NEW REPLACEMENT CSP CODE:
CSP Point Status
Kiosk Banking SSA /NON-SSA / ALLOTED URBAN WARDS
Date:
APPLICATION FOROPENING OF NEW / REPLACED CUSTOMER SERVICE POINT (CSP)
The detailed particulars of the proposed CSP are given below:
SL.
No Items Particulars
Business BC Name NICT TECHNOLGIES PVT. LTD.
1
Correspondent(BC) Details BC Code 1A760000
Village/Street: Block:
G.P./Municipality: Ward:
2 Address of the CSP P.O.: P.S.:
proposed to be opened. District: PIN: State: West Bengal
Latitude: Longitude:
Areas to be covered by Village / Town Gram Panchayat / Municipality Block Population Category
CSP ( Only rural
and semi-urban areas
3 to be covered
Distance from a near by
Name of Link Branch with Link Branch Operator’s
4 Link Branch Code SBI Link Existing CSP Other
Code No. and Distance Name Existing Bank
Residence
between Link Branch and Branch Point
CSP.
Name:
S/W/D/O:
Address(Residence):
Particulars of proposed Vill./Street: Block: Ward:
CSP Operator with recent
color PP photograph dually G.P./Municipality: P.O.:
attested by Bank / Business P.S.: District:
5 Correspondent PIN: State: West Bengal DOB: Age:
Edu. Qualification: No of years of Stay in the present location:
Source of funds for business: Place of Business: -select-
Marital Status: -select- Gender: -select- CIBIL SCORE:
Aadhaar No.: PAN No.:
SBI A/C No.: Branch Name:
Mobile No.:
Email ID:
Computer Literacy: YES/NO(If yes, nature of qualification):
Experience in Selling Financial Products? -select-
CSP's existing banking arrangements: -select-
--------------------------------------
Details of close relative having availed CSP. -select-
Signature of Proposed CSP Operator (If Yes, mention CSP Code):
Previous CSP code deletion of self/family members? -select-
(If Yes, mention CSP Code):
Connectivity Issue: -select-
What is the cash balance you are ready to invest for making cash payments / receipt of deposits as CSP?
Present Occupation / Business : Monthly Income:
Languages known: English Bengali Hindi Others
Particulars of liabilities:
Infrastructure available for CSP Location: -select- Political Affiliation (if any): -select-
Particulars of movable/immovable properties:
Name of the office from which retired: Last Designation:
Any disciplinary action taken against you while in service?
Business Potential
Total Population: No of expected Accounts:
6 No of Households: Annual business expected:
Main activity of people: Potential business through Migrantworkers:
Copy verified and signed by BC in respect of each of the documents enc l os ed.
Details of KYC/Identification (i)VOTER’S CARD / PASSPORT (v)PHOTO
/address documents Submitted by
7 CSP operator and verified by (ii)AADHAAR CARD (vi) POLICE VERIFICATION
Bank & B.C.(Documents are to be
enclosed) (iii)PAN CARD (vii) CIBIL
(iv)EDUCATIONAL QUALIFICATION (viii)
I certify that the above information is true to the best of my knowledge and belief. I will open my CSP
outlet only at approved location by the Bank, otherwise my CSP code may be deleted without any
information.
Date:
Place: Signature of the applicant.
FOR OFFICE USE
Remark of Branch Manager / ChiefManager: All the above particulars and found inorder
1) KYC Verified.
2) Proposed Site Inspection done and found suitable and viable.
Signature of Branch Manager with SS NO………Stamp & date.
Due diligence by CM(FI):
DSH& R&DB Branches)
Signature of CM (FI) (DSH & R&DB Branches) with Stamp &Date.
10
Approved / Rejected – Please advise LHO with valid
reason)
Signature of Regional Manager with stamp & Date
(Signature and Stamp of Business Correspond)
Annexure - A
Names and occupation of two people 1)
to whom reference can be made
(KYC documents of referees 2)
enclosed)
REFERENCE
1) I hereby certify that Mr. / Ms. / Mrs. ……………………………………………………has been a
resident of…………………………… village /town of ………………………. district in the State of
West Bengal for the period of …………..years and has been known to me for period
of…………..years.
(Signature)
Name of Referee…………………………………………………………….
Address……………………………………………………………………….
…………………………………………………………………………………
Designation…………………………………Title…………………………...
2) I hereby certify that Mr. / Ms. / Mrs. ……………………………………………………has been a
resident of…………………………… village /town of ………………………. district in the State of
West Bengal for the period of …………..years and has been known to me for period
of…………..years.
(Signature)
Name of Referee…………………………………………………………….
Address……………………………………………………………………….
…………………………………………………………………………………
Designation…………………………………Title…………………………...
Reference from Sarpanch / Mukhiya / Gazetted Govt. Servant / Post Master / Tahsildar / Police
Inspector / Govt. Teacher.
This is to certify that Mr. / Ms. / Mrs. ………………………………………………….. has been a
resident of (complete address) …………………………………………………..................................
…………………………………………………………………………………………………………… for
…………years and holds a good character in the area. His photograph is herewith attested and I
confirm the same. His date of birth is ……………………
(Signature)
Name: …………………………………………………………………
Address………………………………………………………………..
…………………………………………………………………………. Designation
(withseal) ……………………………………………….
Annexure – B`
Declaration by the Applicant for engagement as CSP
(to be obtained by Link Branch)
I, Shri / Smt / Mr. / Mrs. ……………………………… D/W/S/O ……………………………. Residing
at ………………………………………..………………………………………………………
…………………………………………………………………………………………………………………
…………………………………………………………………………………………………………………
…………………………………………………………………………………
have applied for engagement as Customer Service Point of M/s NICT Technologies Pvt. Ltd.
(National / Circle BC), who is working on behalf of State Bank of India, at ……………………
(location) to provide financial inclusion services. Our Link branch will be SBI …………………..
Branch.
I further declare that NICT Technologies Pvt. Ltd. (BC) has not imposed any charges on me till
date. I have been given to learn from the BC that they will do so and provide me with proper
money receipts only after generation of my CSP Code and prior to due activation of the same.
Hence, I declare that I shall then accordingly submit the money receipt against the charges paid
by me to the BC. I also undertake to submit money receipt from all services/ goods provider
before generation of CSP Code. I also declare that no unauthorized money has been paid by me
to the BC/Bank Official
I understand that the Bank has initiated this procedure to obviate any chances of wrongdoing /
misleading on the part of all concerned.
Yours faithfully,
(Name of CSP) Place:……………..
S/W/D/O……………. Date :
Address
Mobile No:
Email address:
Annexure - C
Declaration by the Applicant for engagement as CSP
(to be obtained by CSP Code generating office)
I, Shri / Smt / Mr. / Mrs. ……………………………… S/D/W/O ……………………………. Residing
at ………………………………………………..………………………………………………
…………………………………………………………………………………………………………………
…………………………………………………………………………………………………………………
…………………………………………………………………………………
Have applied for engagement as Customer Service Point of M/s NICT Technologies Pvt. Ltd.
(National / Circle BC), which is working on behalf of State Bank of India, at
……………….………… (location) to provide financial inclusion services. Our Link branch will be
SBI ……………….….. Branch.
I further declare that NICT Technologies Pvt. Ltd. (BC) has not imposed any charges on me till
date. I have been given to learn from the BC that they will do so and provide me with proper
money receipts only after generation of my CSP Code and prior to due activation of the same.
Hence, I declare that I shall then accordingly submit the money receipt against the charges paid
by me to the BC.
Yours faithfully,
(Name of CSP) Place:……………..
S/D/w/O……………. Date :
Address:
Mobile No:
Email address:
Annexure E
STATE BANK OF INDIA
SCORING SHEET FOR CSP
Name of the Applicant:
Category of Applicant:
Part – A: Quantitative Assessment
# Parameter Criteria Marks Max. Marks
Marks Scored
1 Office i. Nonresidential / 5 5
SSA Area
ii. Residential 2
iii. Located at central place / 5 5
prominent place at the centre
2
iv. Located at elsewhere at the
centre
2 Computer Knowledge i. Yes 1 1
ii. No 0
3 PVR i. Submitted/ acceptable 1 1
ii. Not submitted/ Not
acceptable 0
4 Reference of 2 i. Submitted/ acceptable 1 1
persons known to ii. Not submitted/ Not acceptable
bank 0
5 Distance i. Distance between the place of 2 2
_ business of a BC & base branch
area of (Link) is within 5 kms
operation ii. Beyond 5 km 1
6 CBIL SCORE i. No Default 3 3
ii. Default 0 --
7 Education i. Graduate & above 3 3
ii. 12th class pass 2
8 Infrastructure i. Owned premises 2 2
ii. Rented premised 1
9 Experience in i. YES 2 2
Selling Financial ii. NO 0
Products
Total 25
(Minimum eligible quantitative score: 12.5 i.e. 50%)
CIBIL DEFAULT - NOT ELIGIBLE
INSPECTION REPORT BY THE LINK BRANCH
We forward herewith an application for allotment of CSP in the name of
…..........................................................(name of CSP Operator), received from
…............................................................................(name of BC).
We have scrutinized the application/proposal and found in order as per the Master
Circular for allotment of Csp.
We have verified the KYC along with other related documents.
We have inspected the proposed location of the Csp as per the application submitted.
One copy of the proposal/application and verified copies of documents etc, including
police verification report is kept at the branch.
We therefore, recommend for allotment of CSP at............................................
(location) in the name of ….......................................................................(name of
csp operator) since it is a viable proposition. BM, to ensure that csp outlet open in the
location approved by the LHO.
Distance from linked branch to csp location:
Distance from resident to csp location. ….......Whether is it commutable. Y/N
BM has to ensure that no irregularity should be observed for opening /closing of csp
outlet in time. Time taken from resident to location..........................
( As per CC instruction any application for new/replacement csp code , applicant should
be from the same village/locality where he/she is residing or max within a distance of 1 to
2 km)
…..............................................................
Branch Manager.
