CSP Application Form
Dated ____________ Place ___________________________ BCCSP Code _____________________
I hereby apply to be admitted as an Associate Member of MOS UTILITY. I also apply to be appointed as an Customer
Service Point (CSP) for MOS FINS. My particulars are:
1. Full Name ________________________________________________________ 2. Gender _____________
3. Home Address __________________________________________________________________________
4. Ward _______________________________________ 5. Landmark ________________________________
6. City/Town ____________________________________ 7. District __________________________________
8. State ___________________________ 9. PIN Code ______________ 10. Rented/Owned _______________
11. Mobile _________________________ 12. Landline ___________________ 13. Fax: ___________________
14. Proof-of-ID _______________________________ 15. Proof-of-Address _____________________________
16. Education _______________________________ 17. Date of Birth ________________ 18. Age __________
19. Location of Outlet ______________________ 20. Years in location ____ 21. Rented/Owned ____________
22. Ward _______________________________ 23. Landmark _______________________________________
24. City/Town __________________________________ 25. District ___________________________________
26. State _______________________________ 27. PIN Code ___________ 28. Rented/Owned _____________
29. Mobile _________________________ 30. Landline ___________________ 31. Fax: ___________________
32. Reference 1 (Name, Address, Contact Details)
33. Reference 2 (Name, Address, Contact Details)
34. Photo (2) of Applicant Collected ____________ 35. Photos of Establishment taken _____________________
36. Applicant’s PAN No. _______________________ 37. No. of people working at outlet ___________________
38. Description of services at present outlet: _______________________________________________________
39. E-Mail ID of Applicant (to be used for all communication)
40. SBI A/c No. of Applicant (11 digits) ___________________________ 41. Branch ________________________
BIO – DATA
Contact No :
Date of Birth :
Father Name :
Martial Status :
Past Experience :
Monthly Income :
Type of Account :
Present Occupation :
List of Documents required from New CSP
1. MOS FINS Application form
2. Recent Photographs – Three (One for MOS FINS State Office , One for Head and One
for Police Verification)
3. Personal ID Proof
(Pan card / UID / Election Card / Voter ID Card / Passport/ Driving License /etc)
4. Residential and Business Location proof (Latest paid bill not more than 3months old)
Electricity Bill / Telephone Bill / Rent Agreement / Rent Receipt)
5. Bio- Data
a) Personal details, Education details
b) Av Monthly income
c) Past Experience
d) Family details
e) Languages known
f) Cash handling ability
g) Ability to Handle Technology
h) Details of family member working in the bank, if any
i) Knowledge of area of operation
j) Details of existing bank account
6. Bank Statement – Showing last Six Months Transactions
7. Copy of Education Certificate :
8. Police verification of the Person concerned will be applied by MOS FINS to the
respective Police Station / DCP Office.
9. Forwarding letter to RBO for due diligence of the CSP identified.
10. Bio- Data : Personal details, Education details, Av Monthly income, Past Experience’
Family Details, Languages Known, Cash handling ability, Ability to Handle Technology,
Details of family member working in the bank, if any, Knowledge of area of operation ,
Details of existing bank account.
11. Affidavit on Rs 10/- stamp Stating the following
I, Mr. or Ms.______________________________________________
S/o / D/o ? W/o, Shri _________________________________________ resident of
_ do hereby solemnly
affirm and declare as under:-
1. That I am a citizen of India.
2. I am not a defaulter of any bank with loan or any other instrument.
3. I am not affiliated to any political party
4. I have no criminal record against me since birth.
5. I confirm that none of my immediate family member is working in State Bank of India.
6. I have the capability to handle the cash and operate the technology.
7. I am familiar with the local language.
8. I have the knowledge of the area being assigned to me.
9. The place mentioned as my residence is my own/rented
10. The place mentioned as my business location is my own/rented
11. I will not resort to any irregular transactions / practises in my day to day dealings with the
customers at the outlet so as to arouse/bring disrepute to M/s/ MOS FINS financial
services and State Bank of India. I further undertake to keep MOS FINS and State
Bank of India indemnified against any losses that may arise due to acts of
omissions/commissions on my part.
Verified at Mumbai, on this ______________________ that the contents of the above
affidavit are true and correct to the best of my knowledge and belief and nothing has
been concealed therein.
DRAFT FOR POLICE VERIFICATION
The Deputy Commissioner of Police
Verification of antecedents’ Customer Service Point (CSP)
"MOS FINS” is the national business correspondent of State Bank Of India for implementation of
Financial Inclusion Programme of Govt of India by appointing Customer Service Points (CSPs) at
various allotted locations. We appoint suitable customer service providers on commission basis.
In this connection we advise that as one of the requirements of the bank is that the candidate so
selected should not have any criminal record and a police verification report is required to this effect.
Kindly therefore arrange to do the needful. The required particulars of the person for whom police
verification is needed are given below for your necessary action.
Address of the proposed