Retailer Appointment Check List
All the Submissions to this form will be appended into a table as signatures in the style of open letter.
* Required
Check List self attested
*
LICENSE COPY
GSTIN
PAN CARD
AADHAR COPY
BANK DETAILS
CTS CHEQUE(Fabour Of KhetiBaari)
LETTERPAD 3Nos
Business Division
Please tick the relevant business
*
Pesticides
Seeds
Fertilizer
Output
Other
Firm Details
Dealer Name
*
Address of Dealer
*
GSTIN
*
PAN
*
Personal Details Of Proprietor
Proprietor Name.
*
Contact No.
*
Email ID.
*
Aadhar No.
*
License & Registration Details
Pesticides
Licence No & Validity
Seed
Licence No & Validity
Fertilizer
Licence No & Validity
Bank Details
Consumer Name
*
Branch Address
*
IFSC
*
Account No.
*
Account types
*
Select Account Type
Saving
Current
Dealer Sign authority.
*
License Copy
*
*Maximum allowed file size is 5MB.
GSTIN Copy
*
*Maximum allowed file size is 5MB.
PAN & Aadhar Card
*
*Maximum allowed file size is 5MB.
Photo
*
*Maximum allowed file size is 5MB.
Authorized Signatory
*
Aman
Himanshu
Nitish
Date
*
Submit