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
Referral Type (if applicable)
No Referral
Distributer
RFID - BM
Employee
CP
Referral Code (if applicable)
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. Upload proof of payment / KYC Details
Select file
*
I certify that the above information is true to the best of my knowledge and belif.
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