OMiGa

OMIGA

INTERNATIONAL PVT LTD

SUPPORTING : MG INTERNATIONAL PRIVATE LTD

Corporate Office: No.28/12, 2nd Flr, 1st Floor, Old Sub Registrar Office Building, Kidigekal Main Road, Sahakara Nagar Post, Bengaluru | TC 28/627/6, Ram Tower, Sreekanteswaram, Fort P.O, Thiruvananthapuram, Kerala

Phone : 0471-3511006 | Mob : 9533189883 | Email : omigaii@gmail.com | Web : www.omigaii.com

APPLICATION FORM

Name of Applicant
Address with Pin Code
Email ID
Phone No
Bank Name and Branch
Bank Account No.
IFSC Code
PAN No.
Nominee Name
Relation with the Applicant
Nominee Address
Nominee Phone No.
Introducer ID
Introducer Name

Fund Transfer Details

Advance Amount (in words and figures) Refundable
Name of Fund Transferer
Specify Bank & Account No of the Sender
Mode of Payment (Cash / Cheque / NEFT / RTGS / etc): Cash Cheque NEFT/RTGS Bank Transfer Others	Specify Transaction ID details

DECLARATION

I agree and accept the terms and condition of Omiga International Private Limited

Place:
DATE:

Signature:
NAME:

For Office Use Only
Name of Business Head:	Name of Team Head: