Uttarakhand Gramin Bank (Sponsored By State Bank of India) APPLICATION FORM FOR BUSINESS CORRESPONDENTS AGENTS (FOR OTHER THAN INDIVIDUALS) Photograph 1. Location (Village/Town) Location : District : State : PIN : 2. Full Name the applicant/ organization/NGO/Trust/ Society/Company (IN BLOCK LETTERS) 3. Constitution (attach a copy of the regd. Trust/society deed, byelaws of the trust/society, memorandum of article of association with certificate of incorporation) 4. Date of establishment 5. Registration No (with date of registration) Authorities with whom registered 6. Address of the organization Regd. Office Admin. Office Corporate Office Branch Office Website / email address 7. Telephone No. 8. Chief Contact Person/s with Tel/Mobile No. And his/her designation 9. Currently Banking with (Bank / Branch details) 10. Bank Account Numbers details - 11. Present Business / (since when) 12. Do you have any experience in selling financial products ? If not, will you be able to source desired manpower immediately. We hereby undertake / declare that : Head Office, 18-New Road, Dehradun Ph No. 0135-2710660/ 661, Fax: 01352710662 Mail id:
[email protected] Uttarakhand Gramin Bank (Sponsored By State Bank of India) i) Aforesaid information furnished by us is correct and true to the best of our knowledge and belief and in case found at any stage that the information given by us is wrong, our engagement as Business Correspondent will be cancelled. ii) Our organization/NGO/Trust/Society/company, etc. have never been blacklisted/delisted by any Government/Other Authorities any time in the past. iii) Our organization/NGO/Company is a non-political one and not afflicted to any religious organizations, political parties, etc.