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		Email: support@instantcashworldwide.com

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Agent Transaction

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AGENT'S PROFILE

Name of Organisation
(As appearing in the license)

Full address of Organisation

Phone number (Other then mobile)

Fax Number

E-mail Address

Contact Person

Date of establishment of Organisation

DD/MM/YYYY

Address of the Head Office
(In case of more than one branch)

Number of Branches

Working Hours

Constitution (Individual/Proprietor/Partnership /Private Ltd. Co./Public Ltd. Co.)

	Individual
	Proprietor
	Partnership
	Private Ltd. Co.
	Public Ltd. Co.

Name of the Proprietor/Partners /Director of the Organisation

Name of the persons authorized to sign on behalf of the Organization

Capital (Pls. mail Audited Financial Statements for the last three years)

Details of banks with whom the account is maintained

Can reference be made to banks with whom DD arrangements are enjoyed

Yes

Number of locations at which the Organisation would like to have instant cash installed with addresses (Pls. mail all locations if more than one location)

Number of transactions expected during the first year

Total amount of transactions expected during the first year

Details of deposits/bank guarantee to be offered as security towards instant cash receipt

Please state if there is any other service of similar nature. If so, permission obtained from the Principals to enter into agreement

Name of Users (Location wise)

I hereby declare that the above-mentioned information is true to the best of my knowledge.