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e-NAM Registration Form

Registration Type * :
Registration Level * :
State Mandi

Personal Details

Title * :
First Name * :
Middle Name :
Last Name * :
Gender * :
Date of Birth * :
Relation Type *
Address (Street) * :
Pincode :
State *:
District *:
Tehsil/Sub-district *:
City/Village *:
Post *:
Photo Id Type * :
Photo ID Number * :
Mobile No. * :
Collection Center * :
Email ID *:
Company Name* :
Company Reg. No.* :
License No.* :
Organisation Name* :
Organisation Address* :
Organisation CIN* : Organisation Reg. No.* : Organization CIN/ Reg No* :
Note - Please make sure correct mail ID is mentioned in " Email ID " field as all future communications from eNAM will be sent on same Email ID.

Bank Details

Bank Name * :
Account Holder Name as per Bank A/C *
Bank Account No. * :
Confirm Account No.*
IFSC Code * :
Confirm IFSC Code *
Upload Copy Of Passbook/Cancelled Check in Support :
Passbook Image
Upload One Scan Copy Of Id Proof :
your Image
Registration Acknowledgement:
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