SBIBCMERDAS - APLICATION FROM

STATE BANK OF INDIA

EVERY BANK OF INDIAN

CONTUCT US - http://sbibcmerdas.page.tl/ csp operoter log in - https://kiosk.onlinesbi.com/

APPLICATION FORM FOR KIOSK BANKING

For Office Use

MADRAS Code CSP Code

LINK BRANCH NAME

Fees Details

Affiliation Fees Security Deposit

Insurance Fees Flexes& Registers

Total Fees DD No.

Receipt Number Date of Receipt

Blank Cheque Details

Name of Bank Name of Branch

No. of Cheques A/C. No.

Cheque Number 1._ 2.3.___

Details of CSP

Preferred Bank* : ___________________________________________________

Name of Applicant* : ___________________________________________________

Preferred Location* : ___________________________________________________

Block/Tehsil* : _____________________ District*_______________________

Address of Kiosk Location *: ___________________________________________________

___________________________________________________

Pin Code* : _____________________ State*_________________________

Mobile Number* : ___________________________________________________

Location Type* : FI NON FI

Type of CSP Rural Semi Urban Urban

Proposed Link Branch* : ___________________________________________________

Proposed Branch Code* : __________________ Distance of Link Branch _____________

Villages to be covered by FI CSP

Name of Villages under 5 Km Radius from proposed Kiosk Location

1- _____________________ 2- ______________________ 3- ______________________

4- _____________________ 5- ______________________ 6- ______________________

Photo

Personal Details

Name* : ______________________________________

Father/Husband Name : ______________________________________

Date of Birth* : ________________ Gender:_______________

Residential Address* : ______________________________________

_______________________________________

District* : ___________________________ State*: __________________

Pin Code* : ___________________________

Email ID : ___________________________________________________

Contact Number* : ___________________________________________________

Account No. : ___________________________________________________

Name of Bank : ___________________________________________________ Branch/IFSC code : _____________________ Type of Account ________________

*Bank Pass Book : ___________________________________________________

*PAN Card No. : ___________________________________________________

Driving License No. : ___________________________________________________

Voter ID Card No. : ___________________________________________________

UID No. : ___________________________________________________

Educational Qualification : ___________________________________________________

Technical Qualification : ___________________________________________________

Declaration

I here by declare that the above information furnished by me is true & correct to the best of my knowledge and belief. If the information furnished is found incorrect or false, I am liable for disciplinary action which the organization deems fit.

Signature of Applicant _________________

Name of Applicant _________________