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Part Disbursement Request Form 1

This document is a subsequent disbursement request form submitted by Ramkrushna Ptavin Jagtap Patil for a home loan from Axis Bank. It provides details of the property address, loan account number, and a request to disburse Rs. 1,349,616 to Pantheon Associates LLP via RTGS/NEFT for construction. The customer declares the information provided is true and correct and that original receipts for their contribution have been submitted.

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Hemant Patil
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522 views1 page

Part Disbursement Request Form 1

This document is a subsequent disbursement request form submitted by Ramkrushna Ptavin Jagtap Patil for a home loan from Axis Bank. It provides details of the property address, loan account number, and a request to disburse Rs. 1,349,616 to Pantheon Associates LLP via RTGS/NEFT for construction. The customer declares the information provided is true and correct and that original receipts for their contribution have been submitted.

Uploaded by

Hemant Patil
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Subsequent Disbursement Request Form

(For Home Loan/LAP)

Date: 2 9 0 6 2 0 2 3
Place Pune Loan A/c No. P H R 1 0 3 4 0 7 7 0 4 4 2 1
Customer Name Ramkrushna Ptavin Jagtap Patil
Property address Flat No 106, 1st Floor B Building Acorn Park Sr No 108 2/4 P Wakad, Pune, Maharashtra India - 411057

City Pune State Maharashtra PIN Code 4 1 1 0 5 7


Mobile Number 9 2 0 9 0 8 5 5 5 1 Reg. Email ID [email protected]

Disbursement Details
Builder demand/requirement (if self-constructed) `
1349616

I have submitted original builder demand letter/requirement letter (if self-constructed).


I/We hereby authorize bank to disburse an amount of ` as per below:

Details for disbursement through Demand Draft: (Mark as NA if not applicable)

Sr No. DD Favoring Amount (in `)


1
2
3
4 Internal - TATA AIG GENERAL INSURANCE CO. LTD (Property Insurance)
Total Amount

Details For disbursement through RTGS/NEFT/Transfer: (Mark as NA if not applicable)

Particulars Favoring Details 1 Favoring Details 2

RTGS/NEFT/Transfer RTGS
Beneficiary Name Pantheon Associates LLP
Bank Name Bank of Maharashtra
Bank A/C No. 60373333801
IFSC CODE - In capital letters M A H B 0 0 0 1 4 4 3

RA/Disb./App. Form/Feb. 2020/Ver - I


Disbursement Amount (in `)
1349616
*Information to Borrower:
• In every demand raised by the builder, customer will have to make payment towards his own contribution (e.g.- If the Property value is 10 Lakh ,
3 lakh is your contribution and Loan amount is 7 Lakh For every demand that builder raised for part of 7 lakh, customer will also pay part of 3 lakh).
• Customers also need to submit his/her contribution payment receipts along with disbursement request form.(Please ignore this if your own
contribution is paid upfront and receipts are already submitted)

Customer Declaration
• I/We hereby declare that the above particulars and information given in the form are true and correct. I have submitted original receipts of my
payment to builder/developer/ towards self-construction along with this request.

Yours Faithfully,

Signature Applicant / POA holder Signature Co-Applicant 1/POA holder Signature Co-Applicant 2/POA holder

For more details on Part Disbursement, visit Axis bank website for FAQ’s or Call us on 1860-419-5555/1860-500-5555 (local charg es apply)

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