The Application for e-Mitra Kiosk is a comprehensive form that encompasses multiple critical aspects necessary for establishing an e-Mitra kiosk. Starting with basic details, it necessitates the provision of information such as district, the latest Local Service Provider (LSP), and a photo of the kiosk's owner, underlining the mandatory nature of each field marked with an asterisk (*). It delves deeper into the owner's specifics, requiring details about whether the kiosk is owned by an individual or a company, alongside the owner's name, permanent address, contact numbers, and email ID. The form then shifts focus to the kiosk center itself, asking for the location, name, contact information in both English and Hindi, the concerned police station, and meticulous details whether the kiosk is in an urban or rural setting, including necessary urban or rural addresses. Adding another layer of detail, it requests bank account information of the kiosk for financial transactions. For kiosks with prior existence on the eMitra portal, it inquires about the kiosk ID and associated LSP name. It also requires the applicant to provide specifics about the kiosk's level if it operates at multiple levels. Ensuring legal and operational compliance, the form demands a checklist including ID proof, police verification, educational qualifications, and bank details, concluding with an affirmation that the provided information is correct to the best of the applicant's knowledge, followed by the necessary signatures. This form serves not only as an application but as a vital document ensuring that all e-Mitra kiosks meet the required standard and compliance, making the kiosk setup process transparent and systematic for both the applicant and the authorities.
Question | Answer |
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Form Name | Application Form For E Mitra Kiosk |
Form Length | 2 pages |
Fillable? | No |
Fillable fields | 0 |
Avg. time to fill out | 30 sec |
Other names | emitra near me, e mitra centre in ahmedabad, frnamn, emitra sex |
Application Form for
All fields are mendatory as mark *
Basic Details:-
Dist rict * |
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The latest |
LSP* |
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photo of |
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Kiosks Owner |
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Kiosk Owner Details:- |
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Kiosk Owner Type* |
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Company |
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Kiosk Owner Name* |
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Permanent Address* |
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Owner Phone Numbers*-
Owner |
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Mobile*
Kiosk Center Details:- |
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Kiosk Center Location* |
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Kiosk Center Name (English)* |
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Kiosk Contact (Hindi)* |
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Kiosk Contact Person's Name |
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Kiosk's Phone Numbers |
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Kiosk eMail ID* |
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Police Station (Thana) * |
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Kiosk Address (IF URBAN) * |
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Municipal Town*
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Urban |
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Rural |
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Mobile*
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Ward Number*
Kiosk Address (IF RURAL) *
Panchayat Samiti*
Gram Panchayat*
Village*
PIN Code*
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PIN Code*
Signature of LSP |
Signature of Kiosk Owner |
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Kiosk Bank a/c Details:- |
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A/C Number |
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IFSC Code |
Bank a/c Number |
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Bank Name |
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Branch Name |
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Account Holder Name |
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If this kiosk had already user ID on eMitra Portal please provide us:- |
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Kiosk ID |
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LSP Name |
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Level (Please define the Level of Kiosk if the kiosk having more than one level, mention all
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Details (Name) |
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IT Center |
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Location |
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Government Building) |
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District (Head Quarter) |
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Tehsil |
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Panchayat Samiti / Block |
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Gram Panchayat |
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Village |
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Check List of Enclosures:- |
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I.D. Proof / Address Proof * |
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Police Verification Report* |
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Educational Qualification* |
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Bank A/C Details |
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Above mention check List are checked are correct in my knowledge.
Signature Kiosk Owner |
Signature and Seal |
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LSP |
Date : |
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For Office Use –
Verified By DeGS with Seal