eMitra Services (Government Services)

Required Documents
2500 Security Deposit (Non-Refundable)
4 Color Photo *
1 Voter Card *
1 PAN Card *
1 Kiosk Holder Bonafide Certificate
1 Adhar Card Copy* and
1 Bhamashah Card Copy *
1 Education Proof (Minimum 10th Pass) *
1 House and Shop Electricity Bill Copy *
1 Rashan Card Copy
1 Shop Kiraya Nama copy
1 Bank Pass Book Copy (Account Detail)*
1 Police Character Certificate (Original) *
500/- Non-Judicial Stamp Paper for Agreement (Blank) *

Services / Commission
75% Kiosk Share which amount receive from Rajasthan Govt.
Service Tax / GST condition as per Govt. rules

List of Services
Bill Payemnt : Discom, Phed, BSNL Mobile & Telephone, Private Mobile Company Bills
Digital Certificate : Bonafied, OBC, SC-ST, Minority Cast Certificates, Police Character
Others : Service of Social Welfare Department, Govt. Vacancy Fee Deposit, Colleges Fee
Deposits, Ajmer Education Board Service, Jama Bandi Service, RTI Service, Agriculture
Department Service, Employment Department Service, Private Company Insurance Premium,
Mobile Recharge, DTH Recharge

Hradware Requirement
Types Specifications
Computer • Windows 7
Terminals
Printer • Laser Printer (Color and B/w)
Biometrics Device • Finger Biometrics Device
(MANTRA MFS-100 or MORPHO-1300E2 with RD Service
Registered)
Others • Scanner, Web Cam, Speaker, Headphone with Mice

Technology Working with Internet Broad Band Connection Only.

DD/ Cheque in Favor : Virmati Software & Telecommunication Ltd.
Payble at : Jodhpur

Jodhpur Office Address:

Virmati Software & Telecommunication Ltd.
Office No 324-325, IIIrd Floor, Agarwal Tower, Sardarpura ‘B’ Road, Jodhpur. Raj.
 Application Form for e-Mitra Kiosk
All fields are mendatory as mark *
Basic Details:-

District* - The latest

photo of
LSP* - VIRMATI SOFTWARE & TELECOMMUNICATION LTD. Kiosks Owner

Kiosk Owner Details:-

Kiosk Owner Type* - Individual Company

Kiosk Owner Name* - -

Permanent Address* -

Owner Phone Numbers*- - Mobile*

Owner e-Mail ID -

PAN Card Number* - DOB*

Aadhar Card No* - Bhamashah*

Kiosk Center Details:- * Urban Rural

Kiosk Owner Personal SSO ID* -

Kiosk Center Name (English)* -

Kiosk Contact (Hindi)* -

Kiosk Contact Person's Name - -

Kiosk's Phone Numbers - Mobile*

Kiosk eMail ID* -

Police Station (Thana) * -

Kiosk Address (If Urban) * - -

Municipal Town*

Ward Number* PIN Code*

Kiosk Address (If Rural) * - -

Panchayat Samiti*

Gram Panchayat*

Village* PIN Code*

Signature of LSP Signature of Kiosk Owner

Kiosk Bank a/c Details:- A/C Number IFSC Code
Bank a/c Number* -

Bank Name* -

Branch Name* -

Account Holder Name* -

If this kiosk had already user ID on eMitra Portal please provide us:-

Kiosk ID -

LSP Name -

Level (Please define the Level of Kiosk if the kiosk having more than one level, mention all levels-*

Level Details (Name) Private IT Center

Location (Rajasthan Sampark /
Government Building)

District (Head Quarter) -

Tehsil -

Panchayat Samiti / Block -

Gram Panchayat -

Village -

Check List of Enclosures:-

1. I.D. Proof / Address Proof * -

2. Police Verification Report* -

3. Educational Qualification* -

4. Bank A/C Details -

Above mention check List are checked are correct in my knowledge.

Signature Kiosk Owner Signature and Seal

LSP

Date : / /
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For Office Use –

Verified By DeGS with Seal