FinancialPower

PARTNERSHIP FORM

Individual Non Individual

KEY CONTACT DETAILS

Full name*

Email Address**

Pin*

Address*

Mobile Number*

Photograph* (150px X 150px)

TAX STATUS

Individual Non Individual

ADDITIONAL INFORMATION KEY CONTACT DETAILS

Date Of Birth

PAN Number

Qualification

UIDN Number

NOMINATION DETAILS FOR BROKERAGE / COMMISSION

Nominee Name*

Nominee Address*

Address Of Legal Guardian*

Nominee Date Of Birth

Name Of Legal Guardian*

Relationship*

DETAILS OF BANK ACCOUNT

Account No.*

Bank Name*

City*

Account Type*

Saving Current Others

Branch*

IFSC / NEFT Code*

Preferred Mode Of Receipt Of Brokerage*

By Cheque Direct Credit To My / Our Account

EXPERIENCE IN SELLING

Equity Shares Fixed Deposits Insurance Mutual Funds Bonds Others

I/We hereby declare that the information furnished is true and correct to the best of my/our knowledge and belief. I/We undertake to abide by the terms and conditions stated overleaf and the changes in Terms & Conditions from time to time relating to the empanelment of distributor. I / We am/are not an Employee or a relative of a Director/Employee of the company/or any of its associates.