Agency Registration Form First Name: Date of Incorporation: Last Name: Trade License: Share Holding: Trade License Expiry Date: VAT Registration Certificate No: Contact Email: Agency Short Name: Role --Please select--OwnerAuthorized OfficerAgent RepresentativeAdministrator Residential Status: Beneficiary Name: Country Code: IBAN Number: Confirm IBAN Number: Beneficiary Bank Name: Bank Branch: Swift Code: Account Name: Account Mail: Broker Type: Agency Registration: Telephone Number: Mobile Number: Address 1: Address 2: Country: City No: Swift Code: POA of the Authorized Signatory: Visa: Password: VISA Expiry Date: Password Expiry Date: RERA Broker Card: Emirates ID: RERA Broker Card Expiry Date: Emirates ID Expiry Date: Mailing City : PO Box No: Name of The Authorized Officer: Zip PO Box No: Fax Number: RERA: Agency Name: Bank Account Number : Agency Strength : Contact Mobile: VAT No: Mailing State: Mailing Country: Mailing Zip Code: VAT No:
