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Distributor
IN658594 DATE: 21/SEP/2018 22:28:57
ID No.:
REFERRER INFORMATION
Referrer ID: IN338197 Referrer Name: SHALU RATHI
APPLICATION INFORMATION
Title (If Individual) Mr./Mrs./Ms: Business Name (If not individual):
MR. N/A
Surname, Given Name (If Individual): Contact Person (Business Entity):
RATHI; SAGAR N/A
Mailing Address: Cheque Name (Name on the commission cheque):
VILL. SONTA MUZAFFARNAGAR MUZAFFARNAGAR SAGAR RATHI
UTTAR PRADESH 251203 India (Vihaan)
Shipping Address: Home Phone No & Mobile No:
VILL. SONTA MUZAFFARNAGAR MUZAFFARNAGAR 919805853184; 919805853184
UTTAR PRADESH 251203 India (Vihaan)
Valid ID Type / ID Number: eMail Address:
PAN Card/ BEVPR2855C SAGARRATHI112211@GMAIL.COM
Nationality & Date of Birth: Mother's Maiden Name:
INDIA; 22/MAY/1992
Name of Beneficiary/Nominee: Relationship to the Beneficiary/Nominee:
ARUNA RATHI Mother
Date of Birth of Beneficiary/Nominee:
10/FEB/1972
1. For business entities, an authorised signatory of the company must sign this Distributor Application Form. Received By: _______________
2. You must be 21 years old and above to become a Distributor.
3. By signing below. you certify and acknowledge that you have read and agreed to be bound by the Policies Received Date: _______________
and Procedures.
4. I agree to adhere to the Know Your Customer ( KYC ) requirements as requested by Vihaan Direct Selling Processed By: _______________
(India) Pvt Ltd.
Processed Date: _______________