AIRTEL PAYMENTS BANK LIMITED

CUSTOMER SERVICE POINT ENROLLMENT FORM

CIN: U65100DL2010PLC201058
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1. я   s"#   / BUSINESS CORRESPONDENT DETAILS

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Parent Number (BC/FSE): Parent Type: BC FSE

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Business Correspondent Name

2. e  $ / CSP DETAILS

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Customer Service Point Shop Name:

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Entity Type: Individual Proprietorship Partnership Company Others Sp % 
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Customer Service Point Mobile No.:
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CSP's PAN No.:

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Father’s Name:
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Mother’s Maiden Name:

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Date of Birth: (DD-MM-YYYY): Gender Male Female Transgender

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Nationality:

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ID Proof: License Voter ID Card Pan Card Identity Card E\DQRnjFHURIWKHVWDWHJRYHUQPHQW

* #%  p M: Passport Driving Election Commission Aadhaar Job card issued by NREGA duly signed
Address Proof: License Voter ID Card Identity Card E\DQRnjFHURIWKHVWDWHJRYHUQPHQW

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Language (Hindi/English/Regional Language):

4.   / MAILING ADDRESS

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Shop/Communication Address Permanent Residence Address is same as Shop/Mailing Address Yes No

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Shop/Flat/Door/Block No. Name of Premises building/Village Shop/Flat/Door/Block No. Name of Premises building/Village

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Pin: Pin:

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Phone No.: Phone No.:

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Alternate Mobile No.: Alternate Mobile No.:

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5. e *+/p,  - 0я / LEGAL STATUS OF CSP FIRM/ESTABLISHMENT

 %  a$% , k   = / Documentation as per the policy

6. e % & ' / CSP DECLARATION*

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I have read and fully understood this CSP Form along with Terms and Conditions, and unconditionally agree to abide by the Terms and Conditions for CSP Enrollment Form
at all times. I declare that all the information provided herein and documents I have submitted with this Form are true, correct and complete and is not false or misleading.
I also declare that I am signing this Form along with Terms and Conditions in my full capacity, senses and knowledge.

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I have attached copies of all the requisite documents with this CSP Enrollment Application Form.

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Place: Date:

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/Signature of CSP with Stamp /Business Correspondent Signature with Stamp

FORM NO. 60 [See second proviso to rule 114B]

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Name ______________________________________________________________________________________________________________________________________________D.O.B________________________________

Father’s Name ___________________________________________________________________________________________________________________________________________________________________________

Address_________________________________________________________________________________________________________________________________________________________________________________
Pin Code ______________________________ Telephone Number with STD Code ________________________________________ Mobile Number _________________________________________________________

Amount of Transaction (First Cash in amt) ___________________________________________________________________________________________________ Date of Transaction ____________________________

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Mode of Transaction: Cash Cheque Card Draft/ Bankers’ Cheque Online transfer other
Aadhar Number issue by UIIDAI (If available) ________________________________________________________________________________________________________________________________________________
If applied for Pan and it is not yet generated enter date of application&Acknowledgement No ________________________________________

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(a)Agriculture income (Rs.) _____________________________________________(b)Other than Agriculture income (Rs.) _______________________________________________________________________________

Detail of the document being produced support of identity Proof _____________________________________________________________________________________________________________________________

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Detail of the document being produced support of address Proof _____________________________________________________________________________________________________________________________
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Permanent Account Number and my/ our estimated total income (including income of spouse, minor child etc. as per section 64 of Income-tax Act, 1961) computed in accordance with the provisions of
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(Signature of declarant)
 TERMS AND CONDITIONS FOR CUSTOMER SERVICE POINT/BUSINESS CORRESPONDENT’S AGENT(“CSP”) ENROLLMENT FORM
1. SCOPE OF SERVICES
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Airtel Payments Bank Limited (“Services”):
1.1 Identifying potential Customers to avail the said Services
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from time to time;
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1.4 Sale of other third party products;
1.5 Receipt and delivery of remittances / other payment instruments.
1.6 To perform all activities relating to the marketing, promotion and distribution of
Services.
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 L ,GHQWLǟFDWLRQRIDFFRXQWKROGHUVDQGǟWPHQWRIDFWLYLWLHV Principal/Airtel Payments Bank Limited or bank(s) and/or its customers.
ii. Facilitation of cash deposit and cash withdrawal from the accounts by the
Customers or on behalf of the Customers as per the approved procedure.
iii. Facilitation of cash management services through collection of funds and
deposits to entities/businesses as per the approved procedures and
arrangements provided by the Bank.
1.8 Any other service that may be mutually agreed to in writing, from time to time as per
applicable regulatory guidelines
2. GENERAL OBLIGATIONS of CSP
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as amended from time to time in the performance of the Services and (ii) all rules and
procedures concerning the conduct of the CSPs business relating to the Services
reasonably prescribed fromtime to time.
  CSP will ensure that prior to enrolling any person to the Services of Airtel Payments
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.<& GRFXPHQWVDQGLQIRUPDWLRQIURPWKH&XVWRPHUV
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cross-checking the photocopy with the original copy of the document and deliver the
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Airtel Payments Bank Limited or its authorized representatives at regular interval.
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• The Customer’s photograph on the Enrollment Form is to be tallied with the
photograph on the POI,
• CSP has to verify the self-attested copy of the POI and POA submitted by the
Customer at the point of sale with the originals before activation of the Services of
the Customer. CSP has to sign and certify that originals of the documents
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• The details on the Customer Enrollment Form tally with the details on the POI and
POA documents submitted by the Customer.
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Laundering(AML) standards / Combating of Financing of Terrorism (CFT) /
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on the Enrollment Form. CSP also has to be informed by the Principal / Airtel
Payments Bank Limited about the consequent liabilities for any kind of
non-compliance of this important activity.
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Airtel Payments Bank Limited from time to time.
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law or regulations issued by RBI from time to time.
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FHUWLǟHGDVSHUWKHVNLOOUHTXLUHPHQWVODLGGRZQE\WKH3ULQFLSDO$LUWHO3D\PHQWV%DQN
Limited necessary training in this regard shall be given by the Principal/Airtel Payments
Bank Limited.
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Payments Bank Limited at alltimes.
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point, Services are not denied due to non-availability of funds.
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by Airtel Payments Bank Limited as communicated by the Principal/Airtel Payments
Bank Limited and shall not follow any unfair tradepracticein marketing the Services.
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advisedby Principal /Airtel Payments Bank Limited, from time to time. The CSP shall
furnish its action plan to meet any shortfall toPrincipal in writing. The Parties may re-set
the targets of performance as per the market conditions.
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the Principal or Airtel Payments Bank Limited on behalf of the Principal to any third
party without the prior written consent of the CSP. The notice of such assignment will
be provided by the Principal or Airtel Payments Bank Limited orassignee to the CSP
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the CSP to its successor or assignee after taking prior written approval from the
Principal and following prescribed process.
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obligations under the Terms and Conditions. All the contractual and statutory
payments including wages, salary, provident fund contribution, etc. shall be the sole
responsibility of the CSP.
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of providing any service to any person / entity providing competitive Services or
provide any third party with any information / data pertaining to the Services, without
obtaining the prior written approval of the Principal.
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Limited and provide all documents and other relevant data and Information to assist in
any Investigation of any allegation / Instance of fraud.
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process as Intimated by the Principal as may be laid down by Airtel Payments Bank Limited.
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used for the purpose of promotion and marketing of the Services.
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Airtel Payments Bank to inspect and take copies of all things material to the business
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premises used in connection with the business.
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end-user, the CSP shall forth with inform the Principal and provide the Principal with
details of the circumstance of the dispute and shall not institute proceedings in respect
of it without the prior written consent of the Principal. If any legal proceeding is
instituted by any Customer, the CSP shall immediately intimate the same to the
Principal and provide all documents and Information to enable the Principal to take
appropriate action.
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Customer is making false demands, claims as part of the Services, the CSP shall
immediately notify the Principal.
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manner and also get the same insured against all risks, at its own cost and shall hand
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products reach the Customer in perfect appearance and usable condition.
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LV QHFHVVDU\ IRU WKH &XVWRPHU WR HNjHFWLYHO\ XWLOL]H WKH 6HUYLFH 7KHVH OHDǠHWV
brochures and user guides shall be provided by Principal to the CSP, from time to time.
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warranty other than those contained in the standard terms and conditions laid down by
the Principal / Airtel Payments Bank Limited from time to time.
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maintained by itself to ensure service delivery to Customers of Airtel Payments Bank
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/ Airtel Payments Bank Limited.
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etc. at this outlet.
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lease by the CSP and shall comply at all times with all applicable laws or clearances
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services against sale of any other product or goods.
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business.
3. PRINCIPAL & AGENT RELATIONSHIP
These Terms and Conditions are being entered on a principal-to-agent basis and CSP shall
act as an agent of the Principal / Airtel Payments Bank Limited. CSP shall provide the
Services in accordance with the provisions of these Terms & Conditions and applicable
legal/regulatory/statutory guidelines and further in compliance with any operating
4. INDEMNITY
4.1 The CSP shall compensate the Principal and Airtel Payments Bank Limited, its
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on part ofthe CSP or the CSP Channel due to which any damage is caused to the
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it from the Facilitation Fee, payable to the CSP and shall also been titled to appropriate,
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deems, the CSP owes to the Principal/Airtel Payments Bank Limited.
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from the other obligations of the CSP and shall survivetermination.
5. FACILITATION FEE
5.1 In consideration of the Services to be provided by the CSP and performance of the
pay commission to CSP as per the Airtel Payments Bank Limited’s policy.
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expenses and charges which may be incurred or paid by the CSP during and with
regard to the provision of the Services as contemplated here under. All payments by
Principal/Airtel Payments Bank Limited (as the case may be) to the CSP shall be
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absence of Permanent Account Number [PAN], Principal/Airtel Payments Bank Limited
will deduct tax at higher rate as applicable under the Income Tax Act, 1961.
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6. TERMINATION
6.1 Principal/Airtel Payments Bank Limited can terminate or suspend this arrangement by
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Principal.
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DUUDQJHPHQWLQFDVHRILQDFWLYLW\LQ&63šVDFFRXQWIRUDFRQWLQXRXVSHULRGRIGD\V
6.4 Airtel Payments Bank Limited can immediately terminate this arrangement in case of
any misrepresentation, fraud or misconduct onthe part of the CSP.
6.5 Principal shall have the right to immediately terminate these Terms and Conditions on
receiving instructions from Airtel Payments Bank Limited.
6.6 On termination of these Terms and Conditions, the CSP will immediately cease to use
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DQG VKDOO UHWXUQ DOO XQXVHG LQIRUPDWLRQ OHDǠHWV EURFKXUHV XVHU JXLGHV WR 3ULQFLSDO
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- Dues post termination, if any, and
- CSP account with Airtel Payments Bank Limited
7. PENALTIES
The CSP shall not directly charge the Customers any fee for Services rendered by it on behalf
of the Principal or Airtel Payments Bank Limited other than the charge levied by Airtel
Payments Bank Limited for such Services. Additionally under no circumstances, fake/false
receipts should be issued by the CSP for the willful fraud transaction done by the CSP which
is not transacted through Airtel Payments Bank software/portal. However, if any CSP is found
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transactions, it shall be liable with such action by the Principal and/or Airtel Payments Bank
Limited which may include but not be limited to, issuance of a show cause notice,
suspension or termination of these Terms and Conditions and levying penalty as it may
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8. INTELLECTUAL PROPERTY RIGHTS
Except as provided for in this Agreement, CSP shall not acquire a right to use and shall not
use without the Principal or Airtel Payments Bank Limited’s prior written permission in each
instance, the names, characters, artwork, designs, trade names, trademarks, or service
marks of Airtel Payments Bank Limited for any purpose and shall maintain all copyright,
trademark, service mark or other proprietary notice on Airtel Payments Bank Limited’s
Services and otherwise comply with Airtel Payments Bank Limited’s reasonable quality
control requirements. The said Services shall be provided under the branding and trademark
owned by Airtel Payments Bank Limited and, all goodwill associated with the brand name
shall vest exclusively with Airtel Payments Bank Limited and CSP shall have no right, lien or
interest in the same.
9. CONFIDENTIALITY
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to the Customers or prospective customers, proprietary data and databases, all trade
secrets, know how licenses, know how formula and processes shall be deemed to
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FRQǟGHQWLDO DOO GDWD SURYLGHG E\ 3ULQFLSDO RU $LUWHO 3D\PHQWV %DQN /LPLWHG DQG
resultant data generatedby it relating to the provision of the Services under this Terms
and Conditions and will not use it for any purpose other than to perform its obligations
under this Terms and Conditions.
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Limited and/or its customers, which comes to its knowledge while providing the
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the prior written consent of the Principal / Airtel Payments Bank Limited and shall be
liable in case of breach thereof.
10. COMMUNICATION
All notices, requests, demands and other communications shall be in writing and the same
shall be deemed to be served, if given personally delivered or sent by registered mail or
e-mail, SMS or other Electronic Medium to the address or mobile number given in this CSP
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conclusively be deemed to have been received two Business Days from the time of posting
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successful transmission.
11. JURISDICTION
The Terms and Condition shall be construed in accordance with the laws in India, and shall
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Conditions.
12. AMENDMENT
Principal/Airtel Payments Bank Limitedshall always have right to add, delete, amend or alter
all or any of the Terms and Conditions and such amended terms and conditionsshall be
binding on the CSP as per intimation to the CSP by the Principal.
13. MISCELLANEOUS
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to be employees or agents of Airtel Payments Bank Limited and the CSP assumes full
responsibility for their supervision and control.
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DFWLRQVXLWRUSURFHHGLQJVRUWKHLVVXDQFHRIDQ\RUGHUZULWLQMXQFWLRQDZDUGRUGHFUHH
RI DQ\ FRXUW DJHQF\ RU RWKHU JRYHUQPHQWDO LQVWUXPHQWDOLW\ LQYROYLQJ WKH VXEMHFW
matter of this Terms and Conditions.
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contents of these Terms and Conditions.
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/Signature of CSP with Stamp