All Fields Mandatory
PERSONAL FINANCE
PROTECTING INVESTING FINANCING ADVISING
TMB NIDHI Ltd.
DSA Application Form
Please fill in all the required details in BLOCK LETTERS. Tick boxes as applicable.
Service Applied for DSA Loan
Date of Application:
Self attested photo
graph of key person
Rubber stamp
DSA Name
Operating
Office Address
Landmark City PIN
Landline Fax No. Email ________________________________________________________________
Website
Registered Office
Address
Landmark City PIN
Landline Fax No. Email ________________________________________________________________
Website
Residence
Address
Landmark City PIN
Landline Fax No. Email _________________________________________________________________
Website
DSA Structure Public Limited Pvt. Ltd Partnership (Registered? Yes No ) Proprietorship Others (Please Specify)
Principal Line of Business _____________________________________________________________________________________________________
GST No Registration No
Goods & Service Tax
Registration No.
Date of Incorporation
Details of Proprietor/Partners/Directors
Name Qualification Designation Contact No Nationality Aadhar No %share
Requirement:
Address, Office Address, Work/ Business Experience, PAN No.etc.
Attach Proof of DOB/ Address/ Identity & Signature (Copy of Passport/ Pan card/Voter's ID)
Copy of PAN Card
Current / Prior Experience Details
Product Serviced Average Accounts (in No's and in INR'000) ______________________________________________
PF/VER1/OCT/2017/ABC
Area of Operations No of executives_____________________________________________________________________________
Is there any outstanding court orders and/ or current, pending or potential, litigation against your concern or to your knowledge, against any of your employees? If YES,
please attach details in an annexure to this form
Do you employ sub-contractors to do any of your core activities?
If YES, please attach details in an annexure to this form with similar confirmation requirements
Not been removed/ dismissed from service (previous employment) If
YES, please provide the details
Not been found guilty of misconduct in professional capacity If
YES, please provide the details
Not an un-discharged insolvent
If YES, please provide the details
Bank Details
Beneficiary Name Bank___________________________________________________________________________________________
Credit Account No. Branch_________________________________________________________________________________________
Centre (Location) Account Type _________________________________________________________________________________
RTGS/IFSC Code______________________________________________________________________________________________________________________________________________________________________________________
Name of Principal (Proprietor/ Partner/ Director)_______________________________________________________________________________________________________________________________________________
Name of Service Provider:___________________________________________________________________________________________________________________________________________________________________________
Sign Position ________________________________________________
Rubber Stamp Date
RM Recommendation: ___________________________________________________RM Name: ________________________________________ RM Signature: ________________________________________________
KYC Details
INSTRUCTIONS
Attach Your Pan
Attach Proof Aadhaar
Attach Your Rent Agreement
Attach Proof of Payment
Self Attested Copy of Bank Pass Book / cheque Book
Attach Your Office Center Photos after Approval
Note – All Document Should Be Self Attested
GRL GROUP
TMB NIDHI Ltd. Contact Us:
Corporate office :- No.11, 2nd Stage, 2nd Block, Outer Ring Road, Near +91-92199-31545
BDA Complex, Nagarabhavi layout, Bangalore-560 072
Institution office :- 50, Canal Rd, Naya Ganj, Kidwai Nagar, Kanpur, Uttar
Pradesh 208001
G-mail :- [email protected],
www.grlgroup.co.in
Visit us :- www.grlgroup.co.in
