Please email with us for list setup with us...
All the csp operator are nottice that please send there csp code no . operator name , mail adreess , ph number , csp location , csp link branch , ko & sub ko name for satuping our system .
Very soon we will changed our system to service our csp. to devlop our system please suggsation with us . your sujection will grouth with us....
Thank you
B.C. MERDAS
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- ______________________
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 _________________
Date
