:: Details required to create your Ayusante ID in INDIA ::

Details needed for Ayusante Distributor Application for Individuals in INDIA :

APPLICANT INFORMATION

NAME :

PAN CARD NUMBER :

DATE OF BIRTH (dd/mm/yy ) :

CELL NUMBER :

Email ID :

PERMANENT ADDRESS

HOUSE NAME / DOOR NO :

STREET NAME :

FLOOR :

LANDMARK :

CITY :

DISTRICT :

STATE :

PIN CODE :

NEAREST POST OFFICE :

PRESENT ADDRESS / SHIPMENT ADDRESS

HOUSE NAME / DOOR NO :

STREET NAME :

FLOOR :

LANDMARK :

CITY :

DISTRICT :

STATE :

PIN CODE :

NEAREST POST OFFICE :

BANK DETAILS

YOUR BANK NAME :

YOUR NAME IN BANK :

ACCOUNT NUMBER (16 DIGITS) :

IFSC CODE :

CO-APPLICANT INFORMATION

NAME :

PAN CARD NUMBER :

DATE OF BIRTH (dd/mm/yy ) :

CELL NUMBER :

Email ID :

Send me your soft copy documents to my Email ID : gmkurs@gmail.com :

• Your scanned soft copy of PAN Card
• Your scanned soft copy of Bank Canceled Cheque leaf
• Your scanned soft copy of Address Proof.
• One scanned copy of Passport size Photograph

Contact me :

Kumar Raj Urs G

Mobile : +91 9900322949.
Chikmagalur, Karnataka. INDIA.

Face Book ID : https://www.facebook.com/kumar.rajurs.5
Gmail ID : gmkurs@gmail.com

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