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CSP Application Form

Dated

Place

BCCSP Code

I hereby apply to be admitted as an Associate Member of Zero Microfinance and Savings Support Foundation. I also apply to be
appointed as an Customer Service Point (CSP) for Zero Microfinance and Savings Support Foundation. My particulars are:

1.

Full Name

2. Gender

3.

Location of Outlet ________________________________________________________________________

_________________________________________________________________3a.Years in Location______

4.

Ward

5. Landmark

6.

City/Town

7. District

8.

State

11. Mobile

9. PIN Code

10. Rented/Owned

12. Landline

14. Proof-of-ID

13. Fax:

15. Proof-of-Address

16. Education

17. Date of Birth

18. Age

19 Home Address __________________________________________________ _______________________

_____________________________________________20. Years in location___21. Rented/Owned _______
22. Ward

23. Landmark

24. City/Town

25. District

26. State
29. Mobile

27. PIN Code

30. Landline

28. Rented/Owned
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. Applicants 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)

Applicants Signature

41. Branch

ALWs Signature

ZMFs Signature