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Details of Sole Proprietor / HUF
Details of Partners/Directors 1
Client Registration Application Form
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*
--- Select City ---
Agra
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VIJAYWADA
Client Name
*
Customer Account Code
*
Full Name of Firm/HUF/ Corporate/Proprieorship/ Partnership/Individual
*
Correspndence Address (with Landmark)
*
Email
*
PAN NO.
*
City
Pincode
Ph. NO.
*
State
Country
Is the premise
Owned
Leased
Licensed
Office premises have been occupied by applicant since years.
Years
Same As Correspndence Address
Office Address (with Landmark)
*
PAN NO.
City
Pincode
Ph. NO.
State
Country
Is the premise
Owned
Leased
Licensed
Office premises have been occupied by applicant since years.
Years
Same As Correspndence Address
Registerd Address (with Landmark)
*
PAN NO.
City
Pincode
Ph. NO.
State
Country
Is the premise
Owned
Leased
Licensed
Office premises have been occupied by applicant since years.
Years
Date of Formation
/Incorporation of Proprietors/HUF/
Partnership/Corporate
1
2
3
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5
6
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1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
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2002
2003
2004
2005
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2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
CIN No
Same As Correspndence Address
Warehouse Address (with Landmark)
*
PAN NO.
City
Pincode
Ph. NO.
State
Country
Telephone No
Fax
Sales Tax Registration Details
GST Certifivate
*
Download GST Certificate
CST Certifivate
*
Download CST Certificate
GST Registration No
*
State
*
Validity
*
CST Registration No
*
State
*
Validity
*
Bank Account Details
Cancelled Cheque Leaf
*
Download Cancelled Cheque Leaf
Bank Pass Book
*
Download Bank Pass Book
Bank Statement
*
Download Bank Statement
Bank Name
*
Branch
*
Bank Account Type
*
Saving
Current
NRI
NRO
NRE
Bank Account No Bank Account No
*
Date of Opening Account
*
MICR Code
*
Net worth as per balance sheet as on
*
Rs.(In Lacs)
*
Trading experience
*
Year
*
Details of Introducer
Name
Gender:
Male
Female
Relation with Applicant
Permanent Address with Landmark
PAN No.
City
Ph No.
State
Country
Pincode
Telephone No
Fax
Mobile No
Email Id
Signature
___________________________________
Details of Referencer - 1
Name
*
Gender:
*
Male
Female
Relation with Applicant
*
Permanent Address with Landmark
*
PAN No.
*
City
*
Ph No.
*
State
*
Country
*
Pincode
*
Telephone No
*
Fax
*
Mobile No
*
Email Id
*
Signature
___________________________________
Details of Referencer - 2
Name
Gender:
Male
Female
Relation with Applicant
Permanent Address with Landmark
PAN No.
City
Ph No.
State
Country
Pincode
Telephone No
Fax
Mobile No
Email Id
Signature
___________________________________
Details of Sole Proprietor / HUF
Name
Gender:
Male
Female
Permanent Address with Landmark
City
Pincode
State
Country
Date of Birth(Proprietor/Karta)
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
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23
24
25
26
27
28
29
30
31
January
February
March
April
May
June
July
August
September
October
November
December
1920
1921
1922
1923
1924
1925
1926
1927
1928
1929
1930
1931
1932
1933
1934
1935
1936
1937
1938
1939
1940
1941
1942
1943
1944
1945
1946
1947
1948
1949
1950
1951
1952
1953
1954
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1958
1959
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1961
1962
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1965
1966
1967
1968
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1971
1972
1973
1974
1975
1976
1977
1978
1979
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
Mobile No
Email id
Pan No(Proprietor/Karta):
Passport Size Photo of Proprietor/Karta
Download Passport Size Photo of Proprietor/Karta
Note:Passport Size Photo of Proprietor/Karta with signature across the photograth
Speciman Signature of Proprietor/Karta
___________________________________________
Details of Partners/Directors 1
Name of Partner / Director
*
Gender:
*
Male
Female
Designation:
*
Permanent Address with Landmark
*
City
*
Pincode
*
State
*
Country
*
Date of Birth(Proprietor/Karta)
*
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
January
February
March
April
May
June
July
August
September
October
November
December
1920
1921
1922
1923
1924
1925
1926
1927
1928
1929
1930
1931
1932
1933
1934
1935
1936
1937
1938
1939
1940
1941
1942
1943
1944
1945
1946
1947
1948
1949
1950
1951
1952
1953
1954
1955
1956
1957
1958
1959
1960
1961
1962
1963
1964
1965
1966
1967
1968
1969
1970
1971
1972
1973
1974
1975
1976
1977
1978
1979
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
Mobile No
*
Specimen Signature
Email Id
*
PAN DETAILS
PAN No.(Partner/Director)
*
Passport Size Photo of Proprietor/Karta
Download Passport Size Photo of Proprietor/Karta
Note:Passport Size Photo of Proprietor/Karta with signature across the photograth
Speciman Signature of Proprietor/Karta
________________________________________
Details of Partners/Directors 2
Name of Partner / Director
Gender:
Male
Female
Designation:
Permanent Address with Landmark
City
Pincode
State
Country
Date of Birth(Proprietor/Karta)
*
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
January
February
March
April
May
June
July
August
September
October
November
December
1920
1921
1922
1923
1924
1925
1926
1927
1928
1929
1930
1931
1932
1933
1934
1935
1936
1937
1938
1939
1940
1941
1942
1943
1944
1945
1946
1947
1948
1949
1950
1951
1952
1953
1954
1955
1956
1957
1958
1959
1960
1961
1962
1963
1964
1965
1966
1967
1968
1969
1970
1971
1972
1973
1974
1975
1976
1977
1978
1979
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
Mobile No
Specimen Signature
Email Id
PAN DETAILS
PAN No.(Partner/Director)
Passport Size Photo of Proprietor/Karta
Download Passport Size Photo of Proprietor/Karta
Note:Passport Size Photo of Proprietor/Karta with signature across the photograth
Speciman Signature of Proprietor/Karta
________________________________________
Details of Partners/Directors 3
Name of Partner / Director
Gender:
Male
Female
Designation:
Permanent Address with Landmark
City
Pincode
State
Country
Date of Birth(Proprietor/Karta)
*
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
January
February
March
April
May
June
July
August
September
October
November
December
1920
1921
1922
1923
1924
1925
1926
1927
1928
1929
1930
1931
1932
1933
1934
1935
1936
1937
1938
1939
1940
1941
1942
1943
1944
1945
1946
1947
1948
1949
1950
1951
1952
1953
1954
1955
1956
1957
1958
1959
1960
1961
1962
1963
1964
1965
1966
1967
1968
1969
1970
1971
1972
1973
1974
1975
1976
1977
1978
1979
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
Mobile No
Specimen Signature
Email Id
PAN DETAILS
PAN No.(Partner/Director)
Passport Size Photo of Proprietor/Karta
Download Passport Size Photo of Proprietor/Karta
Note:Passport Size Photo of Proprietor/Karta with signature across the photograth
Speciman Signature of Proprietor/Karta
________________________________________
Details of Partners/Directors 4
Name of Partner / Director
Gender:
Male
Female
Designation:
Permanent Address with Landmark
City
Pincode
State
Country
Date of Birth(Proprietor/Karta)
*
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
January
February
March
April
May
June
July
August
September
October
November
December
1920
1921
1922
1923
1924
1925
1926
1927
1928
1929
1930
1931
1932
1933
1934
1935
1936
1937
1938
1939
1940
1941
1942
1943
1944
1945
1946
1947
1948
1949
1950
1951
1952
1953
1954
1955
1956
1957
1958
1959
1960
1961
1962
1963
1964
1965
1966
1967
1968
1969
1970
1971
1972
1973
1974
1975
1976
1977
1978
1979
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
Mobile No
Specimen Signature
Email Id
PAN DETAILS
PAN No.(Partner/Director)
Passport Size Photo of Proprietor/Karta
Download Passport Size Photo of Proprietor/Karta
Note:Passport Size Photo of Proprietor/Karta with signature across the photograth
Speciman Signature of Proprietor/Karta
________________________________________
Details of Partners/Directors 5
Name of Partner / Director
Gender:
Male
Female
Designation:
Permanent Address with Landmark
City
Pincode
State
Country
Date of Birth(Proprietor/Karta)
*
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
January
February
March
April
May
June
July
August
September
October
November
December
1920
1921
1922
1923
1924
1925
1926
1927
1928
1929
1930
1931
1932
1933
1934
1935
1936
1937
1938
1939
1940
1941
1942
1943
1944
1945
1946
1947
1948
1949
1950
1951
1952
1953
1954
1955
1956
1957
1958
1959
1960
1961
1962
1963
1964
1965
1966
1967
1968
1969
1970
1971
1972
1973
1974
1975
1976
1977
1978
1979
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
Mobile No
Specimen Signature
Email Id
PAN DETAILS
PAN No.(Partner/Director)
Passport Size Photo of Proprietor/Karta
Download Passport Size Photo of Proprietor/Karta
Note:Passport Size Photo of Proprietor/Karta with signature across the photograth
Speciman Signature of Proprietor/Karta
________________________________________
Details of Partners/Directors 6
Name of Partner / Director
Gender:
Male
Female
Designation:
Permanent Address with Landmark
City
Pincode
State
Country
Date of Birth(Proprietor/Karta)
*
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
January
February
March
April
May
June
July
August
September
October
November
December
1920
1921
1922
1923
1924
1925
1926
1927
1928
1929
1930
1931
1932
1933
1934
1935
1936
1937
1938
1939
1940
1941
1942
1943
1944
1945
1946
1947
1948
1949
1950
1951
1952
1953
1954
1955
1956
1957
1958
1959
1960
1961
1962
1963
1964
1965
1966
1967
1968
1969
1970
1971
1972
1973
1974
1975
1976
1977
1978
1979
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
Mobile No
Specimen Signature
Email Id
PAN DETAILS
PAN No.(Partner/Director)
Passport Size Photo of Proprietor/Karta
Download Passport Size Photo of Proprietor/Karta
Note:Passport Size Photo of Proprietor/Karta with signature across the photograth
Speciman Signature ________________________________________