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Prospect Detail Form

This document is a prospect detail form that collects personal and financial information from a customer. It requests information such as name, address, date of birth, contact details, bank account information, package details, and signatures. The customer confirms they are over 18 and have not paid any subscription fees. The form is used to process a customer's enrollment in a package with the company.

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rishichauhan25
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We take content rights seriously. If you suspect this is your content, claim it here.
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2K views1 page

Prospect Detail Form

This document is a prospect detail form that collects personal and financial information from a customer. It requests information such as name, address, date of birth, contact details, bank account information, package details, and signatures. The customer confirms they are over 18 and have not paid any subscription fees. The form is used to process a customer's enrollment in a package with the company.

Uploaded by

rishichauhan25
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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PROSPECT DETAIL FORM

(Fill in Capital Letter Only)

DSA ID ……………………………………………………………………………………………………………………

Password ………………………………………………. Confirm Password…………………………………..………….

Name ………………………………………………………………………………………………………………………

Father’s Name ……………………………………………………………………………………………………………

Co-Applicant …………………………………………. Relation (If any) ………………………………. Age …….…….

Email ……………………………………………………………………………………………………………………….

Address ………………………………………………………………………………………………………………….....

City …………………………………………………….. District.. ………………………………………….…………….

Pincode ……………………………………………………………… State ………………………………………………

Mobile No. For OTP ………………………………………………….. Mobile …………………………………………

Date of Birth …….. ……… ………… Pan No. ……………………….………………………………………..

Aadhar Card ……………………………………….. GST No. ……………………………………………………………

A/c No. ………………………………………..…… Bank Name …………………………………………………………

IFSC Code ………………………………….……………… Bank City Town ……………………………………………

Senior Advisor Name ………………………………..Senior Adv. Contact ………………………………………………

Safe Shop GBV Package ………………………………………………… Package Cost ………………………………..

Safe Shop RBV Package ………………………………………………… Package Cost ………………………………..

( ) I agree I am above 18 Years of age.


( ) I have not paid any charges as subscription fees/enrollment/registration.

---------------------------- ------------------------------------- ----------------------------------


Dated Customer Name & Signature Upline Name & Signature

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