Associate Registration
Referral ID
*
Enter Referral ID
Name
*
Enter Full Name
Date of Birth
*
Select DOB
Mobile No
*
Enter Mobile No.
Please Enter Correct Mobile No.
Email ID
*
Enter Email ID.
Ex.:abc@xyz.com
PAN Card
*
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Aadhar No
*
Invalid Aadhar No
Pin Code
*
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Local Address
*
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Permanent Address
*
Enter Permanent Address.
Nominee Name
*
Father
Husband
Wife
Mother
Brother
Sister
Cousin
Uncle
Aunt
Son
Daughter
Father-in-law
Mother-in-law
Brother-in-law
Sister-in-law
Partner
Proprietor
Relation
*
Nominee Mobile No.
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Sponser's Details:
Sponser Distributor Id*
Co-Applicant Details:
Title *
Mr.
Mrs.
Miss.
Full Name *
Relation *
--Select--
Father
Mother
Wife
Sister
Brother
Husband
Other
Address Details:
Country *
India
State *
--Select--
Andaman And Nicobar Islands
Andhra Pradesh
Arunachal Pradesh
Assam
Bihar
Chandigarh
Chattisgarh
Dadra And Nagar Haveli
Daman And Diu
Delhi
Goa
Gujarat
Haryana
Himachal Pradesh
Jammu And Kashmir
Jharkhand
Karnataka
Kerala
Lakshadweep
Madhya Pradesh
Maharashtra
Manipur
Meghalaya
Mizoram
Nagaland
Orissa
Pondicherry
Punjab
Rajasthan
Sikkim
Tamil Nadu
Telangana
Tripura
Uttar Pradesh
Uttarakhand
West Bengal
District *
--Select--