Hospital

General Details

Name of the Service Station*

Address*

Country*

State*

District*

City*

Pincode*

Mobile Number*

Phone Number with STD Code*

FAX Number

Email*

Address Proof (jpg/pdf):*

Others

Legal Status:

Business Commencement (Month & Year):*

Business Commencement Certificate (jpg/pdf):*

Remarks

Referred By

Manufacturing Company Auth Type:

Upload Manufacturing Company Auth Doc (jpg/pdf):

Cashless Facility

Availability Cashless Facilities:

Yes

Details of Facilities:

Tariff

Upload Parts Tariff (doc/xls/pdf):

Upload Labour Tariff (doc/xls/pdf):

Staff Details

Name of Manager (or) Contact Person

Designation

Office Number

Residence Number

Mobile Number

Total No. of Employees (on company's payroll)

Total No. of Employees Proof (xls/pdf):

Bank Details

Bank Name

Account No

Branch Name

MICR No

IFSC Code

Cheque in favour

Upload Cancelled Cheque (JPG/PDF)

Statutory Details:

Registration No.*

Upload Registration document (jpg/pdf)

PAN No*

Upload PAN (jpg/pdf) *

GST No Ex: 06BZAHM6385P6Z2

Upload GST (jpg/pdf)

NOMBRE Enterprises

Authorised Automobile Service Station