Dealer Registration Form

DETAILS OF THE ORGANIZATION

Name of the Organisation

Full Postal Address of Shop/ Office

Phone Number

STD Code

Email

NAME & ADDRESS OF PROPRIETOR / PARTNERS / DIRECTORS

Type
—Please choose an option—ProprietorPartnersDirectors

Name

Residential Address

Phone Number

STD Code

KYC DOCUMENTS

Choose from the drop down list
—Please choose an option—Pan CardAadhar CardVoter CardDriving LicenseRation CardPassport

Upload Document

Choose from the drop down list
—Please choose an option—Pan CardAadhar CardVoter CardDriving LicenseRation CardPassport

Upload Document

OTHER COMMENTS

6+5=?