IndusViva

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Indusviva T&C Agreement

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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

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Commission Method

Bank

Paypal

Paypal details

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Paypal Email *:

Paypal Number *:

Bank details

IFSC Code *:

Bank Name *:

Branch Name:

Account Holder Name *:

Account Number *:

Confirm Account Number *:

Applicant's Information

Title *:

Date of Birth*:

PAN (Self)

Distributor Name * :

Gender *:

Address1 *:

Education *:

Address 2 :

Profession *:

Town/Area :

Monthly Income :

State *:

City/District *:

Aadhaar No :

Post Office :

Mobile

Phone :

Email :

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

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Position *:

Sponsor Id *:

Sponsor Name *:

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Important Information

Dear Distributor,
Your Personal Information Is Safe With IndusViva INC.

Date	2020-0101-1818	Week	286

Your Personal Information Is Safe With IndusViva INC, For More Details Contact [email protected]