Proprietor Name*

GST No.

Bank Account No.*

IFSC Code*

Cancelled Cheque Photo*

PAN Card No.*

PAN Card Photo*

Aadhar Card Number*

Aadhar Front Photo*

Aadhar Back Photo*

Mobile No.*

Email

Distributor Code*

Distributor Name*

State*

District*

City*

Retailer Scheme Slab*

Target Letter photo*

Passport Photo