Retailer Registration

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Full Name (As per PAN)

Father/Husbad Name

DOB

Shop Name

Whastapp Mobile Number

Gender

PAN Number

Aadhaar Number

GST Number

Address

Pincode

District

State

City

Retailer Photo

Aadhar Front Photo

Aadhar Back Photo

PAN Photo

Shop Photo

Referral Code

Shop Location (Drag and drop the point)

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