GoldMate | Application for empanelment of Business Associate

Name *

Constitution

If registered under any Law, furnish details

Full Address [Please provide proof of address] *

Premises Own /Rented

Land Line with STD Code

Mobile No *

E-mail

Key person to contact with designation

Number of Representatives

Presently providing BA Services to

Bank account details

Past experience in this line of business

Other information

Bank Passbook

Self-Attested Copy of PAN

Self-Attested Copy of Adhaar

Place

Select Applying

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Application for BA