year, mention the total number of such Form No. 15H
filed along with the aggregate amount of income for which said declaration(s) have been filed.
18. Mention the distinctive number of shares, account number of term deposit, recurring deposit, National Savings Schemes, life insurance policy number,
employee code, etc.
Before signing the declaration/verification, the declarant should satisfy himself that the information furnished in this form is true, correct and complete in all
respects. Any person making a false statement in the declaration shall be liable to prosecution under section 277 of the Income-tax Act, 1961 and on
conviction be punishable-
a. In a case where tax sought to be evaded exceeds twenty-five lakh rupees, with rigorous imprisonment which shall not be less than six months but which
may extend to seven years and with fine;
b. In any other case, with rigorous imprisonment which shall not be less than three months but which may extend to two years and with fine.
The person responsible for paying the income referred to in column 15 of Part I shall allot a unique identification number to all the Form No. 15H received
by him during a quarter of the financial year and report this reference number along with the particulars prescribed in rule 31A(4)(vii) of the Income-tax
Rules, 1962 in the TDS statement furnished for the same quarter. In case the person has also received Form No.15G during the same quarter, please allot
separate series of serial number for Form No.15H and Form No.15G.
The person responsible for paying the income referred to in column 15 of Part I shall not accept the declaration where the amount of income of the
nature referred to in section 197A(1C) or the aggregate of the amounts of such income credited or paid or likely to be credited or paid during the previous
year in which such income is to be included exceeds the maximum amount which is not chargeable to tax after allowing for deduction(s) under Chapter
VI-A, if any, or set off of loss, if any, under the head “income from house property” for which the declarant is eligible. For deciding the eligibility, he is
required to verify income or the aggregate amount of incomes, as the case may be, reported by the declarant in columns 15 and 17."
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