Safe-shop-signup-form.pdf
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SAFE AND SECURE ONLINE MARKETING PRIVATE LIMITED A-3/24, JANAK PURI, NEW DELHI - 110058 1
NAME
:-
2
FATHER'S NAME
:-
3
ADDRESS
:-
CITY PIN CODE
::-
4
DATE OF BIRTH
:-
5
NOMINEE
:-
6
MOBILE No.
:-
7
PAN No.
:-
8
AADHAR CARD No. :-
9
PRODUCT + B. KIT
:-
10
LOGIN ID
:-
11
REFR. LOGIN ID
:-
12
PARENT LOGIN ID
:-
12
E-MAIL ID
:-
13
BUSSINESS KIT
:-
Signature of Sponcer
( STATE)
Purchase Rs.900/- Compulsory Signature
PLACE :DATE :-
/
/ 2017
NOTE :- PAN No OR AADHAR No & PHOTO IS COMPULSORY *
NAME
:-
2
FATHER'S NAME
:-
3
ADDRESS
:-
CITY PIN CODE
::-
4
DATE OF BIRTH
:-
5
NOMINEE
:-
6
MOBILE No.
:-
7
PAN No.
:-
8
AADHAR CARD No. :-
9
PRODUCT + B. KIT
:-
10
LOGIN ID
:-
11
REFR. LOGIN ID
:-
12
PARENT LOGIN ID
:-
12
E-MAIL ID
:-
13
BUSSINESS KIT
:-
Signature of Sponcer
( STATE)
Purchase Rs.900/- Compulsory Signature
PLACE :DATE :-
/
/ 2017
NOTE :- PAN No OR AADHAR No & PHOTO IS COMPULSORY *
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