Basic details
   
Select Type
Your Name :
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Your Firm's Name :
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Shop Name / Popular Name :
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Your Birthday / Firm's Registration Date :
Invalid date of birth.
Your / Firm's Legal Constitution :



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BUSINESS ADDRESS  
   
Address :
(from where services will be provided – due diligence visit may be done)
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State :
District :
City / Village :
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Postal Code :
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Block / Tehsil (optional) :
Locality / Market (optional) :
Nearby Landmark (optional) :
   
PERMANENT ADDRESS
   
Registered Mobile No. :
(to be used for beam)
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Your Alternate No. :
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Email :
(to be used for beam)
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PAN No. :
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BANK DETAILS
   
Bank Name:
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Bank Branch:
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Account No./IMPS/MMID
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IFSC Code:
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Proof documents (self attested) 
   
Proof Of Identity :
(Should match full name given above)
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Proof Of Address :
(Should match permanent address given above)
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Services Services
 
Telecom +Data
DTH
Travel(Air+Bus+Hotel Booking)
Utility Bills
REQUIREMENT : Mobile,Internet, PC,
  Printer Required
INTEGRATION FEE :
Essential Services : Rs. 900.00 
Banking Services + Essential : Rs. 1500.00 
Railway Services + Essential : Rs. 5500.00 
Banking + Railway Services + Essential : Rs. 7000.00 
Distributor Fee : Rs. 10000.00 
Select Payment Type
Select Payment Amount 
TID of Payment: 
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Refered by:
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