You are on page 1of 1

ECLIPSE

INTERNATIONAL
APPLICATION FORM
FREELANCER NAME
FREELANCER ADDRESS
CITY
STATE
PIN CODE
FREELANCER EMAIL ID
FREELANCER MOBILE NUMBER
PLAN (A/B)
PAID APPLICATION FEE
PAY THROUGH (PAYTM/BANK)
FREELANCER BANK ACCOUNT DETAIL
ACCOUNT HOLDER NAME:
ACCOUNT NUMBER
BANK NAME:
BRANCH NAME:
IFSC CODE:
FREELANCER PAYTM NUMBER (NOT NECESSARY):

THANK YOU FOR REGISTER WITH “ECLIPSE INTERNATIONAL”

You might also like