ch,uih eYVh LVsV ØsfMV dks& vkWijsfVo lkslkbVh fyAN ISO 9001:2008 CERTIFIED COMPANY (Hkkjr ljdkj }kjk ekU;rk IkzkIr) jft- dk;kZy;%& 30] pUnzk Iysl] izFke ry] /kkSyiqj gkml] ,e-th- jksM+] vkxjk 282001 (m-iz-) iathdj.k la[;k MSCS/CR/734/2013 vfHkdrkZ iathdj.k vkosnu i= Authorized Center Code vf/kd`r dsUnz chtkad fnukad------------------ Region {ks= vf/kd`r dsUnz izca/kd }kjk izekf.kr vkosnd dh QksVks Cadre Applied For Recognition ekU;rk gsrq vkosfnr egksn;@egksn;k eSa] Jh@ Jherh@ dqekjh iq=@ iRuh@ iq=h Jh Ckh,uih eYVh LVsV ØsfMV dks-vkWijsfVo lkslkbVh fyfeVsM dk@ dh lnL; gw¡ ,oe~ vfHkdrkZ cuus gsrq viuk vkosnu izLrqr djrk@ djrh gw¡A eSa lkslkbVh }kjk fu/kkZfjr vfHkdrkZ iathdj.k 'kqYd tek djus ds fy;s lger gw¡ A eSa ?kks"k.k djrk@ djrh gw¡ fd eSa fdlh Hkh vkijkf/kd ekeys esa lafyIr ugha gw¡ ,oe~ U;k;ky; esa esjs fo:¼ dksbZ okn ugha py jgk gSA vkosnu i= esa mYysf[kr lwpuk esjs laKku iw.kZr% lR; ,oe lgh gSA lnL;rk la[;k tUe frfFk Hkk"kk dk Kku 'kSf{kd ;ksX;rk vk;q gkbZLdwy ls de Lukrd @ ih- th- fgUnh gkbZLdwy @baVj O;olkf;d f'k{kk vaxzsth iSu dkMZ la[;k vU; (iSu dkMZ dh Loa; lR;kfir izfr laayXu djsa) i=kpkj gsrq irk ftyk fiudksM jkT; eksckby ukfer dk fooj.k Ukke vk;q lEcU/k ukfer ds gLrk{kj vfHkHkkod dk fooj.k (;fn ukfer ukckfyx gS) uke eksckby lEcU/k vfHkHkkod ds gLrk{kj ifjp;drkZ lnL; }kjk ?kks"k.kk eSa] vkosnd lnL; dks lkslkbVh vfHkdrkZ ds #i es ------------------------------------------------------ dSMj ij dk;Z djus gsrq vuq'kalk djrk@ djrh gw¡ ,oe~ mUgs vfHkdrkZ cuus ij vko';d izf'k{k.k ,oa lgk;rk le;& le; ij nsus dk fo'okl fnykrk @ fnykrh gw¡A vkosnd lnL; }kjk vfHkdrkZ ds #i esa fd;s x;s leLr dk;Z ds fy;s iw.kZ #i ls esjk mRRkjnkf;Ro gksxkA ifjp;drkZ dh lnL;rk la[;k ifjp;drkZ dk uke ifjp;drkZ dk dSMj ifjp;drkZ ds gLrk{kj izFke tekurh fooj.k gLrk{kj f}rh; tekurh fooj.k gLrk{kj uke uke irk irk dsoy dk;kZy; mi;ksx gsrq vkosnu i= dh tkap ,oe~ lHkh layXu izi=ksa dk LkR;kiu mudh ewyizfr ls dj fy;k x;k gS rFkk mUgs larks"ktud ik;k x;k gSA lHkh tekufr;ks us gLrk{kj esjs le{k fd;s gS] ,oe leLr vkSipkfjdrk;sa iw.kZ djok nh x;h gSA vkosnd lnL; dks vfHkdrkZ ds #i esa fuEu dSMj dk dk;Z djus gsrq vuqefr iznku dh tkrh gSA dSMj layXu 1- rhu uohu jaxhu QksVks dk;kZy; eksgj ,oe~ vf/kd`r vf/kdkjh ds gLrk{kj iathdj.k 'kqYd 2- LFkk;h irk izek.ki= 3- 'kSf{kd ;ksX;rk izek.ki= 4- vk;q@ tUe izek.ki= 5- iSudkMZ dh Nk;kizfr ljy laap; [kkrk la[;k uke b - dksM iathdj.k jlhn la[;k fnukad U;qUkre tek jkf'k (bUVªksM~;wlj ds v/khu QhYM odZj in gsrq vkosnu fd;k gSA izkIr vkosnu dh tkWap esjs }kjk dj yh xbZ gS ,oa fuEu izdkj ls vkSipkfjdrk, iw.kZ djok nh xbZ gSA) 1. Three (3) recent passport size coloured photographs of the applicant have been received / ds ikliksVZ lkbt ds 3 uouhre jaxhu QksVks izkIr fd;s x;sA 2. An attested photocopy of the permanent address of the applicant has been received. /izkFkhZ ds LFkk;h fuokl ds izek.k i= dh QksVks izfr izkIr dh xbZA 3. An attested photocopy of the education qualification of the applicant has been received. /izkFkhZ ds 'kS{kf.kd ;ksX;rk ds izek.k i= dh QksVks izfr izkIr dh xbZA 4. An attested photocopy of the birth certificate of the applicant has been received. /izkFkhZ ds tUe frfFk ds izek.k i= dh QksVks izfr izkIr dh xbZA 5. An attested photocopy of the PAN card no./ Form 49 A of applicant's Income tax has been received./izkFkhZ ds vk;dj ds LFkk;h [kkrk la[;k (Pan Card) dh lR;kfir QksVks izfr izkIr dh xbZ / 49 A QkeZ izkIr dj fy;k x;k gSA 6. The guarantor of the applicant have signed in front of me./ izkFkhZ ds tekufr;ksa ds gLrk{kj esjs lkeus djok;s x;sA Signature & Office Seal of Authorised Person/ vf/kd`r O;fDr ds gLrk{kj ,oa dk;kZy; eksgj DECLARATION / 1. 2. 3. . 4. 5. 6. 7. 8. 9. mn~?kks"k.k I have not been declared of unsound mind. / eSa dHkh vLoLFk efLr"d dk O;fDr ugh ?kksf"kr fd;k x;kA I have not been declared nisolvent. /eSa fnokfy;k ugh ?kksf"kr fd;k x;kA I have good created worthiness in the market and have not at any times suspended payment to my creditors. /esjh cktkj esa vPNh lk[k gSa vkSj eSaus dHkh Hkh vius nsunkjksa dk Hkqxrku ugh jksdkA I am an honest and hard working person and bear a good moral charector and have never been convicted by a competent court for any offence involving moral turpitude. /eSa ,d bZekunkj vkSj esgurh O;fDr gwWa vkSj esjk pfj= vPNk gSa vkSj eq>s dHkh l{ke vnkyr }kjk uSfrd cqjkbZ;ksa esa fyIr gksus dk nks"kh ugh Bgjk;k x;kA I possess good health and as such, can carry on the duties assigned to me. / esjk LokLF; vPNk gS ftlls eSa eq>dks lkSaih xbZ ftEesnkfj;ksa dk Hkyh Hkkafr fuokZgu dj ldrk gwWaA I don't have any criminal record not there is any criminal proceeding pending against me in any court of law and. I am also not involved in any terrorist or smuggling activities. / esjk dksbZ vkijkf/kd ekeyk iqfyl esa ntZ ugh gS vkSj uk gh fdlh U;k;ky; esa yfEcr gS] rFkk eSa fdlh vkradoknh vFkok rLdjh dh xfrfof/k esa 'kkfey ugh gw¡A I know regional language as well as have working knowledge of english and as such can explain the scheme of society to the prospective member account holders. / eq>s {ks=h; Hkk"kk dk Kku gS ftlesa Hkkoh lnL; [kkrk/kkjh dks lkslkbVh dh ;kstukvksa ds ckjs esa le>k ldrk gw¡A I ameager to work as an field worker of the society on collection basis./ eSa lkslkbVh ds {ks+=h; dk;ZdrkZ ds #i esa dysD'ku ds vk/kkj ij dk;Z djus ds fy, mRlqd gw¡A I applicant do solemnly declare that the details given above are true to the best of my knowledge and information/ eSa vkosnudrkZ ,rn~ }kjk ?kks"k.k djrk@djrh gw¡ fd mijksDr fn;s x;s fooj.k esjs lgh ,oa tkudkj esa iw.kZ #i ls lR; gSA vkosnd ds gLRkk{kj PROMISES AND INDEMNITY 1. That I shall maintain the highest standards of quality and skills while performing my services as a field worker of the society towards its business and take due care, caution and diligence in providing or agencey services. 2. That I assure and undertake that while regarding my service a field worker of the society, qua third parties I will not furnish any false or misleading information to any person I shall work with honesty sinceraly, devotion, dedication and shall not misuse my position. 3. That I shall abide by all the rules, manuals regulations and instructions issued by society its officials and seniors from time to time for the purpose rendering my service and shall not assign or otherwish transfer the benefit of my agency or part there of to any third party. 4. That I agree to work on collection basis as per quantum of business moblized by me from the esteemed member account holders as per the rules of the society. 5. That I shall not misuse my position as an field worker of the society and shall always work within the ambit and scope of my authority and if at any time i am found working beyond my scope and author under this agreement I shall not be personally liable for such conduct and society shall not be liable for the same. if the society is held liable for any such conduct which has been done by me when exceeding the scope and ambit of my authority / agence. I Agree and undertake to indemnify the society its officials foe any such civil wrong and or / Criminal proceedings. 6. Theat I understand and clarify that the relationship between the society and my self made under this application is purly of a "principal and field worker" and I undertake not to claim any rights as employee of the society not any such previllage or benefit as payable to any employee. 7. That for due performance of my obligations i herebe undertaken toindemnifty the society, its partners, officers, employees against all and kind of loss, damages, injuries or liabilities caused directly indiretly by me due to negligence in performance, declaration of duty, default, misconduct, dishonesty, non- ferformance, error in judgment, breach of duty, mismanagement and/or embezzleme resulting from any of an act of comission and collection during the course of recognition as field worker with society. 8. That i am furnishing two guarantors in fovour of the society who shall be jointyand sseverally liable for any kind of loss/ damages/ injuries/ liabilities caused directly or indirectly be me due to negliger in performance of my duty or mismanagement / embezzlement caused by me curing the course of my association as a field worker of society. 9. That my ageancyas a field worker would be liabl e to be ternated by the society at any time without assigning any reason whatsover, and without any notice thereof, AGREE AND UNDERTAKEN FOR THE IMMEDIATE RETURN of all documents and paper concerning agency as well asall receipts, counterfoils and deposits of contribution receive which have been trust by me for the society. 10. That i shall be bound to deposit the promoter kit, I card and other items issued by the society at the concerned authorised center after becoming inactive as a field worker as per the eligibility crite defined by the society. 11. That any dispute, arising out of or in connectior with theagency shall be resolved by arbitration under Multi-State Co-operative society Act 2002 Arbitration proceeding and proceeding arising out of award shall be binding to both the parties. Applicant Signature