Application Number: …………………
Sole/First Applicant
1. Full Name: Mr. / Mrs. / Ms.: ………………………………………………………...
…………………………………………………………………………………………………………..
2. Father’s Name/ Husband’s name/ Natural guardian (in case of minor):
…………………………………………………………………………………………………………
3. Date of Birth: ……………………………………………………………………………….. 4. Religion: ………………………………………………………….
5. Occupation: ………………………………………………………………………………………………………………………………………………………………………
6. Profession/ Nature of Business: ………………………………………………………… 7. PAN: ……...……………………………………………………….
8. Permanent Address: ………………………………………………………………………………………………………………………………………………………….
City: ………………………………………………… State: …………………………………………………………….. Pin: ……………………………………………..
Correspondence Address: ………………………………………………………………………………………………………………………………………………….
City: ……………………………………………….. State: …………………………………………………………….. Pin: ……………………………………………..
9. Communication
Home: ……………………………………………. Work: ………………………………………………….. Mobile: …………………………………………………
Fax: ………………………………………………… Email: ……………………………………………………………………………………………………………………
Joint Applicant
1. Full Name: Mr. / Mrs. / Ms.: ……………………………………………………………………………………………………………………………………………..
2. Relation to the First Applicant: ………………………………………………………………………………………………………………………………………….
3. Father’s Name/ Husband’s name/ Natural guardian (in case of minor):…………………………………………………………………………………………………………………………………………......
4. Date of Birth: ……………………………………………………………………………… 5. Religion: ………………………………………………………….
6. Occupation: ………………………………………………………………………………………………………………………………………………………………………
7. Profession/ Nature of Business: ………………………………………………………… 8. PAN: ……...……………………………………………………….
9. Permanent Address: ………………………………………………………………………………………………………………………………………………………….
City: ………………………………………………… State: …………………………………………………………….. Pin: ……………………………………………..
Correspondence Address: ………………………………………………………………………………………………………………………………………………….
City: ……………………………………………….. State: …………………………………………………………….. Pin: ……………………………………………..
10. Communication
Home: ……………………………………………. Work: ………………………………………………….. Mobile: …………………………………………………
Fax: ………………………………………………… Email: ……………………………………………………………………………………………………………………
I confirm having read and understood the declaration hereinafter.
…………………………………………………………………………………… ……………………………………………………………………………………
(Signature of the Sole/First Applicant) (Signature of the Sole/Joint Applicant)
ADDITIONAL INFORMATION (FOR NRI OR FOREIGN CITIZEN OF INDIAN ORIGIN ONLY)
Sole/First Applicant
1. Nationality.: ……………………………………………………………………………………………………………………………………………………………………..
2. Native place in India: ………………………………………………………………………………………………………………………………………………………..
3. Passport (Please tick if Indian/for Foreign kindly specify): Indian / Foreign ……………………………………………………………………….
4. Passport No.: ………………………………………………………..…...... Date of Issue: …………………………... Valid up to: …………………………
5. Date of Birth mentioned in Passport: ………………………………………………… 6. Place of issue: …………………………………………………
7. Contact person Name in India: ……………………………………………………………………………………………………………………………………….…
9. Correspondence Address: ………………………………………………………………………………………………………………………………………………….
City: ……………………………………………….. State: …………………………………………………………….. Pin: ……………………………………………..
10. Communication
Home: ……………………………………………. Work: ………………………………………………….. Mobile: ………………………………………………….
Fax: ………………………………………………… Email: …………………………………………………………………………………………………………………….
11. i) a) NRO Account: ……………………………………………………………… b) Name of bank and branch: ……………………………………………
…………………………………………………………………………………………………. c) IFSC/ RTGS/ NEFT CODE: ……………………………………………….
ii) a) NRE Account: …………………………………………………………… b) Name of bank and branch: ……………………………………………
…………………………………………………………………………………………………. c) IFSC/ RTGS/ NEFT CODE: ……………………………………………….
Joint Applicant
1. Nationality.: ……………………………………………………………………………………………………………………………………………………………………..
2. Native place in India: ………………………………………………………………………………………………………………………………………………………..
3. Passport (Please tick if Indian/for Foreign kindly specify): Indian / Foreign ……………………………………………………………………….
4. Passport No.: ………………………………………………………..…...... Date of Issue: …………………………... Valid up to: …………………………
5. Date of Birth mentioned in Passport: ………………………………………………… 6. Place of issue: …………………………………………………
7. Contact person Name in India: ……………………………………………………………………………………………………………………………………….…
9. Correspondence Address: ………………………………………………………………………………………………………………………………………………….
City: ……………………………………………….. State: …………………………………………………………….. Pin: ……………………………………………..
10. Communication
Home: ……………………………………………. Work: ………………………………………………….. Mobile: ………………………………………………….
Fax: ………………………………………………… Email: …………………………………………………………………………………………………………………….
11. i) a) NRO Account: ……………………………………………………………… b) Name of bank and branch: ……………………………………………
…………………………………………………………………………………………………. c) IFSC/ RTGS/ NEFT CODE: ……………………………………………….
ii) a) NRE Account: …………………………………………………………… b) Name of bank and branch: ……………………………………………
…………………………………………………………………………………………………. c) IFSC/ RTGS/ NEFT CODE: ……………………………………………….
I confirm having read and understood the declaration hereinafter.
…………………………………………………………………………………… ……………………………………………………………………………………
(Signature of the Sole/First Applicant) (Signature of the Sole/Joint Applicant)
OTHER ENTITY (FOR APPLICATION IN NAME OF OTHER ENTITY)
1. Name of the Organization: ………………………………………………………………………………………………………………………………………………..
2. Status (Please tick or specify): Proprietorship Firm / HUF / Partnership Firm / Company / AOP/BOI / others……………..…….
………………………………………………………………………..…...... 3. Place: ……………….…………………………... Date of Issue: ………….…………..
(Please enclose a copy of Incorporation/ Registration Certificate, PAN Card and Board Resolution)
4. Registered/ Head Office Address: …………………………….……………………………………………………………………………………………………….
City: ……………………………………………….. Phone: …………………………………………………….. Mobile: ……………………………………………..
5. Name of the authorized signatory: …………………………………………..……………………………………………………………………………….………
Designation: ……………………………………. Phone: …………………………………………….. Mobile: ……………….…………………………………….
Fax: ………………………………………………… Email: …………………………………………………………………………………………………………………….
6. IT PAN: ………………………………………………………………
We confirm having read and understood the declaration hereinafter
Signature of authorized signatory with seal (Please sign within the space provided)
Place: ……………………………………. Date: ………………………………….
Unit Details
1. Project.: …………………………………………..……………… 2. Unit Number: …………………………………………3. Area (SBA)…………………….
4. Car Park: ……………………….…Unit Price: ……………..………………………………………………………………………………………………………...…… ………………………………………………………………………………………..(Rupees…...... only)
5. Loan Required: YES/NO………………………… Preferred Financial Institution …………………………………………………………………………..
6. Reference ………………………………………………………………………………………………………………………………………………………………………….
7. Reasons for Opting this property:
a) ……………………………………………………………………………………………………………………………………………………………….………………………….
b) ……………………………………………………………………………………………………………………………………………………………………………….………….
c) ……………………………………………………………………………………………………………………………………………………………….………………………….
8. Purpose of Purchase: Investment/Residence …………………………………………………………..……………………………………………………….
9. Favourite Newspaper …………………………………………………………..……………………………………………………………………………………………
10. Favourite Magazine …………………………………………………………..……………………………………………………………………………………………
11. Favourite TV Channel ………………………………………………………..……………………………………………………………………………………………
12. Favourite Radio Channel …………………………………………………..……………………………………………………………………………………………
Payment Details
1. Payment Plan (Please tick in the chosen mode) Down Payment / Installment
2. Booking Amount: ……………….…Unit Price: ………….………,…… (Rupees…...... only)
3. Cheque / Pay order / DD: ……………………………………… 4. (Rupees…...... only)
5. Drawn on: ……………………………………………………………………………………… in favour of Purti Realty payable at Kolkata
Declaration
1. I/We hereby solemnly declare that all the foregoing facts are true to the best of my/our knowledge and nothing relevant has been concealed or suppressed. I/We also undertake to inform Purti Realty of any future changes, related to the information and details shown in the APPLICATION FORM.
2. I/We hereby also declare that I/We have read and understood the terms and conditions of sale and all other information/ conditions stated along with the APPLICATION FORM including the number of unit offered, price schedule and area statement.
3. By signing this APPLICATION FORM, I/WE do hereby solemnly accept and agree to abide by the general terms and conditions as stipulated in the accompanying General Terms and Conditions, which may be modified or amended by Purti Realty
4. I/We, further agree to sign and execute the necessary documents as deemed necessary, as and when required by Purti Realty
5 I/We, unconditionally agree to pay the payments as per schedule within the due date. Failing which the booking made against my application would stand cancelled as per the terms of the accompanying General Terms and Conditions.
6. I/We Non Resident Indian/ Foreign Citizen of Indian Origin do solemnly declare that I we want the unit (applied for) for our use only.
7. I/We have signed this APPLICATION FORM after having read and understood what is written hereinabove in full conscience.
I confirm having read and understood the declaration hereinafter.
…………………………………………………………………………………… ……………………………………………………………………………………
(Signature of the Sole/First Applicant) (Signature of the Sole/Joint Applicant)
……………………………..………………………………………… FOR OFFICE USE ONLY ………………………………………………..…….……..……………….
Name of the Executive______Signature______
Place: …………………………………… Date: ……………………………