CSC e-Governance Services India Limited

Application for withdrawal/surrender of CSC ID

(The complete application form, duly signed by the concerned VLE, should be submitted to the
respective state team. Please use BLOCK LETTERS.)

1) CSC ID*:

2) VLE Name*:

3) Aadhaar:

4) State*:

5) PAN*:

6) Reason for Withdrawal*: ________________________________________________

7) Mandatory documents required*:

 Copy of PAN card, or
 Copy of Aadhaar card, or
 Copy of Voter ID

* Mandatory Fields

** By providing the above details, I understand the following:

1. Once the CSC ID is blocked / deleted, I will not be able to login on to the Digital Seva Portal.
2. I will not be able to avail any service/product through the CSC network.
3. The wallet balance associated with my CSC id would be transferred to the Bank account as per the
banking details available on the Digital Seva Portal.
4. I shall not indulge in any business activity presenting or posing as a CSC.
5. In case, I am found engaged in any CSC activity, a legal action may be taken against me.

I hereby certify that the information provided above is to the best of my knowledge and is accurate. I
will be legally obligated and responsible for any discrepancy. I also understand, that my ID once
withdrawn, I will not be able to use the services on Digital Seva Portal.

Signature of the State Head/District Manager VLE Signature

Name: ______________________
Date: ______________________