Registration Form For Centre Partners

Business Name:

Business Type:

Business Address:

City:

State / UT:

Post Code:

Full Name:

Gender

Mobile No.:

Email Address:

PAN:

Aadhaar:

Area of Business Premises (in sq. ft.):

No. of Customers Engaged Per Day:

Select the infrastructure items from the list below that are present at your business premises:

Computer

Internet

Printer

Describe the Services Presently Provided:

I/we request to be appointed as Center Partner on the terms and conditions mentioned on this page, which have been read and understood by me.

Signature: