Bio Data

(on Non-judicial stamp paper of Rs.
100/- purchased in State of Service )
AFFIDAVIT CUM INDEMNITY BOND
(IN CASE OF COMPANY / FIRM /SOCIETY )
I, (Name of Person ) , …… (Designation of Person ) of … (Name & Address of Society/

Company/ Firm ) (“the Society/ Company / Firm “), a society / trust registered under the
Societies Registration Act 1860 / Indian Trust Act 1882 or (Name of Act ) or A partnership[
firm registered under Partnership Act or A company registered under Companies CAT 1956 /
2013 …having registration No ……….. dated ……. PAN No and having its principal place of
Business at ……………………………………(Address with PIN No )
…………………………………………………………………………{herein after referred to as
“CSC” and which expression shall, unless its repugnant to the context or meaning there of,
means and include its heirs , administrators , successors , employees and assigns}
(IN CASE OF INDIVIDUAL VLE )
I, (Name of Person ) , …… Resident of … (Address of person Society ) (“VLE“),having PAN

No ……………………. And CSC ID …………………………………… and having its
principal place of Business at ……………………………………(Address with PIN No ) herein
after referred to as “CSC” and which expression shall, unless its repugnant to the context or
meaning there of, means and include its heirs , administrators , successors , employees and
assigns}
…………………………………………………………………………
do hereby solemnly affirm , declare and undertake ,
THAT :-
1. I/ We Am/ are running a Common Service Centre with CSC ID no…

………………………………………. And authorized to provide supply / services provided
through Common Service Centers to Resident / Citizens of India .
2. the Name , Address , CSC ID , PAN and other particulars declared above of CSC are true
and correct.
3. I / We hereby Confirm and undertake that the above mentioned “ CSC” is eligible for
providing “Dig pay” services and having necessary “Technical infrastructure”{ these
infrastructure shall be further enhanced or modified as per Compliance of Law ,
Authority or Any Statute as applicable } as mentioned hereunder to provide “Digipay
Services” , which includes and not limited to following details as prescribed:
 Technical infrastructure
 Minimum of 1 operational Computers (Laptop or PC) with genuine / licensed software
 Computer should have reliable internet connectivity with the minimum speed of 256 kbps
 One printer and scanner
 At least one STQC certified registered biometric device connected with the computer.
4. I /We hereby agree that I am personally liable for :

 For any unlawful or malpractice or fraudulent activity done at my centre ,
 For deficiency in services or performance at my centre
 any other applicable penalty levied by any statutory Authority including levied , RBI ,
NPCI , BANK , UIDAI etc
 all acts, deeds and Compliances and breach of any Statutory Act , rules , Bye laws
including that of Aadhaar (Target Delivery of Financial and other subsidies , Benefits and
Services ) Act 2016 and Information Technology Act 2000 and , further Amendments of
these Acts ,
 Any act incidental and ancillary to the above
5. I/We hereby declare, confirm and undertake that neither me nor any promoter / key management
personnel / partner of the Company / Firm / Society are not being blacklisted/ suspended/refused
empanelment by any Government Organization or Local/ Municipal Authority and are not found guilty
by any court in India for any Fraudulent Activity, or found involved in default of any statutory act,
deed, law etc applicable in India.
6. I hereby agree that I shall be solely liable for any action including legal course such as FIR etc if I
or any person from my centre is found involved in any unlawful activity , fraudulent , activity
including transaction/activity with any person , client , bank , Authority etc and if found against me or
my CSC.
7. I/We for ourselves and my/our respective heirs, executors , employees , Assigns and administrators
jointly and severally agree, affirm and undertake that the “CSC e GOVERNANCE SERVICES
INDIA LIMITED having its registered office at 4th Floor , Programme Management Unit,
Electronics Niketan , 6 CGO Complex , Lodhi Road , New Delhi -110 003” , its successors and
assigns and its managers, agents, officers and servants and their respective estates and effects are
and shall from time to time and at all times hereafter be kept safe and saved harmless and
indemnified for and in respect of such amount , payment and against all actions, losses, cost, charges,
expenses and demands whatsoever in respect of the said amount , payment or delivery of the all
Services through CSC and all acts deed “ including acts and deed in SUPRA (1) to (4) of this
affidavit , we hereby declare , confirm and undertake that we will be responsible for all types of
Offence, Penalties , legal action etc and any law or statute applicable present or future and any act
deed incidental and ancillary to these act.
8. I further agree that if any declaration Supra (1) to (7) is found incorrect than
 “CSC” affiliation/ registration as CSC with “CSC e GOVERNANCE SERVICES
INDIA LIMITED “ shall be immediately cancelled and
 Any loss losses, cost, charges, expenses and demands shall be adjusted against any
balance lying bank account, wallet account or any amount including commission etc
payable by “CSC e GOVERNANCE SERVICES INDIA LIMITED” or its Associates to
me or CSC.
 Further any Deposit lying as Security with for providing any services through CSC shall
be forfeited and we agree for that and have no objection in forfeiture of security by “CSC
e GOVERNANCE SERVICES INDIA LIMITED” or its Associates.
9. I hereby agree and confirm that all matters related to above services and Supra (1) to (8) are
subject to Delhi jurisdiction.
DEPONANT
Verification:-
Verified at ………….. (Place)……….. on this …… day of ……….. 2018 that the content of the above
affidavit are true and correct to the best of my knowledge. No part of it is false and nothing material has
been concealed there from.
DEPONENT
PLACE:
DATE:

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(on Non-judicial stamp paper of Rs.

100/- purchased in State of Service )

AFFIDAVIT CUM INDEMNITY BOND

(IN CASE OF COMPANY / FIRM /SOCIETY )

I, (Name of Person ) , …… (Designation of Person ) of … (Name & Address of Society/

(IN CASE OF INDIVIDUAL VLE )

I, (Name of Person ) , …… Resident of … (Address of person Society ) (“VLE“),having PAN

do hereby solemnly affirm , declare and undertake ,

1. I/ We Am/ are running a Common Service Centre with CSC ID no…

4. I /We hereby agree that I am personally liable for :

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