KIOSK BANKING

APPLICATION FOR OPENING OF NEW CUSTOMER SERVICE POINT(CSP)

(The detailed particulars of the proposed CSP are given below)
Sr.
No. ITEMS PARTICULARS
Business BC Name Starfin India Pvt Ltd 
Correspondent(BC) BC Code 1A780000
Details Settlement A/c No.
1   Commission A/c No.  
Reference No. in Kiosk
Scanner used
Address of the Village: SSA/Ward Details
Customer Service
Point proposed to be G.P/Ward: Block/Municipality:
2 opened PS: District:
  PIN: State:
  Latitude: Longitude:
 
Areas to be covered
by the CSP SSA Non SSA :
Village Name:
Cluster No.:
3
Gram Panchayat: Address:
 Block: Village/Town/City:
District: Pop. Category : Rural/Semi-
urban/Urban/Metro- Rural
Link Branch Link Branch
Name of Link Branch Name Distance from
Code
with code No. and
4 Link Branch Existing Other
distance between
CSP Point Existing Bank
Link Branch and CSP
Particulars of Name:
Proposed CSP S/D W/O Of :
Operator with recent
colour PP photograph Residential Address:
& signature Village: Village Code:
Block: Block Code:
District: District Code
PIN Code: DOB: Age:
Educational Qualification:- No. of years of stay in the present location:
Source of funds for business :
5
Place of Business: Rented/Owned- Rented
Aadhaar No.: PAN No:
CSP's existing banking arrangements:
Bank A/C No.: Branch Name:
signature Mobile No.:
Landline No.:

Email ID:

Experience in Banking/Insurance Business:

BUSINESS POTENTIAL
Total Population: No of expected Accounts:
Annual business expected: Approx. No. of Business establishments:
No of households:2000 Potential business through Migrant Workers:
6 Main activity of people: Workers,Labour
 Details of KYC
(Identification/ Copy verified and signed by BC in respect of each of the documents enclosed:
Residence) documents (i) Proof of Identity (v) Self Declaration in lieu of PVR
7 submitted by CSP
(ii) Proof of Residence (vi) Annexure-2
operator and verified by
BC. [Documents are to (iii) Academic qualification certificate (vii) Receipt, if any
be enclosed] (iv) Police Verification Report (viii)

(Signature and stamp of Business Correspondent)

FOR OFFICE USE

Verified all the above particulars and found in

order.We confirm that declaration by the applicant for
8 engagement as CSP (Annexure-1) has been
obtained.
Signature of Branch Manager/Chief Manager
Recommended
9
Signature of Mgr./CM (FI)
Recommended (reasons,if rejected)
10
Signature of AGM (FI&MF)
Approved
11
 Signature of DGM (FI&MF)

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sent for Code Code Re- Stage Re- Inactive Mapping Villages List BC /
Deletion Deleted Issued mapping Re- mapping List Module /
/ Re- mapping Region /
mapping Branch