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NAL Date of Birth: D D M M Y Y Y Y Gender : c Female Male c Full Name: SHOP ADDRESS Name of Outlet/Shop: Outlet Address: City/Village: Tehsil: Pin Code: District: State: STD Code: Registered Mobile No.: Tel.: E-mail ID: Doing Business Since: PERMANENT ADDRESS Address: City/Village: Tehsil: District: Pin Code: State: Stay in the Village/Town Since: Registered Mobile No.: STD Code: Tel.: KYC DOCUMENTS Accepted Address Proof: c Voter ID c Aadhaar c Ration Card c Driving License.

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