:: NEW DIRECT SELLER REGISTRATION FORM ::

Date *

Product Information

Select Product

Sponsor's Details

Sponsor ID *

Placement ID *

Group

Left

Right

E-Pin

Account Type *

Sr. Advisor Name *

Sr. Advisor Contact

Payment's Details

Payment Mode *

DD. No./Bank

D.D. Date

NEW DIRECT SELLER INFORMATION

DIRECT SELLER ID. *

Name *

Father's/Husband's Name *

Mobile *

Alternate Mobile : *

Email:

D.O.B. *

Gender :

Marital Status

Profession

Aadhar No.

GST No.

Valid characters: Alphabets, Numbers .

Co-Applicant's Details

Nominee Name

Relation

D.O.B.

Billing Address

State *

City *

Post Office *

District *

Pin Code

Phone(O/R)

Address

SAME AS ABOVE

Shipping Address

State *

City *

Post Office *

District *

Pin Code

Mobile

Address

Banking DETAILS

Bank Name

Branch Name

Account No.

Pan No.

IFSC Code

INCOME TAX ASSESSES

Login Information

* NOTE

Password can be minimum 4 characters and maximum 10 characters long

Password *

Re-confirm Password *

Term And Condition*

I Agree With Terms And Conditions

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