Annexure I
Application Form for Empanelment as Business Sourcing Associate for Bank of India
(BSA)
The Photo
Bank of India,
SUB: Application for Empanelment as Business Sourcing Associate (BSA) with Bank
of India
I submit herewith my application for the empanelment as Business Sourcing Agent
(BSA) for Bank of India at Branch/ RBC / Zonal Office. I have
read all the terms and conditions relating to the service and undertake that they are
acceptable to me.
Sr. Particulars
No
1 Full Name (in Block letters) (Name of the
Individual/Firm/ Company/Fintech etc)
2 Father's / Husband's Name
3 Constitution (e.g. Individual/ Ex-
Staff/Firm/Company/Fintech.
In case of Ex staff, please mention his/her PF Number
4 Date of birth in case of individuals/Date of incorporation
in case of Non Individuals
5 Age/No of years in existence
6 Present activity
7 No of years of experience in the present activity
8 Educational qualifications
9 Languages known
10 Address (Documentary proof to be attached like latest
Telephone/Mobile Bill/Electricity Bill/Gas Bill/Ration
card/Aadhar Card/Shop Act License/Registered Rental
agreement etc
A. Residential:
B. Office
11 Mobile Number/Alternate Mobile number if any (Should
have mobile in own name
12 IN/CIN etc /Aadhar
E mail ID
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15 Copy of income proof/ITR
16 Latest Bank statement for the last 12 months
17 Copy of appointment-if serving with any other
institution/Bank
18 Copy of Registration certificate of Firm/MOA &
Certificate of incorporation in case of a Company
19 Any prohibition from any regulatory authority to conduct
Business ( Yes/No, if yes, the reasons there of)
20 Any case of violation of Indian Penal Code/ other law
enforcement agency pending ( Yes/No, if yes, the
reasons there of)
21 Reference letter from 2 reputed persons from the locality
(Name and contact Number)
22 Relative to existing staff (if Yes) Please furnish the full
details of the staff member
INFRASTRUCTURE AVAILABILITY in case of Other than Individuals
Name of the Institution
Nature of Work
Period of association
Connectivity (e mail, internet etc.)
Volume of work
Office space (in Sq. ft.
Owned or Rented
Number of employees
No of Computer available
Any other information which the applicant wishes to bring to the knowledge of the Bank:
I declare that all statement made in this application and documents submitted are true,
complete and correct to the best of my knowledge and belief. I understand that in the
event of any information/document being found untrue/incorrect at any stage my
application is liable to be rejected and if already empanelled, the empanelment is liable
to be terminated.
Place: Signature of the Applicant
Date: (Name of Applicant and seal)
vrar.F
Head CI
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