PURE EARTH
Affiliate Name (as per aadhaar)
Upload Passport Size Photo (Limit:1MB File types: JPG | Jpeg | PNG)
Aadhaar Number
Upload Aadhaar (Limit:1MB File types: JPG | Jpeg | PNG)
Email Address
Mobile
Alternate Mobile
Permanent Address Line1
Permanent Address Line2
City
Pin Code
Present Address Line1
Present Address Line2
Present City
Present Pin Code
Time Commitment —Please choose an option—Full TimePart Time
Specify hours per week, if Part Time
Preferred Start Date —Please choose an option—ImmediateWithin a weekWithin a monthFlexible
PAN
Upload PAN (Limit:1MB File types: JPG | Jpeg | PNG)
GST Name
GST Number
GST Address
Bank Name
Branch Name
Account No
IFSC Code
Referred By
Referred Ph No
I confirm that the information provided in this application is correct and complete. I allow Pure Earth Reality Tech to validate the information provided. I authorize Pure Earth Reality Tech to verify the details submitted. I understand that admittance into the program is at the discretion of Pure Earth, and I agree to follow the terms and conditions mentioned in the partnership agreement
