Brihanmumbai Mahanagarpalika

Agent Registration
License No.:*
Issue Date:*  (DD/MM/YYYY)
Valid Upto Date:*  (DD/MM/YYYY)
Agency Name:*
Licensee Name:*
Office Address
Address 1 :*Address 2 :  
Address 3 :  Building No.:  
Land Mark :  Lane No.:  
District:  City:*
State:  Country:  
Postal Code:*
Phone No.:  Mobile No.:  
E-Mail Id:*
  • Enter valid e-Mail Id, all communications will be done through this id.
  • Verification mail will also be sent on this mail id.

Please Note :- Check spam mail if verification mail is not received in inbox.
Resident Address
   Same as office address
Address 1 :  Address 2 :  
Address 3 :  Building No.:  
Land Mark :  Lane No.:  
District:  City:  
State:  Country:  
Postal Code:  
Phone No.:  Mobile No.:  
E-Mail Id:  
Bank/Other Info.
Bank Name:  Branch Name:  
Account No.:  Account Type:  
PAN No.:*TIN No.:  
Password:*Confirm Password:*

Enter Value From Above Picture:*
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