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Ebankmitra Registration Form PDF
Ebankmitra Registration Form PDF
AND
GOVERNMENT TO RURAL INDIA
Under the aegis of the National e-Governance plan of Rural Banking Development Authority of India
Application No 18
M/S eBankmitra Channel Partner Application Form for KIOSK Banking For any query please
call +91-8406831699 or write to: info@ebankmitra.co.in,support@ebankmitra.co.in
THIS KIT CONTAINS THE FOLLOWING FORMS:
FORM 1:- PERSONAL PROFILE
FORM 2:- INFRASTRUCTURE / FINANCE
(NOTE: Filling of both forms is mandatory. The information furnished by the applicants shall be treated in
strict confidence.)
The investment to be made by Channel Partners is based on the District/state level partner, Details are as under
(a) VLE Registration Charge: - Rs.15800/-only
(b) District Level Channel Partner: - Rs 49800/- only
(c) State Level Channel Partner: - Rs 149800/- only
Mode of Payment:-
(1)By Cash Deposit Method (Please send Xerox copy of cash receipt.)
(2) By Cheque (3) By RTGS/NEFT/Online transfer
I have read and understand all information/terms & conditions and signed this agreement
PLEASE MENTION IS BRIEF A FEW DETAILS ABOUT YOUR ACHIEVEMENTS, YOUR TYPICAL DAILY ROUTINE,
YOUR BUSINESS GOALS AND AMBITIONS.
DECLARATION
I We declare that the details and information provided by me /us herein above, are true to the best of my /our knowledge and
belief
DATE:
PLACE……………………………………………………….. Signature………………………………………………………………….
FORM 2 - INFRASTRUCTURE I FINANCE
STRUCTURE OF THE BUSINESS ENTITY FOR CHANNEL PARTNERSHIP
(NOTE: Please check that the details are in tune with the investment required for the city chosen by you.)
*Subject to terms & conditions.
CHOICE OF DISTRICT/STATE FOR DISTRIBUTION PURPOSES________________________________
PROPOSED LOCATION WITHIN THE CITY__________________________________________________
REASONS FOR CHOICE OF LOCATION_____________________________________________________
MENTION REASONS FOR INTEREST IN THIS BUSINESS______________________________________
CURRENT INFRASTRUCTURE AVAILABLE_________________________________________________
WHETHER HAVING ANY PREMISES
_________________________________________________________________________________________
_________________________________________________________________________________________
CENTRALITY OF LOCATION & THE RATIONALE
(Please give details regarding location, proximity to industrial belt I educational institutions I residential localities and
the status of the neighborhood etc.)
DETAILS OF ADDITIONAL OFFICE INFRASTRUCTURE
Telephone: Yes No
Fax : Yes No
Internet : Yes No
1. Please provide only correct Information otherwise your application may be Canceled in future.
2. Please provide your Security money in above mention account only.
3. After filling application form please send it to under mention address:-
eBankmitra
Rdb boluvered building 8th
EP & GP floor,Sector-5
Salt Lake,Kolkata,
West Bengal-700091, India.
4. you can also submit your app 'cation form online on E-mail:-
info@ebankmitra.co.in
support@ebankmitra.co.in
5 .For any further query please contact our costumer care executive.
DECLARATION
We declare that the details and information provided by me 1 us herein above are true to the best of my I our
knowledge and belief
DATE:
PLACE (Signature)
BRING BUSINESS, EDUCATION, DEVELOPMENT
AND
GOVERNMENT TO RURAL INDIA
Under the aegis of the National e-Governance plan of Rural Banking Development Authority of India
Permanent Address
Contact Number.................................................. E-mail..........................................................................................
Are you in job..........................................................................................................................................................?
Monthly Income from all sources..............................................................................................................................
Type of Property for CSP outlet...............................................................................................................................
Mode of Payment office............................................................................................................................................
If cash Deposit then cash receipt no..........................................................................................................................
Declaration:- Above mention all information about me are true in my knowledge and I declared that if found
any wrong information then Rural Banking Development Authority of India will not responsible for any type of
cancellation,
(Signature)
Name: …...................................................................................................................................................................
Address: …................................................................................................................................................................
Designation (with seal)..............................................................................................................................................
Nearest Bank Details for where vie Apply: Branch Name.....................................Branch Code..............................
Branch Address..........................................................................................................................................................
1. Read the Terms & Conditions of every product of eBankMitra Carefully on Brochure
2. Before Installation of any software please read the file How to Install or call +91-8406831699
3. Fill up the application-form carefully.
4. Attached all essential document including Demand Draft for Trading Account (min. 25000/- in Favor
of Onlinepaypointcsp payable at your Regional office for knew your regional office please call
+91-8406831699)
5. Essential documents -
(a) ID Proof
(b) Address Proof
(c) Demand Draft (For. trading Account)
6. Complete Fill-up Application Form
7. Please send the application form by registered post or speed post only.
8. Please de not install any software without prior information from SCA
9. All software is locking with Password for unblock please call +91-8406831699)
10. All Software are procreated by End-user license of Rural Banking Development Authority, so do
Not make any type of amendment and share with anyone.
11. For more information please visit www.ebankmitra.co.in
12. For any type of information please write to support@ebankmitra.co.in
Declaration:- Please provide only correct information and attached all essential document with your application
form ,Rural Banking Development Authority will not Responsible for any type of cancelation due to missing of
any Document.