Application Form for FASTag ( RFID ) service
 

Important Instructions

   1) Fields with * are mandatory
   2) You are requested to fill all details correctly.

A. Details of the Center

   
Applied for State:

Division:

District:
   
Location / Area of working  Example: colony name, area etc.
   
   
Name of the Person *
   
Address *
   
Contact Number *  With STD code
   
Mobile Number *  Without 0 or leading +91
   
Email *  
   

B. Payment Details

Payment Mode DD / Cheque / Transaction / UTR Number / DU Number (For SBI Collect) Date Receive Date



Bank Details Amount

C. Upload proof of payment

Select file *
   

  I certify that the above information is true to the best of my knowledge and belif.




Copyright © 2016 NICT Technologies Pvt. Ltd. All rights reserved.