Authorized Agency Registration
Please fill in all the required details to create your account
Full Name
Username
(Automatic)
Address
PIN Code
Mobile Number
Email ID
State
--Select State--
ANDAMAN AND NICOBAR ISLANDS
ANDHRA PRADESH
ARUNACHAL PRADESH
ASSAM
BIHAR
CHANDIGARH
CHHATTISGARH
DADRA AND NAGAR HAVELI
DAMAN AND DIU
DELHI
GOA
GUJARAT
HARYANA
HIMACHAL PRADESH
JAMMU AND KASHMIR
JHARKHAND
KARNATAKA
KERALA
LAKSHADWEEP
MADHYA PRADESH
MAHARASHTRA
MANIPUR
MEGHALAYA
MIZORAM
NAGALAND
ODISHA
OTHER
PONDICHERRY
PUNJAB
RAJASTHAN
SIKKIM
TAMILNADU
TELANGANA
TRIPURA
UTTAR PRADESH
UTTARAKHAND
WEST BENGAL
Shop Name
Aadhar Number
PAN Number
Account Type
-- Select Account Type --
Retailer
Distributor
Super Distributor
ID Charge
NSDL PAAM Charge
eKYC Service Charge
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