Agency Registration | OCTA DEVELOP

Agency Registration Form

First Name:

Date of Incorporation:

Last Name:

Trade License:

Share Holding:

Trade License Expiry Date:

VAT Registered:

VAT Registration Certificate No:

Contact Email:

Agency Short Name:

Role

Nationality:

Residential Status:

Beneficiary Name:

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 Name:

POA of the Authorized Signatory:

Visa:

Passport:

VISA Expiry Date:

Passport 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:

Mailing State:

Mailing Country:

Mailing Zip Code:

Agency Registration Form

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Agency Registration Form