REGISTRATION FORM
To be filled by Online Agents members requesting for Online
Booking through
www.irctc.co.in. / Web services Portal
[Soft Copy] * Mandatory
NAME SERVICES
Company Name *
Person Representing Company
First Name *
RAVI
Middle Name
KIRAN
Last Name *
AKURATI
Date Of Birth *
05-05-1982
Office Address * as verified by Deptt of POST
D.No.21-11-151, MAIN ROAD PERALA, NEAR ANDHRA BANK,
PRAKASAM DISTRICT,
City *
CHIRALA
State *
AP
Pincode *(to be verified by the Principal Agent
523157
Country*
INDIA
Phone Number*/Mobile No
9603405883
Fax Number
Email Id *
Verified PAN No.
[email protected]
AKMPxxx278N
Declaration of Sub agent obtained (Soft copy available with the Principal Agent).
Willing to be registered with
M/s_________________
He is not registered with any other Principal Agent
SIGNATURE