Request for Registration
Dealer Registration
All fields marked with (*) are mandatory.
Name of The Firm/Company :
*
Constitution of Business:
*
Proprietorship
Partnership
HUF
Private Ltd. Company
Government Company
Public Ltd. Company
Public Sector UnderTaking
Government Corporation
Government Department
Society
Club
Trust
Other
Select
Type of Dealer:
*
Regular
TAN
Casual
PAN (Permanent Account Number) of the Firm/Company:
Name in PAN Record, if different from name of the Firm:
Do You Have AADHAR Card:
Yes
No
Enter Your UID:
*
Name as per AADHAR :
*
Date Of Birth of AADHAR Card holder:
*
Designation of AADHAR Card holder:
*
Manager of Coop. Society
Director of Firm
Head Of Office Or Authorized Officer (State /Central Govt)
Karta Of Hindu Undivided Family
Managing Director / Authorized Director
Others
Owner of the firm
Partner
President/Secretary (Society, Club Or Association)
Proprietor
Select
Mobile No of Applicant:
*
-
Email of Applicant:
*
Image Character :
*
Enter the Image Characters:
*
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