Customer Registration

Customer Registration

Customer Name ^*

Model ^*

Make ^*

Registration Number ^*

Date of Registration ^*

Upload Scan Copy of Registration

Expiry Date of Tax Token^*

Upload Scan Copy of Tax Token

Expiry Date of Pollution^*

Upload Scan Copy of Pollution

Expiry Date of Insurance^*

Upload Scan Copy of Insurance

Name of Insurance Company^*

Customer Mobile Number^*

Customer Email ID^*

Password ^*

Confirm Password ^*