CUSTOMER SERVICE POINT APPLICATION FORM

Nearest Branch
Name of Bank
Approx Distance with Nearest Branch
Applicant Photo
Applicant's Details
Applicant Name*
Father / Husband Name*
Gender (Male/Female)*
Date of Birth (DD/MM/YYYY)*
Marital Status*
Permanent Mobile Number*
Permanent Address
Village / Street Name*
District*
G.P./ Municipality / Corporation*
Sub Division*
City*
Block*
State*
PIN Code*
Shop / OUTLET ADDRESS
Censes Village Name
Censes Village Code
Latitude
Longitude
Village / Street Name *
District*
G.P./ Municipality / Corporation*
Sub Division*
City*
Block*
Police Station*
Post Office*
State*
PIN Code*
Locality*
Mobile Number*
Alternate Mobile Number*
WhatsApp Number*
Mail ID*
Applicant Signature *:
Applicant’s Identification Details
Aadhar Card Number*
Ration Card No.
Pan Card Number*
Driving License No.
Voter Card Number
Passport No.
Electricity Bill No.
Others
BANK DETAILS
Bank Name*
Branch Name*
Branch SOL ID*
A/C Holder Name*
Savings A/C No.*
OD Account Number
Customer ID*
IFSC Code*
Shop / Outlet Infrastructure
Outlet Profile
STD/PCO, Cyber cafe, Stationary shop, Ice cream/Juice shop, Super Market, Gift shop, Tour & Travel shop, Telecom shop, Property dealer, Etc.
Internet Availability (YES/NO)*
Computer Availability (YES/NO)*
Dongle/Mobile/Dial Up/Broadband
Laptop/Desktop
Computer Specification (Processor)
Computer Specification (RAM)
REFERENCE DETAILS
Refernce Name*
Street Name*
District*
Locality*
Sub District*
City*
State*
Reference Relation *
Pin Code*
Mobile Number*
Mail ID
Reference Signature*
Present Business / Occupation, if any
Do you have any experience In selling financial products? If yes, give details.
Present Monthly income :
Present Income
Languages known ( say fluent / not so fluent)
English
Hindi
Regional Language (specify)
any other (specify)
No. of years of stay in the town / village in town in village*
Do you have any advance police records? if yes, give details*
Name, address and occupation of two people (not related to applicant) to whom reference can be made*
(i)
(ii)
Default if any to Bank / Financial Institutions (give details)
Infrastructure available : ( office, area, Location, computer, Internet, Tel No. etc)
Are you willing to invest in the machine and other equipment for Carrying out transactions as Business correspondents.
Are you willing to invest in the machine and other equipment for Carrying out transactions as Business correspondents.
Are you ready to take general insurance cover for a minimum of Rs. 1,00,000/- on the cash balance to be held by you overnight and cash in transit:
Applicant Signature *:
Our Bank Details
Bank Name Account Name Account Number IFSC Code Branch Name
BANK OF BARODA SARNA INFOCOM PVT. LTD. 00300200001000 BARB0PATIPU PATIPUKUR
Bank Name Account Name Account Number IFSC Code Branch Name
ALLAHABAD BANK SARNA INFOCOM PVT. LTD. 50494268383 ALLA0210423 NAGER BAZAR DUMDUM
DECLARATION WITH APPLICATION FORM

hereby solemnly affirms and state that the above information is true and correct to the best of my knowledge and belief. Nothing has been hided, manipulated or modified by me. In case, If SARNA INFOCOM PVT. LTD finds any untrue or false, they have full rights to terminate my candidature without assigning any reasons. Also initiate appropriate legal action against me and I personally liable to make good any loss or damages Caused to SARNA INFOCOM PVT. LTD.

Having understood carefully all the terms & conditions I agreed to submit my application for the above post. I also agree to abide by all revised terms and conditions from time to time in future for betterment of the all concern. I also understand that SARNA INFOCOM PVT.LTD.COMPANY reserves full rights & power and also it is upon the sole Discretion of it either to accept or reject my application without assigning any reasons. I also accept that mere applying Does not provide me any rights to claim for appointment directly or franchisee basis.

I agree to bear the necessary cost to be incurred / fixed by the management of SARNA INFOCOM PVT.LTD. COMPANY Installation connectivity related infrastructure / machineries.

Place*:
Date* :
Check List of Documents
(Please Submit After Branch Verified and Self Attested) (Originals to be presented during verification)
Resume
10th Admit Card
Last Educational Qualification
PAN CARD
VOTER I.D. CARD
Aadhaar Card
Ration card
Police Verification Report
Name printed Cancelled Cheque/Self Attested Bank Passbook copy
BC Certificate(IIBF/IBA/IN HOUSE)
Reference Letter from Pachayat/Municipality
CIBIL REPORT