OFFICE OF THE COMPETENT AUTHORITY UNDER THE PUDUCHERRY PROTECTION OF INTERESTS OF DEPOSITORS IN FINANCIAL ESTABLISHMENT ACT, 2004 Revenue Complex, Saram, Puducherry (opp. to Government Automobile Workshop) APPLICATION UNDER SECTION 7(2) OF THE PPIDFEA ACT, 2004 FOR ASSESSMENT OF DEPOSIT LIABILITIES 1. Name : 2. Father / Husband Name : 3. Age : 4. Address : 5. Occupation : 6. Membership Number in TBFL : 7. Type of liability or liability due to TBFL : Mortgage Loans:- (i) Jewel Loan (ii) Property Loan Qty. pledged ............ gms Amount obtained Rs. ............................. Amount obtained Rs. ........................ Amount paid back Rs. ............................. Amount paid back Rs. ........................ Balance amount Rs. .............................. Balance amount Rs. ........................ Value of the property Rs. ............................. Value of the pledged Rs. ......................... Details of property : ....................................... ............................................................................... - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - ACKNOWLEDGEMENT SLIP Application No.: Name : ........................................................................................................ Address : ........................................................................................................ ........................................................................................................ ........................................................................................................ (iii) Schemes - Amount deposited: Total Rs. .............................................................. (1) Savings Account : Rs. (5) Cumulative Deposit : Rs. (2) Fixed Deposit : Rs. (6) Thirumala super : Rs. savings scheme (3) Recurring Deposit: Rs. (7) Others : Rs. (4) Cheque Bounced : Rs. Date : ........................ No. ........................ 8. Total amount claimed from TBFL (in case : of depositors) 9. Details of Cases / litigation, if any, : pending or disposed of (Enclose copies) 10. Total amount due to TBFL (in case of : Jewel and Mortgage loans or any other type of loan). 11. Any other details available : 12. Document enclosed (Please enclose : photocopies only). ------------------------------------------------------------------------------------------------------------------------------------------ FOR OFFICE USE ONLY Total amount due to / from TBFL as : assessed by competent Authority
