Registration Form-Agri Reach Mobile Application

Firm Name
(If case of no legal name, please write Individual Name /Known in mandi / market)* Firm's Legal Identity No.(GST/ Firm Reg./ Pan card)(Any one) Pan Card No. (If firm's legal documents are not available, provide Owner's/ Proprietor's/ Individual's-Pan card details) Aadhaar Card No. (If firm's legal documents are not available, provide Owner's/ Proprietor's/ Individual's-aadhaar card details) Contact Person Name*

WhatsApp No. Email Address

Enter Mobile Number*

Designation /Position (Relationship with the firm) (Ex- Owner/ Proprietor /Employee's designation/ Relative/ Agent/ etc. ) Category Status(Any)*
Commodity Trader/ Commission Agent
Food Processor
Service Provider

If (Trader/ Agent/ Food Processor) Name of the Commodity If (Service provider) Name of the Services Address of the Firm/ Company Town* District* State* Pin Code* Business Turnover (If available) Rupees in lakhs Business Tenure(Yrs.) Any Association with SLCM Group (SLCM/ NEFM/ Kissandhan/ Growth)

Yes

If associated with Competitor (Related to Agri. commodity), Name Any Suggestion/ Feedback Date:

Respondant Email ID( Person's Mail ID who is filling the form)*

Declaration:*
1. I hereby declare that the information furnished above are true and correct to the best of my knowledge and belief and I undertake to inform you of any changes therein, immidiately. In case of any of the above information is found to be false or untrue or misleading or misrepresenting, I am aware that I may be held liable for it.

2. I am providing the above information and signing this form by my own free will. The Company i.e. Sohan Lal Commodity Management Pvt. Ltd. has not exerted any dur pressure or influence on me in this regard. Further, I hereby authorize Sohan Lal Commodity Management Pvt. Ltd. to use the information for its commercial purposes only. I agree

Mobile verification*

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