Connector Registration Form

Personal Details

Entity*

Channel Name*

Mobile*

Alternate Number

Email*

Do you fall under MSME category?*

Yes No

Do you have an Account with ICICI Bank*

Yes No

ICICI Account Number* Explain to the connector reason of asking for ICICI Bank a/c details.

Bank Name*

Bank Account Number*

Pincode* City and State will auto-fill from pincode

City*

State*

Address*

Professional Network*

VSTS ID*

iBox ID/VPTS ID*

SBP Code (If the SBP Code is unavailable, leave the field blank)

DBP Code*

SAC Code*

GST number available (GSTIN)*

Yes No

PAN Number*