:: NEW DIRECT SELLER REGISTRATION FORM ::

Date *

Product Information

Select Product

JOINER’S DETAILS

JOINER ID *

Placement ID *

POSITION

TEAM (A/L)

TEAM (B/R)

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 .

FSSAI NO.

NOMINEE DETAILS

Nominee Name

Relation

D.O.B.

Aadhar No.

Pan No.

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

Login Information

* NOTE

Password can be minimum 4 characters and maximum 10 characters long

Password *

Re-confirm Password *

Previous DIRECT SELLER ID : -