Jaya Financial Services

FINANCIAL SERVICES INDIA PVT LTD

Registered & Corporate Office
D.No. 126, Ground Floor, 4th Avenue, Sundar Nagar, Guindy, Chennai, Tamilnadu, India – 600 032
Website: www.jayaafs126.com
Email: [email protected]
Ph: 044-2233 0528

AGENT - FORM - JAYAAFS-0005

CODE

NAME *

AGE *

PAN *

FATHER NAME *

SPOUSE / HUSBAND *

GENDER *

MALE FEMALE

DATE OF BIRTH *

EDUCATION *

EXPERIENCE *

NATIONALITY *

RELIGION *

PRESENT ADDRESS *

PERMANENT ADDRESS *

CONTACT NO *

EMAIL ID

BANK NAME *

A/C NUMBER *

IFSC CODE *

BRANCH *

NOMINEE NAME

NOMINEE (IN CASE MINOR) GUARANTOR

REQUIRED DOCUMENTS

NOTE: You must have to upload one id proof and address proof.

AADHAR

ChooseFile

PAN

ChooseFile

RATION CARD

ChooseFile

VOTER CARD

ChooseFile

BANK PASS BOOK FIRST PAGE COPY

ChooseFile

AGENT PHOTO *

ChooseFile

TERMS & CONDITIONS

Cost of Agent application form is Rs.500/-
Agent application LOGIN Fee is Rs.1250/-
Agent/Agency should be renewed yearly once before the expiry date. All the agents should nominate a nominee at the time of registration.
Agent does not have any right to collect any fees from the Client in case of any violation the Agent/Agency shall be terminated without any notice by the company.

ACKNOWLEDGEMENT *

I agree to above Terms & Conditions.

Select	Product Name	Price	Quantity	Sub Total
	Agent Registration Fee	250 INR		0.00 INR


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