BEAM CUSTOMER REGISTRATION APPLICATION

Customer Registration cum Loyalty Membership

* Mandatory fields | Do not use any abbreviations

YOUR NAME *

(Attach Photocopy Of Photo ID if not Introduced)

Mr. Ms.

YOUR BIRTHDAY

DATE*

MONTH*

YEAR*

YOUR FATHER / MOTHER’S NAME*

ADDRESS*

(Attach Photocopy Of Photo ID if not Introduced)

NEARBY LANDMARK*

LOCALITY*

CITY

VILLAGE

TEHSIL / BLOCK

STATE*

DISTRICT / BOROUGH*

if other please specify

POSTAL CODE*

YOUR MOBILE NO*

(Registered Mobile No (RMN) For Transactions & Loyalty Rewards)

EMAIL (If Having)

MONTHLY INCOME* (Tick one)

Below Rs. 10,000 Rs. 10,000-25,000 Rs. 25,000-50,000 Above Rs. 50,000

WHICH DO YOU HAVE

Mobile Internet Connection Car Fridge

YOUR PRESENT OCCUPATION* (Tick As Applicable)

DOCUMENT UPLOAD* (Please upload JPG image file upto 500 KB only)

PHOTO
PROOF OF IDENTITY (Documents Accepted)
PROOF OF ADDRESS (Documents Accepted)

DECLARATION*

I accept the terms and conditions.