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Application Form
Personal Details
Applicant's Name/ Firm
*
Address
*
If Applicant is a firm than specify contact person/ Father's Name
*
City State
*
D.O.B.
*
Pin Code
*
Mother's Maiden Name (for security Purpose)
*
Contact Details
Telephone No. Home
Telephone No. Business
Telephone No. Mobile
Email ID
*
Nominee
*
Realation With Nominee
*
& Your Payment Details
-You Make Demand Draft in Favor of STAR ICON Marketing Pvt. Ltd.Payble at Udaipur & Send to Company Address By resisterd mail
Demand Draft No.
*
Demand Draft Date
*
Amount (in Rs.)
*
Name of Bank
*
Branch
*
IBD A/c No.
*
Sponsor's Details (To be filled by Sponsor only)
Sponsor's ID No
Sponsor's Name
Sponsor's User ID No
mr/mrs/miss
First Name
Middel name
Last name
Product Order Details If you Purchase
I certify you have offered the
STAR ICON MARKETING PVT. LTD.
Distributor shop to the application is entirely material omission or distortion and that all presentation mad of introducing this application have compiled with the application rules for operation for an IBD. I agree to personally indemnify. Defand and holo harmless against any claim cost or liability resulting from my breach of this provision.
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