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Retail Outlet Application

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Application Form

PERSONAL DETAILS

Name of Individual *

Father's Name

Email Address *

Phone No *

Aadhar No

PAN No

POSTAL ADDRESS

Postal Address *

State

District

Block

Thana

Pin Code

PERMANENT ADDRESS

Same as Postal Address

Permanent Address

State

District

Block

Thana

Pin Code

FIRM / COMPANY DETAILS

Firm / Company

Regd. No.

Trading License No.

PAN No.

GSTN

PROPOSED AREA / LOCATION DETAILS

Area / Location Name

Khasra No

Plot No.

NH / SH / PWD Name

Total Area of Land (Approx in Meter)

OTHER DETAILS

Know Through

Referred By

Landline No.