DHANHIND

Distributor:

Application Details:

Retailer Company Name *

PAN Number*

ShopOwner FirstName ( as per PAN Card )*

Owner LastName *

Mobile No*

Alternate Mobile No*

Email*

Office Address Details:

Address1*

Address2*

Pincode*

State*

District*

City*

Area*

Landmark*

Residence Address Details:

Address1*

Address2*

Pincode*

State*

District*

City*

Area*

Landmark*

Other Details:

Date Of Birth

Marriage Date

KYC(ID & Signature Proof):

ID Proof Type*

ID Proof Number*

ID Proof Image*

Name as per PAN *

(Note:- * Acceptable File Type: .GIF | .JPG | .JPEG | .BMP | .PNG | .PDF , * Special Character not allowed ( !~@#$%^&()* ))

KYC(Address Proof):

Address Proof Type*

Address Proof Number*

Address Proof Image*

Name as per Aadhar

Address Proof Image (Back side )

Office Address Proof Type

Office Address Proof Image *

(Note:- * Acceptable File Type: .GIF | .JPG | .JPEG | .BMP | .PNG | .PDF , * Special Character not allowed ( !~@#$%^&()* ))