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FAMILY ONE REGISTRATION FORM

Name of Partner(s): _________________________________________________________


Agency Name: _________________________________________________________________
Agency Code: _________________________ Date of Agreement: ______________________
Business Unit (CDMA/GSM/Enterprise/Digital Mumbai/Wireline/Branded Retail) _______________________
Products being sold (Postpaid/Prepaid/PTB/Rdel/Photon/Walky) _______________________________
Office Address: _______________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
Landline: ______________ Mobile: ____________________ e-mail:____________________
Residence Address: ____________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
Landline: ______________ Mobile: ____________________ e-mail:____________________
Details of Self & Family:
S.No.

Name

Relatio
n

Gender

Date of Birth (dd/mm/yyyy)

1
2
3
4

Date of Anniversary (if married) ______________________

------------------------Date: _____________

Signature of Partner

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