Name (required)

NIRC (required)

Registered Address

Mailing Address

Mobile Number

Emergency Contact Person
Name

Emergency Contact Person
Mobile Number

Email Address (required)

Shirt Size

Other Informations

Category
Motorcycle/MotorbikeCarVanLorry (1T)Lorry (2T)

Employment Status WorkingNotWorkingSelf-Employed

Type of Driving License

Bank

Bank Account Holder

Bank Account Number

Training yesno

Referral Code (If Any)

Date
Attachment
Identity Card
Front
Back
Drive License
Front
Back
Vehicle insurance
Front

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