ANNEXURE V(b)
APPLICATION FORM FOR APPOINTMENT OF COLLECTION (RECOVERY) AGENTS

1. Name of the Agent :
2. Address (including :
Telephone Numbers, fax :
Nos, e-mail address) :
3. PAN No. :
4. Present Bankers :
5. Personal Particulars :
(a) Age
(b) Qualification
(c) Experience
(d) Family members and their status
Name
Age
Relationship
Whether Dependent?
If employed, employers name & address
(1)
(2)
(3)
(4)
(5)
(e) Present Income
(f) Income from Recovery activity, if any
(g) House whether owned? If yes, please furnish us particulars viz., location, market value of the property etc.,
(h) Passport No,. if available, and its validity
(i) Certificated from IIBF for having undergone 100 hrs training on
6. Existing Clientele:
Name of the client
1st Assignment obtained on
No. of assignments entrusted
No. of assignments completed
No.
Amt.
No.
Amt.
7. References:
(i) _________________________________
(ii) _________________________________
8. Information furnished above is correct to the best of my knowledge & belief. Copy of the
documentary proofs, wherever applicable, duly certified by me are enclosed
(Name & Signature)
Date:
Police verification, if considered necessary, carried out on.
Other Particulars verified and comments, if any:
(Authorised Bank Official)