GICHF

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 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) *

Payout Structure

Preferred date of personal disucssion *