Agency Registration

Be With the Winning Team

Information for Admin
Registration Date Introducer Name Mobile No
30-03-2017  
 
Personal Detail  
   
Select Your Agency Type *  Individual            Firm   
         
First Name * Middle Name Last Name * Email Id
Mobile No * WhatsApp Moblile No DOB Sex *    
Male Female    
Address * Country * State * District    
   
City / Taluka Pin No.        
       
(Note : * If your City is not listed in the options above, kindly mention your city in the address box.)
         
Pan Card No Adhar Card No.
 
 
Nominee Detail     (Note : *Nominee’s age Must be above 18.)
Name Relation D.O.B.
 
Account Detail
A/C Name A/C No Confirm A/C No Bank Name
IFSC Code Bank Address