Application for Empanelment

Personal Detail

First Name / Company Name *
Last Name / Company Name *
Regd. Address *
Preferred GICHF Branch *

PAN Number *
Company Name *
Email Id *
Mobile No. *

Bank Details for NEFT/RTGS

Bank Name *
Name of Account Holder * (as appearing on cheque leaf)
Complete Bank Account No. * (as appearing on cheque leaf)
Passport Photo *
Aadhar Card *
(Photo, Address and Aadhar no. clearly visible)
PAN Card (Only front view) *
Preferred date of personal disucssion *