Classification: Public

Field
Fieldreport
Report
_________ Date:-

Distributor/ Merchant Name: ________________________________ CIF ID:__________________________

Working address:____________________________________________________________________________

__________________________________________________________________________________________
KYC address:________________________________________________________________________________

___________________________________________________________________________________________

Annual Income:- Rs2-5 Lakhs Rs 5-10Lakhs Rs >10Lakhs

Education Qualification_________________ Shop Owned Rental

Login address:_______________________________________________________________________________

__________________________________________________________________________________________

__________________________________________________________________________________________

I confirm that above information shared by me is true & accurate to the best of my knowledge.
______________________________

_______________________________

Distributor Signature

To be filled by Fino Employee

I strongly Recommend Mr./ Mrs_______________________________________ for Aeps Restriction removal

____________________ ____________________ ____________________

CH Signature RH Signature/Recommendation Mail ZH Signature/ Recommendation Mail

____________________ ____________________ ____________________

CH Name RH Name ZH Name

Classification: Public