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Name of the Applicant: _________________________________________________________________________ Beneficiary Name :_____________________________________________________________________________ Father’s / Husband Name:_______________________________________________________________________ Date of Birth : _____________________ Occupation : _______________________ Gender : Male ( ) / Female ( ) Phone : ___________________________ Mobile : _______________________ Pan No. : ___________________ Email : ________________________________________ Address Information Address : ___________________________________________________________________________________ ________________________________________________________________________________________ ____ Post / PS. : _____________________ City : _______________________ District : ________________________ State : _________________________ Pin code : _______________________ Account Information Bank Name : _______________________________________Branch Name : _____________________________ Account No : __________________________ IFSC Code : _____________________ ECS : ECS ( ) / Non ECS ( ) Nominee Information Nominee Name : _____________________________________ Relation : _________________ Age : _________ Sponsor Details Name of Sponsor : _____________________________________________________________________________ Contact No. : _____________________ Sponsor ID : __________________________ Position : Left ( ) / Right ( ) New Member ID : _____________________________ All Payments to be made in favor of __________________ Account No. _____________ . Have read and agreed to the terms & Conditions written overleaf to be a purchaser. I also declare that all the above information filled above is true of the best of my knowledge and I am purchasing this product with my own decision. Note: Any Claims / Refund should be within 30 days from the date of joining / registration. The Membership / Registration is non transferable. Any Membership / Registration on a single person name cannot exceed more than three. All Forms should be submitted dully filled & signed with a passport size photograph affixed. For any further queries kindly contact Office between 9.00 am to 6.00 pm Monday to Friday. Signature_____________ ____ Office : “DIDC”, G-13, NANO, Haware Fantasia Business Park, Next to Inorbit Mall, Sector 30, Nr. Vashi Station, Vashi, Navi Mumbai.

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Page 1: Registration Form Personnel Information Name of the Applicant: _________________________________________________________________________ Beneficiary Name

Registration Form

Personnel Information

Name of the Applicant: _________________________________________________________________________

Beneficiary Name :_____________________________________________________________________________

Father’s / Husband Name:_______________________________________________________________________

Date of Birth : _____________________ Occupation : _______________________ Gender : Male ( ) / Female ( )

Phone : ___________________________ Mobile : _______________________ Pan No. : ___________________

Email : ________________________________________

Address Information

Address : ___________________________________________________________________________________

____________________________________________________________________________________________

Post / PS. : _____________________ City : _______________________ District : ________________________

State : _________________________ Pin code : _______________________

Account Information

Bank Name : _______________________________________Branch Name : _____________________________

Account No : __________________________ IFSC Code : _____________________ ECS : ECS ( ) / Non ECS ( )

Nominee Information

Nominee Name : _____________________________________ Relation : _________________ Age : _________

Sponsor Details

Name of Sponsor : _____________________________________________________________________________

Contact No. : _____________________ Sponsor ID : __________________________ Position : Left ( ) / Right ( )

New Member ID : _____________________________

All Payments to be made in favor of __________________ Account No. _____________ .

Have read and agreed to the terms & Conditions written overleaf to be a purchaser. I also declare that all the above information filled above is true of the best of my knowledge and I am purchasing this product with my own decision.

Note:Any Claims / Refund should be within 30 days from the date of joining / registration.The Membership / Registration is non transferable.Any Membership / Registration on a single person name cannot exceed more than three.All Forms should be submitted dully filled & signed with a passport size photograph affixed.For any further queries kindly contact Office between 9.00 am to 6.00 pm Monday to Friday.

Signature_________________

Office : “DIDC”, G-13, NANO, Haware Fantasia Business Park, Next to Inorbit Mall, Sector 30, Nr. Vashi Station, Vashi, Navi Mumbai.

Page 2: Registration Form Personnel Information Name of the Applicant: _________________________________________________________________________ Beneficiary Name

Registration Form

Personnel Information

Name of the Applicant: _________________________________________________________________________

Beneficiary Name :_____________________________________________________________________________

Father’s / Husband Name:_______________________________________________________________________

Date of Birth : _____________________ Occupation : _______________________ Gender : Male ( ) / Female ( )

Phone : ___________________________ Mobile : _______________________ Pan No. : ___________________

Email : ________________________________________

Address Information

Address : ___________________________________________________________________________________

____________________________________________________________________________________________

Post / PS. : _____________________ City : _______________________ District : ________________________

State : _________________________ Pin code : _______________________

Account Information

Bank Name : _______________________________________Branch Name : _____________________________

Account No : __________________________ IFSC Code : _____________________ ECS : ECS ( ) / Non ECS ( )

Nominee Information

Nominee Name : _____________________________________ Relation : _________________ Age : _________

Sponsor Details

Name of Sponsor : _____________________________________________________________________________

Contact No. : _____________________ Sponsor ID : __________________________ Position : Left ( ) / Right ( )

New Member ID : _____________________________

All Payments to be made in favor of __________________ Account No. _____________ .

Have read and agreed to the terms & Conditions written overleaf to be a purchaser. I also declare that all the above information filled above is true of the best of my knowledge and I am purchasing this product with my own decision.

Note:Any Claims / Refund should be within 30 days from the date of joining / registration.The Membership / Registration is non transferable.Any Membership / Registration on a single person name cannot exceed more than three.All Forms should be submitted dully filled & signed with a passport size photograph affixed.For any further queries kindly contact Office between 9.00 am to 6.00 pm Monday to Friday.

Signature_________________

Office : “DIDC”, G-13, NANO, Haware Fantasia Business Park, Next to Inorbit Mall, Sector 30, Nr. Vashi Station, Vashi, Navi Mumbai.


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