Registration Form

Registration

Registration Form

Fill out the form below to register or contact us directly, and our team will contact you promptly. We are committed to providing you with the information you need!

Dealer Personal Information

Registration No*

Dealer's Name*

Father Name*

Qualification*

Date of Birth*

Aadhar No*

Mobile No*

Phone No

Email*

Pan No*

Address of Dealer*

Firm/Society Information

Fiem/Co.Society Name*

Name of Proprietor/Partner/Director (1)*

Name of Proprietor/Partner/Director (2)

Address*

District*

State*

Pin Code*

Police Station Area*

Panchayat Samiti*

Phone No

E-Mail ID*

Mobile No. (1)*

Mobile No. (2)

Mobile No. (3)

GSTIN No*

PAN No*

Dealer Bank Details

Name of Bank*

Bank Account No*

IFSC Code No*

Branch Address*

Allotted Product

ABPL Fuel Station (1)*

ABPL Fuel Station (2)

Diesel/Petrol Stirage Tanker

Registration No*

Dt*

Valid Upto*

Month/Year*

Allotted Area Location

Village*

Post*

Tahsil*

District*

Land Information

Land Owner Name*

Mauza*

Khata No*

Khasra No*

Thana No*

Power Supply Through*

Electric Connection*

Diesel Generator*

Solar Power*

Dealer Ship + Branding + 18% GST Amt. Rs.5,00,000/- Non Refundable

Contact Amount Mode of Payment-RTGS/NEFT/CHEQUE/CASH

Contact Amount*

Date*

Enclosed Document

Photo*

Dealer Pan card*

Firm Pan Card*

Aadhar Card / Driving License*

ITR 2 Year*

Land / Shop Rent Agreement*

Stamp Paper (1000 X 2)*

Stamp Paper (1000 X 4)*

GST Registration*

Cheque 2 Nos with SIgn Crossed without Date*

Land Janmabandi / Lease Deed / Bapi Patta etc / Naksha Tress*

Account Details

Name	Alluvial Biofuel Private Limited
Account No	18190210000809
IFSC Code	UCBA0001819
Bank Name	Uco Bank
Bank Address	Kuldeep Singh Road Dumka Jharkhand-814101