VERICON

Registration Form

Basic Details

Name of the company

E-mail

Registered Address:

City :

phone :

mobile :

Fax :

Business Description :

Proprietorship Partnership Private Ltd.

Name of the Owners :

Name

Tel no.

Contact no.

E-mail Address

Tel no.

Contact no.

E-mail Address

Business type :

Branch/Warehouse Details with Address (If Any)

Bank Refrence

Bank name

A/C Type

A/C no.

IFSC/NEFT Code

Sales Tax Registration nos:

PAN Card No.

GST/TIN No.

Refrences :

Dealer 1 :

Contact Persion :

Phone no.

Dealer 2 :

Contact Persion 2 :

Phone no.2

Documents To Be Attached :

Bank Statement For last 6 months(latest)

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GST Certificate - copy

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Pan Card -Copy

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Company Registration -Copy

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Shop Act -copy

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NEFT/RTGS Details -copy

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