ONBOARDING FORM

Personal Information(Details of managing person who is managing business on behalf of the entity)

Name Father's Name/ Spouse Name Mother Maiden Name

Khajamoinuddin Maimud Miya

Date of Birth Gender Physically Handicapped

06-MAY-2002 Male No

Marital Status Mobile Number Email ID

919535909360

Country Category Service Interested

India ALL

PAN No.
KQXPK6793K

Qualification Details

Highest Qualification Course Institute Name

Date of Passing
29-MAR-2024

Business Details

Applied For Entity Type Annual Turnover

CSP Individual

Nature of Business Net Worth Operating Since

Self Employed 3 2022

Expected Buisness/ Month Current Occupation Engaged with other bank/ company
Self Employed

Shop Address/ Office Details

Shop/ Office Name Shop/ Office Address Pincode

Sharanayya Ambedkar Circle, Maine Road 585306
Chimmanchod, Chincholi,
Kalaburagi, Karnataka, Pin
-585306

State City
 Karnataka Gulabarga

Open Time Close Time Weekly Off

09:00 AM 18:00 PM

Proof Type Proof Number

Aadhaar Card

Permanent/ Registered address

Address Pincode State

Ambedkar Circle, Maine Road 585306 Karnataka
Chimmanchod, Chincholi,
Kalaburagi, Karnataka, Pin
-585306

City Proof Type Proof Number

Gulabarga Aadhaar Card

Current Address

Address Pincode State

Ambedkar Circle, Maine Road 585306 Karnataka
Chimmanchod, Chincholi,
Kalaburagi, Karnataka, Pin
-585306

City Proof Type Proof Number

Gulabarga Aadhaar Card

Bank Information

Bank Name Account Type Account Number

Federal Bank Savings 99980115857372

IFSC Code
FDRL0001604

Other Information

Device Name IMEI Number Connectivity

Name Relation Address

Contact No. Age

This is a System generated form and doesn’t require any signature.

 DECLARATION BY CSP

I hereby submit following declarations as an applicant for becoming CSP of Spice Money Limited ("Spice").

1. I have not been found/ pronounced to be of unsound mind by any competent authority and declared/ adjudicated as
insolvent by any competent court;
2. I have neither been found guilty of any criminal offences in the course of any investigation nor have participated in or
connived at any fraud, dishonesty or misrepresentation against anyone;
3. I have not violated the code of conduct of any bank or been declared a willful defaulter by any bank/ financial
institutions.
4. I undertake to NEVER share the customer details with others and use the same only for the purpose of carrying
transactions allowed by Spice.
5. I have read, understood and accepted the terms and conditions along with the Privacy Policy on the Spice Money
Portal ("Terms") and the same constitutes legally valid binding agreement upon me.
6. I declare that all the information provided is true and correct. My application is liable to be rejected if it does not satisfy
internal verification of Spice as per its policy. Spice, may in its sole discretion terminate the Agreement/ arrangement
between me and Spice as and when Spice deems fit.
7. I have all the necessary permission and I am legally allowed to carry on business at the above mentioned address/
premises.
8. I shall not engage, deal with or enter into an agreement with any other party or any company/ organization engaged in
rendering/ sale/ promotion of similar services as that of Spice
9. I irrevocably and unconditionally undertake to indemnify and hold Spice and its affiliates/ banks indemnified and
harmless from any claim, liabilities, losses, damages, cost, expenses, charges and penalties in connection with or
arising howsoever out of, transactions carried out by me or any act of commission or omission by me amounting to non-
adhering to any Terms or any breach of applicable laws.

I further declare that I have been interviewed for acting as CSP and duly verified by (Sharanayya) having Distributor ID
1065707 on 29-MAR-2024 .I have provided my KYC documents and other details to him for acting as CSP
of the Company.

FOR DISTRIBUTOR USE

1. I Sharanayya having Distributor ID 1065707 have interviewed Khajamoinuddin for approving his
application to act as CSP on 29-MAR-2024

2. Identity and address of CSP verified with the original documents and copies obtained:
KYC Documents (Submit self-attested documentation proof for one of each of three below)
1. Identity Proof: Passport, Voter ID, Aadhaar Card (Aadhaar Number redacted), Driving license, Others.
2. Address Proof: Passport, Voter ID, Aadhaar Card (Aadhaar Number redacted),Driving License, Latest bank
Statement, Latest Electricity Bill, Other (specify).
3. PAN
4. Shop & Establishment certificate (as applicable)
5. Other required document as and when specified by the Spice Money.

3. I confirm that I have informed to proposed CSP/ Retailer in the local language that:
1. Copy of his/ her Aadhaar letter shall be used for verifying his identity for enrolling him as Customer service point
(CSP)/ Retailer of Spice Money and creating his spice money portal ID (subject to policies and procedures) for the
purpose of distributing/ facilitating services such as direct money transfer transactions, AEPS, BBPS, Travel tickets
etc or any other services which may be launched by Spice Money in future,
 2. As an alternative to submission of Aadhaar letter, he/ she may also submit any officially valid documents such as
passport, driving license, voters identity card, NREGA job card or letter issued by National Population Register as
defined under KYC policy of the Spice.

4. I further declare and certify that I or my authorized personnel on behalf of me, have met proposed CSP/ Retailer in
person and have visited his establishment/ shop and address of establishment/ shop mentioned in this form is as per
the documents submitted by the CSP. CSP has necessary permission and legally allowed to conduct business in the
establishment/ shop mentioned above. I hereby confirm the identity of CSP and his details (including his mobile no.)
and declare that I have compared and duly verified the copy of his KYC documents with his original documents. I
undertake that I shall destroy the copy of KYC documents (in case of Aadhaar) whether in physical or electronic form
lying with me and will not use these KYC documents under any circumstances for any purpose other than mentioned
above, after submitting the same with Spice Money Portal.

5. I have done thorough due diligence of above CSP and shall be liable to indemnify Spice or bank and their officials from
any consequences arising howsoever relating to verification or credentials of CSP

6. CSP is operating its business from above premises for last 5 months 2 years
and has found suitable to conduct Spice business/ services.

7. I (Sharanayya) having Distributor ID 1065707 have already provide my confirmation of above mentioned
declaration in customer application form digitally on Spice Money Portal wherein Spice Money has given access to
submit all the required details.

Date: 29-MAR-2024 Place: 3/106 , grama panchayat ainoli chincholi , inoli , Gulbarga , karnataka

FOR COMPANY USE

Checker 1: Details of CSP verified by on with the documents of CSP

uploaded on the portal.

Checker 2: Details of CSP verified by on with the documents of CSP

uploaded on the portal.

This is a System generated form and doesn’t require any signature.