Basic Details

All fields are mendatory as mark *

District*
LSP* OV TECHNOLOGY SERVICES PRIVATE LIMTED

Kiosk Owner Details

Kiosk Owner Type*
Kiosk Owner Name*
Permanent Address*
Owner Phone Number
Owner Mobile*
Owner e-Mail ID*

Kiosk Center Details

Kiosk Center Location*
Kiosk Center Name*
Kiosk Contact*
Kiosk Contact Person's Name
SSO ID*
Kiosk's Mobile*
Kiosk eMail ID*
Police Station (Thana)*
Kiosk Address (If Urban)*
Municipal Town*
Ward Number*
Kiosk Address (If Rural)*
Panchayat Samiti*
Gram Panchayat*
Village*
PIN Code*

Kiosk Bank a/c Details

Bank a/c Number
IFSC Code
Bank Name
Branch Name
Account Holder Name

If this kiosk had already user ID on Paypoint Portal please provide us

Kiosk ID
LSP Name
Level Details (Name) Private Location IT Center
(Rajasthan Sampark /
Government Building)
District (Head Quarter)
Tehsil
Panchayat Samiti / Block
Gram Panchayat
Village

Check List of Enclosures

1. I.D. Proof / Address Proof*
2. Police Verification Report*
3. Educational Qualification*
4. Bank A/C Details*
Longitude
Latitude

Above mention check List are checked are correct in my knowledge.

Payment Method

Payment Method*
Signature Kiosk Owner Signature and Seal LSP
Date* :

For Office Use- Verified By DeGS with seal