INDIANGLOBALBIZ- 5150

NAME

DATE OF
BIRTH

DD/MM/YYYY
ADDRESS

CITY

STATE

PINCODE OR POSTAL CODE OR ZIP CODE

COUNTRY

PHONE NUMBER

MOBILE NUMBER

EMAIL ADDRESS

(Write full e-mail Address in small letter only )

DEMAND DRAFT NUMBER

DATE OF DEMAND DRAFT

DD/MM/YYYY

BANK NAME & BRANCH FROM WHICH DEMAND DRAFT IS DRAWN

FILL ALL THE DETAILS BELOW FOR YOUR PAYMENT METHOD

1.IF YOU WANT TO RECEIVE PAYMENT BY DEMAND DRAFT OR MONEY ORDER FILL BELOW
PAYEE NAME (DD or MO will be sent to your address made in favour of the NAME mentioned below as your payment

2. IF YOU WANT TO RECEIVE PAYMENT BY DIRECT CASH DEPOSIT FILL BELOW

BANK NAME (WITH THE FULL NAME OF YOUR BANK ONLY IF YOU SELECT PAYMENT BY DIRECT CASH
DEPOSIT )

BANK ACCOUNT NUMBER ( Write the full Account number of your BANK ACCOUNT correctly)

PLACE
SIGNHERE
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