Merchant Application Form.xlsx
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8/18/2019 Merchant Application Form.xlsx
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M
Contact Name
Mobile Number
Email Id
Business Legal Name(*)
Business Email Id
Business Mobile No.
Business Landline No.
Business egistered Address
Cit! " #tate
$in Code
Business %perating Address
Cit! " #tate
$in Code
$roduct and #er&ices sold
'ebsite L
$AN Card No.
Name on $AN card(*)
ate o Establishment
Father Name (Indi&idual Case)
ate o Birth (Indi&idual " $roprietor Case)
Ban+ Account No.
Account ,older Name(*)
Account -!pe(Current#a&ing)
Ban+ Name
Ban+ Branch
Ban+ Branch Address
IF#C code
irector$artners etails
irector /(Name)
irector 0(name)
Buisness Entity
* For Indi&idual
* For $roprietorship
* For $ri&ate Ltd$ublic LtdLL$$artnership
(*)Business Name should be same as the nam
Business Entit! (elect !rom Dro" Do#n)
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8/18/2019 Merchant Application Form.xlsx
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rchant Application Form
Contact Name
1eet 2handel3al
4567088/89
1eet 2handel3al:secureno3.in
Buisness Details
$ri&ate Limited
#ECEN%' IN#ANCE B%2E $;-. L-.
C ung e&elopment Area=
Ne3 elhi
//??/8
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PAN Card
Indi&idual name
Compan! Name
Kumar
Indi&idualCompan! name
