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VENDOR REGISTRATION FORM

PERSONAL INFORMATION

  *Name *DOB DOA
  State City Zone
  Popular Land Mark Address
person

CONTACT DETAILS

  Registered Mobile No Registered Email id Alternate Mobile no
  Alternate Email id

BANKING DETAILS

  *Bank Name *Account No * Account Type
  *IFSC Code

Application For Registration / Change of Nominee

  Apply Date Vendor Code
Vendor Name Vendor firm Name
Nominee
Gaurdian

Declaration ( Please tick the appropriate Box )

I/We do hereby nominate the following person in whom all rights and /or amount payable in respect of monthly income by me/us in the said beneficiary owner account vest in the event of my/our death.
I/We want to cancel the registration of the existing nominee name from my monthly income account
I/We I/we want to cancel the registration of the existing nominee name and update a new nominee name in my monthly income account

Nominee Details

  *Name of the Nominee *Relationship with the applicant * Nominee DOB
  Address of Nominee

In Case of Nominee is Minor

  Name of the Guardian Address of the Guardian Relationship with the nominee

Scan copy of below mention document with self attested

For an Individual
  • Pan Card
  • Driving License
  • Bank Pass Book
  • Last Educational Qualification Certificate
For A Corporate
For a Proprietor Firm

Note :

Self Identity Proof & Address Proof is required in all cases Cancelled Cheque should be given in all cases Min Three Lac security deposit for Regional Level Vendor Min Two Lac security deposit for State Level Vendor Min One Lac security deposit for City Level Vendor Deposit is must if vendor is working as a white-label partner Mail your HD logo for co-branding in our product