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Apply Online for Partner Registration Under PM-Wani Scheme
Company/ Firm Name
Company/ Firm Type
Sole Proprietor
Partnership
Private Ltd. Co.
Public Ltd. Co./ Unlisted
Registered Address
Correspondence Address (If different from regd. office)
City
Pincode
State
-----Select State-----
Andhra Pradesh
Arunachal Pradesh
Assam
Bihar
Chhattisgarh
Delhi
Goa
Gujarat
Haryana
Himachal Pradesh
Jharkhand
Karnataka
Kerala
Maharashtra
Madhya Pradesh
Manipur
Meghalaya
Mizoram
Nagaland
Odisha
Punjab
Rajasthan
Sikkim
Tamil Nadu
Tripura
Telangana
Uttar Pradesh
Uttarakhand
West Bengal
Email
Mobile/Tel
Date And Place of Incorporation
Present Nature of Business Internet Service Provider-Class of License
A-All India
B-State Level
C-City level
Other
Income Tax PAN No.
UIN (Pvt. / Ltd. Co. only)
GSTIN No.
Business Owners Information Designation
Proprietor
Primary Partner
Managing Director
Full Name
Address
City
Pincode
State
Andhra Pradesh
Arunachal Pradesh
Assam
Bihar
Chhattisgarh
Delhi
Goa
Gujarat
Haryana
Himachal Pradesh
Jharkhand
Karnataka
Kerala
Maharashtra
Madhya Pradesh
Manipur
Meghalaya
Mizoram
Nagaland
Odisha
Punjab
Rajasthan
Sikkim
Tamil Nadu
Tripura
Telangana
Uttar Pradesh
Uttarakhand
West Bengal
Mobile / Tel
STD
Email
I declare the information given on this Registration Form is true and correct.
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