D.A.Y. INSURANCE Registration Form

01
Personal Information

Personal Information

Please enter your information and proceed to the next step so we can build your Account.

Fill From Aadhar Manual

Aadhar Number

OTP

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First Name

Middle Name

Last Name

Your Email

Mobile Number

ALt Number

Address Line 1

Address Line 2

PanNum

City

State

Pincode

Birth Date:

Reference By

Company Name(if any)

GST No

02
Professional Information

Professional Information

Please enter your Professional information and proceed to the next step so we can build your Account.

Occupation

Government Private Others

User Type

POS Corporate User

Already Insurance Agent

Yes No

Pos Type

Life Non Life Both

Company Life

Company Non Life

Life Company Reg No

Non Life Reg No

IRDA License No

03
Bank Details

Bank Details

Please enter your Bank Details and proceed to the next step so we can build your Account.

Account Number

IFSC Code

Bank Name

Name on Bank Account

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Cheque Sample

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PassBook Sample

04
Upload Documents

Upload Documents

Please enter your information and proceed to the next step so we can build your accounts.

Document Type

Details Submitted

Fill the Personal Informations/Bank Details