IndusViva

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Indusviva T&C Agreement

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Coupoun Code :

By checking this box, I agree that I have read IndusViva HealthSciences Pvt. Ltd.'s Terms & Conditions and will comply with the same. I understand that failure to abide by these terms and conditions may result in penalties without further notice, up to and including termination of my IndusViva HealthSciences Pvt. Ltd. Distributor Account.

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Distributor Details

Country Information

Country *:

Bank details

IFSC Code *:

Bank Name *:

Branch Name*:

Account Holder Name *:

Account Number *:

Confirm Account Number *:

Applicant's Information

Title *:

Date of Birth*:

Distributor Name * :

Gender *:

Address1 *:

Education *:

Address 2 :

Profession *:

Town/Area :

Monthly Income :

State *:

City/District *:

Aadhaar No :

Post Office :

Mobile

Phone :

Email :

PAN (Self)

Co-Applicant's Information

Co-Applicant Name :* (If unmarried Mother/Father)

Relationship (With Applicant) :*

DOB (Co Applicant) :

PAN (Spouse)

Beneficiary Name :

Relationship : (In case you are single, mention beneficiary name)

Sponsor/Placement Details

Placement ID *:

Position *:

Sponsor Id *:

Sponsor Name *:

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Login Details 1

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Important Information

PLEASE UPLOAD SCANNED COPY OF VOIDED CHEQUE TO THIS FORM FOR VERIFICATION (cheque must be preprinted with your name)

NOTE: It is mandatory that all applications must have attached copies of PAN ID, proof of address (passport/ration card/drivers license/voters ID/telephone bill).
Without these forms, the application will not be accepted.

I agree that I have used indusviva products and I am satisfied with the quality of the products and hence I am taking the distributorship and
I understand that at any point of time this is a part time opportunity only.