APPLICATION

CREDIT CARD APPLICATION FORM FILLING PROJECT

Agreement signed for  CCA FORM FILLING PROEJCT

Date of signing the agreement : ….…………………………………………………………………………

Number of assignments signed-up in agreement : ….…………………………………………………………………………

DEO’s Full Name : ….……………………………………………………………………………………………………………………

Company Name
Service Tax Number (if any)
Full Correspondence Address
Email Address
: ….……………………………………………………………………………………………………………………
: ….……………………………………………………………………………………………………………………
: ….……………………………………………………………………………………………………………………
: ….……………………………………………………………………………………………………………………
: ….…………………………………………………………………… Mobile: ..………………………………

Sales Person’s Name : ….…………………………………………………………………… City: …..…………………………………

Email Address : ….…………………………………………………………………… Mobile: ..………………………………

Total Consultancy Paid (Rs) : ……………………………..... Payment Date: …………………………….....

Bank account details where DEO wants to deposit/transfer the paychecks and refunds:
Bank Name : …………………………………………………………………………….…………………………………………
Account Holder’s Name : …………………………………………………………………………….…………………………………………
Account Number : …………………………………………………………………………….…………………………………………
Branch Name : ………………………………………………………………………… IFSC Code: …………………………..
PAN Number : …………………………………………………………………………

Acknowledgement
I have understood all the terms and clauses for offered job work and their penalty clauses as well. I am
acknowledging that the above information is correct and must be using for all kind of future payments, refund
and other claims for disputes (if any) as well.

Send this acknowledgement form at below email:

submit@shivam-infotech.com

This acknowledgement form must submit back to us within 7 calendar days from date of issuing first
assignment. Otherwise first party is at liberty to terminate the work without any notice.

___________________
Signature (Second Part)
Authorized Signatory
(Name of end-client in this parentheses)