Apply for Distributorship
Personal Details
Your name
*
Your DOB
*
dd-mm-yyyy
Gender
*
Male
Female
Transgender
Contact Number
*
Your email
*
Business Information
Business Name (if applicable)
GST Number
*
Business Address (if different from personal address)
Identification Details
Aadhar Number
*
Upload Photo ID (Max 1mb)
*
Upload Address Proof (Max 1mb)
*
Bank Details (for commission payments):
Bank Name
*
Account Number
*
IFSC Code
*
Upload Cancelled Cheque/Bank Passbook (JPEG/PDF) (Max 1mb)
*
Agreement
I have read and agree to the
Terms & Conditions
of becoming an Origin108 Distributor.
*
I confirm that I have completed the mandatory orientation module.
*
I'm not a robot
*
APPLY FOR DISTRIBUTORSHIP
