REGISTRATION FORM

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REGISTRATION FORM

DIGITALSEWA.IN

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* Indicates required question

FULL NAME *

Your answer

ADHAAR LINK MOBILE NUMBER
*

Your answer

EMAIL ID
*

Your answer

SHOP NAME
*

Your answer

STATE NAME
*

Your answer

DISTRICT NAME
*

Your answer

SHOP LANDEMARK
*

Your answer

PIN CODE
*

Your answer

ADHAAR ADDRESS
*

Your answer

PAN CARD NUMBER
*

Your answer

AADHAR NUMBER
*

Your answer

DATE OF BIRTH
*

MM

/

DD

/

YYYY

PAYMENT MODE
*

Choose

UPI

CARD

NET BANKING

QR CODE

PATNER MODE
*

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RETAILER ₹ 1999

DISTRIBUTOR ₹ 3499

MASTER KIT 4599

BOOKING ID

SELLER NAME
*

Your answer

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