Name of Agency *
Type of Agency *
Legal Status*
Registered under Act *
Registration No. *
Registration Date *
Registration Place *
Validity Date *
Year of Establishment *
Registration Cerfiticate Upload *
Address *
Address Proof Upload * (Only PDF & MAX 2MB File Can Be Uploaded)
Email id of the Agency *(This will be User ID for logging into the portal)
Telephone & Mobile No of the Agency *
Website
PAN of the Agency *
PAN Card Upload * (Only PDF & MAX 2MB File Can Be Uploaded)
TIN / GSTIN
TIN / GSTIN Upload (Only PDF & MAX 2MB File Can Be Uploaded)
Details of the Key Person *
Activities of the Agency *
Password will be generated and sent via email/SMS to the agency.