AGENT REGISTRATON

Local Address

Permanent Address

Declaration

I hereby declare that the details furnished above are true and correct to the best of my knowledge and belief and I undertake to inform you of any changes therein, immediately. In case any of the above information is found to be false, untrue, misleading, or misrepresenting, I am aware that I may be held liable for it. I hereby authorize sharing of the information furnished on this form with the FUNDHOUSETM.

FUNDHOUSE FUNDHOUSE


FUNDHOUSETM
A Trade Name of Chhattis Garh Fin-Corp Lending Private Ltd. RBI Licensed NBFC.
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