Registration Form

A. DEALER DETAILS
YesNo
30km50km75km100km150km
PAN cardVoter IDAdhar cardother
Id Proof

“PROOF” “NO.” “AGE” “GENDER”
Voter Id. MaleFemale
PAN No. MaleFemale
Adhar card No. MaleFemale
other MaleFemale
CashNeftChequeRgts

Cheque /Neft. Date Amount (in figures) Amount (In Words ) only Issuing Bank Cheque /Neft/Rtgs must be issued in favor of Focas India, payable at Indore and forward to Focas India Secretariat.

G. Office Use Only