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Agent Empanelment Form
Applicant Details
 
ARN Code:*
ARN - 
ARN Valid Upto:*
PAN:*
First Name / Company Name:*
Middle Name:
Last Name:*
Country:
State:*
City:*
Date of Birth / Incorporation Date :*
KYD Acknowledgement Date :*
Contact Address :*
PIN :*
Tel. No. Office: Ex (STD-Tel. No.)
-
Tel. No. Residence: Ex (STD-Tel. No.)
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Mobile 1:*
Mobile 2:
Email 1:
Email 2:
Do you have NRI Client Base:
Nature of Business:
  
If the following is additionally applicable:
Details to be Filled by Non-Individual
 
Name of CEO / Key Person :
CEO / Key Person Email :
Name of Contact Person :
Email ID :
Organization Type :
  
Bank details for brokerage payment
 
Bank A/C Number :*
Bank Name :*
Branch Name :*
Branch Address :*
PIN :*
Bank A/C Type :*        
MICR Code :*
IFSC / NEFT Code :*
 
SMS and Email Alerts
 
 
Nominee Details
 
Nominee's Name :
Guardian's Name (In Case of Minor) :
Date of Birth (If Minor) :
Relationship :
Address of Nominee's :
City :
PIN :
Fields marked with * are mandatory
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