Customer Details:

Title* :
Customer Name* :
Mobile Number* :
Date of Birth :
Email Address* :

Note-"ID Proof required for Institutional Customers: ROC (Company Registration Number), CST (Central Sales Tax Number) & PAN (Permanent Account Number)"

Customer ID Proof 1* :
Customer ID Proof 2* :
Customer ID Proof 3* :
(Required only in case of ID Proof No. 2 is Voter’s ID)
Address :
City* :
State* :
Pin Code* :

Vehicle Details:

Model Purchased* :
Model Color :
Date of Purchase* :
Vehicle Identification Number (VIN) / Chassis Number* :
Motor No* :
Battery Number:
Charger Number:
Insurance Covernote Number:

Dealer Details :

Dealer Name* :
Dealer Email :
Dealer Invoice No* :
Dealer Invoice Amount* :
NEMMP Subsidy Amount* :
Dealer Code* :
Dealer City* :
Free Service Coupon No From Owner's Manual* :