Distributor Application Form

PLACE & DISTRICT *

NAME-OF-THE-PARTY *

OFFICE ADDRESS *

FIRM DETAILS

STATUS OF THE FIRM *
PROPRIETORSHIPPARTNERSHIP

AUTHORISED PERSON *

CONTACT NUMBER *

EMAIL ID *

DESIGNATION *

STATUTORY INFORMATION

AADHAR NO *

GST NO *

PAN NO *

BANK NAME *

BRANCH NAME *

ACCOUNT NUMBER *

IFS CODE *