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:


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.

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