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Apply Online for E-Agency

Personal Details
By filling the form I give my consent for using my Aadhaar No. for Aadhaar Authentication
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GST Details
GST Registration Status
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Professional Details
Insurance Agency As*
Life General Composite
Is Agency In-Force (Active)*
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Banking Details
Banking Details for Nominee
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Upload Documents
PAN Card of Agent :
Photo of Agent (80% of the face to be capture):
Original Canceled Cheque with signature of Agent :
Signature of Agent :
Aadhaar Card of Agent :
Allowed file formats are .jpeg, .jpg, .png, .pdf (Max size 2MB)
Allowed file formats for Agent photo and signature are .jpeg, .jpg (Max size 2MB)
I accept all Terms and Conditions.
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