wemlref.a w;aikSignature of Guarantorcj;juthjpapd;; ifnahg;gk;

ÈkhDatejpfjp

wemlref.a m%ldYh $Guarantor Statement / cj;juthjpapd; $w;W

by; ,smskfhys mÈxÑ ud úiska wemlre wheÿï m;%fha i|yka lrk ,o ish¿u f;dr;=re udf.a ±ksfï yeáhg i;H yd ksjerÈ njg;a fu;eka isg fuys i|yka Kh wheÿïlref.a by; fhduq wxlh hgf;a ,nd § we;s Kh uqo, i|yd uu wemlrefjl= f,i fmks isàug ne|S isákd njg;a m%ldY lr isáñ'

Nkw;gb Kfthpapy; trpf;fpd;w ehd; gpizahshpd; tpz;zg;gg; gbtj;jpy; Fwpg;gplg;gl;Ls;s rfy jtfy;fSk; vdJ mwpTf;F mika rhpahdit vd;Wk;> cz;ikahdit vd;Wk;> ,r;re;jh;g;gk; Kjy; ,f;fld; njhif njhlh;ghf ehd; gpizahsuhf nraw;gLtjw;F fl;Lg;gLtjhfTk; NkNy Fwpg;gplg;gl;l ,yf;fj;jpd; fPo; fld; tpz;zg;gjhup flidg; ngw;Wf; nfhz;lhh; vd njhptpf;fpd;Nwd;.

I, resident of address mentioned above, hereby affirm that all the information furnished by me in the above Guarantor Application form is true and accurate to the best of my knowledge and that I will be bound by now and onwards to act as the guarantor of the loan Obtained by the loan applicant under the above reference number mentioned above.

tÉ tka î *skEkaia ,sñgâHNB Finance Limitedvr; vd; gP gpdhd;]; ypkpll;

wemlref.a f;dr;=re m;%h

Guarantor’s Details Form

cj;juthjp tpz;zg;g tpguk;

Guarantor No.

Officer

Entered By

Approved By

D D M M Y Y Y Y

wemlrejkaf.a úia;r $Guarantor’s Details / cj;juthjpfspd; tpguk;

1'2 cd;sl ye÷kqïm;a wxlh1'2 National Identity Card No.1'2 Njrpa milahs ml;il ,y.

Guarantor Registered Date

Existing Customer Yes No

1'1 iïmQ¾K ku 1'1 Name in Full 1'1 KOg;ngah;

^mQcH'$uhd$ñh$fufkúh&

(Rev./Mr./Mrs./Miss.)

(jpU. / jpUkjp. / nry;tp.)

1'3 újdyhg fmr ujf.a ku

1'3 Mother’s Maiden Name

1'3 jpUkzj;jpw;FKd; mk;khtpd; ngah;

mqreIMaleMz;

ia;%SFemalengz;

1'4 ia;S% $ mqreI Ndjh1'4 Gender1'4 ghypdk;

1'5 Khlreg we;s {d;S;ajh1'5 Relationship to Loan Applicant 1'5 tpz;zg;gjhuhpd; cwTKiw

1'6 Wmka oskh1'6 Date of Birth1'6 gpwe;j Njjp

D D M M Y Y Y Y

1'7 ,smskh ^1 jk fma<sh&1'7 Address (Line 1)1'7 Kftup (tupir 1)

1'8 ,smskh ^2 jk fma<sh&Address (Line 2)1'8

1'8 (tupir 2)Kftup

1'9 ,smskh ^3 jk fma<sh&Address (Line 3)1'9

1'9 (tupir 3)Kftup

1'11 ksjfia iajNdjhHouse Type1'11

1'11 tPl;bd; jd;ik

;udf.auOwnedcupik

yjqf,a mßyrKh Owned, but Sharedgq;Flik

l=,S mokuRentedthlif

1'13 ia:djr ÿrl:k wxlh1'13 Fixed Telephone No.1'13 epiyahd njhiyNgrp ,y

1'12 cx.u ÿrl:k wxlhMobile Phone No.1'12

1'12 ifalf;f njhiyNgrp ,y

1'14 jD;a;sfha iajNdjh1'14 Occupation Type1'14 njhopy; jd;ik

/lshdjl kshqla;hsEmployednjhopy;

iajhx-/lshdjl kshqla;hsSelf EmployedRa njhopy;

fiajd úhqla;hsUnemployednjhopypd;ik

2' fiajh lrkq ,nk ia:dkfha f;dr;=re$ Business or Employer Place Details / tpahahuk; / epWtdj;jpd; tpguk;

2'1 ,smskh ^1 jk fma<sh&2'1 Address (Line 1)2'1 Kftup (tupir 1)

2'2 ,smskh ^2 jk fma<sh&Address (Line 2)2'2

2'2 (tupir 2)Kftup

2'3 ,smskh ^3 jk fma<sh&2'3 Address (Line 3)

(tupir 3)2'3 Kftup

2'4 j¾;udk jHdmdrfha m<mqreoao2'4 Experience of Present Business2'4 tpahghuj;jpd; mDgtk;

wjqreÿYearstUlk;

udiMonthskhjk;

2'5 ia:djr ÿrl:k wxlh2'5 Fixed Telephone No.2'5 epiyahd njhiyNgrp ,y

2'6 udisl wdodhu2'6 Monthly Income2'6 khjhe;j tUkhdk;

2'8 uq¿ wdodhu2'8 Total Income2'8 nkhj;j tUkhdk;

2'7 fjk;a wdodhï2'7 Other Income Sources2'7 NtW tUkhdk;

wNs,dI Abhilasha mgpyhi\

iajYla;sSwashakthi

Rarf;jp

ld¾hd,Sh m%fhdackh ioyd $For Office Use Only /fhupahya ghtizf;F kl;Lk;

©HNB Finance Limited - HNBFL/SMEGF1

3' mjqf,a iy jHdmdrfha wdodhï iy úhoï f;dr;=re $Household & Business Income Expense Details /tPl;Lj;Jiw kw;Wk; tpahghuj;jpd; tUkhd nryT tpguk;

ks<Odßhdf.a ku $ Officer Name $ mjpfhupapd; ngah; w;aik $ Signature $ ifnahg;gk; oskh $ Date $ jpfjp

ld¾hd,Sh m%fhdackh ioyd $For Office Use Only /fhupahya ghtizf;F kl;Lk

lafIa;% l<ukdlref.a w;aik iy oskhField Manager’s Signature & Datentspf;fs Kfhikahsupd; ifnahg;gk; kw;Wk; jpfjp

.KldÍêldÍf.a w;aik iy oskhAccountant’s Signature & Datefzf;fhsupd; ifnahg;gk; kw;Wk; jpfjp

iyldr l<ukdlref.a w;aik iy oskhAssistant Manager’s Signature & Date cjtp Kfhikahsupd; ifnahg;gk; kw;Wk; jpfjp

YdLd l<ukdlref.a w;aik iy oskhBranch Manager's Signature & Datefpis Kfhikahsupd; ifnahg;gk; kw;Wk; jpfjp

4' mjqf,a iy jHdmdrfha j;alï f;dr;=re $Household & Business Asset Details /

wxlh

Index

,y

whs;uh

Item

cUg;gb

1 bvï $Lands / ,lk;

2 f.dvke.s,s $Buildings /fl;blk;

3 r: jdyk $Motor Vehicles /thfdk;

4 h;=re meÈ $Motor Bikes /Nkhl;lhh; thfdk;

5 ;%s frdao r: $Three Wheelers /Kr;rf;fu tz;b

6 .Dy WmlrK $Home Appliance /tPl;L cgfuzk;

7 hkaf;%damlrK $Machinery /,ae;jpuk;

8 jHdmdßl f;d.h $Business Stock /tpahghu ,Ug;G

9 iaj¾KdNrk$Jeweleries /eiffs;

wxlh

Index

,y

whs;uh

Item

cUg;gb

jákdlu ^re'&

Value (Rs.)

ngWkjp (&gh)

10

11

12

13

14

15

16

tl;=j $Total /nkhj;jk;

fjk;a j;alï$Other Assets /NtW nrhj;Jfs;

jákdlu ^re'&

Value (Rs.)

nryT (&gh)

tPl;Lj;Jiw kw;Wk; tpahghuj;jpd; nrhj;J tpguk;

we֕ me<֕ClothsMilfs;

wOHdmkhEducationfy;tp

wdydrFoodczT

l=,S úhoïRentthlif

.uka úhoïTravelinggazk;

ffjoH úhoïMedical ExpenseskUj;Jtk;

úÿ,s" c," ÿrl:k ì,am;aa iy fjk;aUtilitiesePh;> kpd;rhuk;> njhlh;ghly; kw;Wk; Vida nryTfs;

fjk;a úhoïOther ExpensesNtW nryTfs;

uq¿ úhoïTotal Expensesnkhj;j nryTfs;

w; b;sß uqo, $ Balance in Hand / ifapUg;G

^re'& (Rs.) (&gh)

wdodhï ^re'&

tUkhdk; (&gh)Income Rs.

bÈß udih ;=< wdodhï úia;r

mLj;JtUk; khjj;jpd; tWkhd tpguk;Expected Income Details of next Month

uq¿ wdodhï

nkhj;jtUkhdk;(&gh)Total Income

m%Odk jHdmdrfha wdodhïMain Business Incomegpujhd tpahghuj;jpd; tUkhdk;

fjk;a jHdmdrhkaf.a wdodhï Other Business IncomeNtW tpahghu tUkhdk;

bvï" f.dvke.s,s wdodhï Income from Lands & Buildingsfhzp kw;Wk; fl;blk; %ykhd tUkhdk;

l=,S wdodhï Rent Incomethlif tUkdk;

ia:djr ;ekam;= $b;=reï fmd,S wdodhïFixed Deposits/Savings Interest Incomeepiyahd itg;gpd; %ykhd tUkhdk;

iaÓr /lshd j,ska ,o wdodhïSalary & Wages Incomeepiyahd njhopy; %ykhd tUkhdk;

fjk;aa wdodhï (......................................) Other Incomes (......................................)NtW tUkhdk;(......................................)

r:jdyk wdodhï Income from Motor Vehiclesthfdq;fspd; %ykhd

^re'& (Rs.) (&gh)

fjk;aa wdodhï (......................................) Other Incomes (......................................)NtW tUkhdk;(......................................)

fjk;aa wdodhï (......................................) Other Incomes (......................................)NtW tUkhdk;(......................................)

úhoï

nryT (&gh)Expenditures

w; b;sß uqo, $ Balance in Hand / ifapUg;G

^re'& (Rs.) (&gh)

wdodhï ^re'&

tUkhdk; (&gh)Income Rs.

úhoï

nryT (&gh)Expenditures

fjk;a úhoï (..............................................)Other Expenses (..............................................)NtW nryTfs (..............................................)

fjk;a úhoï (..............................................)Other Expenses (..............................................)NtW nryTfs (..............................................)

úhoï idudkHh

ruhrup nryT tpguk;Average Expenditures

^re'& (Rs.) (&gh)

wdodhï idudkHh

ruhrup tUkhd tpguk;Average Income

^re'& (Rs.) (&gh)