Retailer’s outlet visit report

Date: ……./………../…………
Visit No. : …. (State Code – say “DL”, Month – say “Dec” “01”,001)
CSP /Retailer name: ……………………………………………………………………………………………………………………………….
CSP /Retailer ID: ……………………………………………………………………………………………………………………………………….
Shop/ Business address:
……………………………………………………………………………………………………………………………………………………
………………………………………………………………………………………………………………………………………………………………….
…………………………………………………………………………………………………………………………………………………………………
City - …………………………………………… State-……………………………………………, Pincode:

Permanent address:
……………………………………………………………………………………………………………………………………………………
………………………………………………………………………………………………………………………………………………………………….
…………………………………………………………………………………………………………………………………………………………………
City - …………………………………………… State-……………………………………………, Pincode:

Sr Particulars Yes/No Remarks Annexure

no.
1 Whether Signage is displayed for 1
- PPI Issuer ie. Spice Money
- BBPS – Spice Money
- Yes Bank
- RBL Bank
- Indusind Bank
- Fino Bank
- ICICI Bank
If not advise SMA to display the
same.
2 Whether customer care and 2
grievance officer details of Spice
Money and BC Banks are
displayed?

If not advise SMA to display the

same.
3 Schedule of charges are 3
displayed?

If not advise SMA to display the

Sr Particulars Yes/No Remarks Annexure
no.
same.
4 Whether register for AEPS, MATM, 4
MPOS has been maintained?
Please guide CSP if not
maintained, format is available on
the portal.
5 Whether overcharging done by 5
CSP?

If yes, then highlight and warn to

not to charge from customer.
6 Whether KYC documents are lying 6
in the outlet?

If yes, then highlight and warn to

not store any document of
customer with him.
7 Whether it is noticed that any 7
possibility of misuse of KYC
documents lying at the CSP
outlet?
If yes, then highlight and warn to
misuse any document of
customer.
8 Whether following certificate at 8
outlet
8.1 Retailer certificate 8.1
8.2 BC certificates of Yes Bank is 8.2
published?
8.3 BC certificates of Indusind Bank is 8.3
published?
9 Whether Shop / Business address 9
is same as shared by SMA at the
time of onboarding or in updated
records.
10 Any other thing observed at outlet 10
? if yes, please specify

Note: Photo as an evidence of availability of abovementioned requirements are to be obtained

mandatorily. If requirements are not fulfilled, then it need to be mentioned accordingly in remark and
post that mentioned requirement are also to adhered at the time of visit itself.
Signature of Agent /CSP Signature of Sales officer

Name:

Name:

City:

State:

Employee ID/code:

Contact no.:
Annexure 1: Photo of signage available at outlet

Annexure 1.1:

Annexure 2: Photo of customer grievance officer and contact details available at outlet

Annexure 2.1:

Annexure 3: Photo of schedule of charges available at outlet

Annexure 4: Photo of customer grievance officer and contact details available at outlet

Annexure 5: Photo of record or register maintained for transaction carried out

Annexure 6: Photo of KYC document lying in outlet or in device or in mobile or laptop

Annexure 8: Photo of Spice Money retailer certificate displayed at outlet

Annexure 8.1: Photo of Yes Bank BC certificate displayed at outlet

Annexure 8.2: Photo of Indusind Bank BC certificate displayed at outlet

Annexure 9: Photo of shop or business address with retailer/Adhikari

Annexure 10: Photo of any other details