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Business Correspondent - Application Form-2

BC

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Sam Mashi
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96 views

Business Correspondent - Application Form-2

BC

Uploaded by

Sam Mashi
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Business Correspondent

Application Form

BUSINESS CORRESPONDENT APPLICATION FORM

Please fill the form in English with black ink and use BLOCK LETTERS
* Mandatory to be filled AFFIX RECENT
PASSPORT SIZE
PHOTOGRAPH OF
THE APPLICANT

Please sign across,


sign should overlap
on photo & APEF

Prefix First Name Middle Name Last Name


Name

Mobile Number

Category of BC Individual NSS PDS/FPS NRLM/SRLM Ex-Servicemen CSC NULM RSETTI Others

Population Classification Metro Urban Semi-Urban Rural


of BC Location

Address Line 1
Line 2

City/ District

State Pin Code

Alternative no.

Address for proposed


BC location for
customer connect
( if any)
Pin Code

PAN

Email ID

Latitude Longitude

IIBF Certificate IIBF Certificate D D M M Y Y Y Y


Number Passing Date

Prefix First Name Middle Name Last Name


Father’s name

Mother’s Maiden
Name

Date of Birth
D D M M Y Y Y Y Gender Male Female Transgender
(DD:MM:YYYY)

Nationality

Driving Election Commission PAN Aadhar Job card Issued by NREGAduly signed
Proof of ID(POI) Passport License Voter ID Card Card Card by an other of the state government
Proof of Address(POA)
Driving Election Commission Aadhar Job card Issued by NREGA duly signed by
Letter Issued by Passport License Voter ID Card Card an other of the state government
National population
register (NPR)

KYC Document Number Expiry Date D D M M Y Y Y Y

ACCOUNT DETAILS

IPPB Branch Name IFSC I P O S 0 0 0 0 0 0 1


Account Name
(As per Bank record)

Account Type Savings A/c Current A/c

IPPB Account Number

BUSINESS CORRESPONDENT DECLARATION


I have read and understood the terms & conditions provided in agreement and unconditionally accept them as binding on me. I hereby declare that the
particulars given herein are true, correct and complete in all respects and the documents submitted along with this ‘Business Correspondent Enrollment
form’ are genuine. I hereby undertake to inform India Post Payments Bank Limited of any change in the information provided herein above.

DATE:

PLACE:
Business Correspondent signature with stamp

Note: For List of Documents, please see below.

List of Documents

Individual Identify

i. Proof of identify (Any of the below)

a. Passport
b. Driving License
c. Voter ID Card
d. Pan Card
e. Aadhar Identify Card
f. Job Card Issued by NREGA duly signed by an officer of the state government

ii. Proof of Address (Any one of the below)


a. Aadhar Card
b. Driving License
c. Passport
d. Voter ID Card
e. Job Card Issued by NREGA duly signed by an officer of the state government
f. Letter Issued by National population register (NPR)

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