Direct Selling Agents (DSA) Program

Please Select Partnership Type

Please fill in the details below ( Direct Selling Agents )

Vendor Type *

Name *

Mobile Number *

Email id *

Website

GST Number

Registration Number

Incorporation Date

Company Type

Office Address

Address Line 1

Address Line 2

Landmark

Pincode

City

Regd Office Address

Checkbox this box if Regd Address same as Office Address

Address Line 1

Address Line 2

Landmark

Pincode

City

Details of Proprietors/Partners/Directors

Name

Designation

Contact No

Pan No

% Share

Add

Experience(no. of years)

Area of Operation

Cos Empanelled

Office Infrastructure details

Cities/locations

office area(sq fts)

No of branch offices

No of Staff

No of Computers

Name

Profession

Employer

Designation

Contact No

Add

Current/Prior Experience details

Product Serviced

Average Accounts(in No's and in INR'000)

Regulatory Details

Shop & Establishment Act Registration No

Bank Detail

Bank Name

Branch Name

A/c Holder Name

A/c Number

IFSC Code

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Captcha Code *1051

In There any outstanding Court Orders and/or current or pending litigation against your company

Yes

I confirm that all particular given herein above are true and correct

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Type of Loan * Please select the type of loan you need

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