Application Form
Online Registration
First Name
*
Middle Name
Last Name
*
Date Of Birth
Address
Address 1
*
Address 2
City
*
PIN Code
*
Pin code should be of 6 digits
State
*
- Select a state -
Andaman Nicobar
Andhra Pradesh
Arunachal Pradesh
Assam
Bihar
Chandigarh
CHATTISGARH
Dadra and Nagar Havel
Delhi
DIU AND DAMAN
Goa
Gujarat
Haryana
Himachal Pradesh
Jammu and Kashmir
Jharkhand
Karnataka
Kerala
Lakshadweep
Madhya Pradesh
Maharashtra
Manipur
Meghalaya
Mizoram
Nagaland
Orissa
Punjab
Rajasthan
Sikkim
Tamil Nadu
Tripura
Uttar Pradesh
Uttaranchal
West Bengal
Mobile 1
*
Mobile 2
Landline No
Email
*
Company/Firm's Name
*
Store Location
*
Area
*
Interested for store type
*
Franchisee (500-750 sq.ft)
Additional Information
Current Occupation
*
Family Business
Self Employed
Job/Service
House Wife
Unemployed
Other
Business Sector
*
Retail
Distributor/Trader
Agency
Not Applicable
Other
Doing Business Since
*
Less than 1 Year
1 to 5 Years
More than 5 Years
Not Started as yet
Operating from
*
Shop/Office
Home
Door To Door
Not Applicable
Others
Leader of any society, committee or group
*
No
Yes
Education Qualification
*
Post Graduate
Graduate
Under Graduate
Other
Applicant type
*
Individual
Proprietor
Partnership
Private Limited
Applicant's photo
(Upload jpg,gif,png Images only)
Jurisdiction of police station
*
Bank Information
Bank Name
*
PAN No
*
Declaration
I hereby declare that the details given herein are true, correct and complete to the best of my knowledge and belief, the photo copy of the documents submitted at a later stage are genuine and belong to me. I hereby undertake to promptly inform All Time Data Private Ltd in writing, of any changes in the information provided herein above and agree and accept that All Time Data Private Ltd is not liable or responsible for any losses, costs, damages arising out of any actions undertaken or activities performed by All Time Data Private Ltd on the basis of the information provided by me as also due to my not intimating / delay in intimating such changes. I hereby authorize All Time Data Private Ltd to disclose, share, remit in any form, mode or manner, all / any of the information provided by me. I hereby agree to provide any additional information / documentation that may be required by All Time Data Private Ltd, in connection with this application. I also agree that All Time Data Private Ltd has the right to reject my application form on any ground without any reason and I understand that INR 5,000/- paid towards the application processing fees is non refundable.