Select:* Retail Customer Corporate Customer

Application Number*

Application Date*

Mobile*

OTP*

Pan Number*

ID Proof Type*

ID Proof Number*

ID Copy*

First Name*

Last Name*

Mother's Maiden Name*

Gender*

Male Female Transgender

Date Of Birth*

Passport Size Photo*

Please upload only one file (.jpeg / .jpg / .pdf). Min 200KB and Max 2MB file size allowed.

Please provide the following details if you hold an account with IDBI BANK

Bank Acc. No

Branch Name*

Bank Acc. No

Application Date:

Corporate Name

Type Of Entity

Public Ltd Private Ltd Partnership Proprietorship

Vehicle Number*

RC Copy*

Vehicle Class*

No. Of Tags<

Security Deposit*

Load Amount*

Tag Fee*

Total Amount*

Address Line 1*

Address Line 2*

Pin Code*

State*

City*

Email*

Country*

Address Proof Type*

Address Proof Number*

Address Copy*

Driving License

Valid Upto Date

Res STD

Res Phone No

Off STD

Office Phone NO

I have read and agree to the terms and conditions, View the Terms and conditions. *

I hereby declare that the details furnished above are true and correct to the best of my knowledge.*

* No refund of tag issuance fee.

* The balance in the Tag cannot exceed Rs.10,000 &/or the Tag aggregate transaction value will not exceed Rs 10,000 at any given point during a month.

Vehicle Status Check

If you have registered Vehicle number please choose Vehicle number below else choose Chassis number :

Customer Details

Please provide the following details if you hold an account with IDBI BANK

Vehicle Details

Contact Details