Customer Onboarding
Customer Name
*
Mobile No
*
Email ID
*
Address Line 1
*
(Flat/House No./Floor/Building & Locality)
Address Line 2
*
Address Line 3
*
Landmark
*
Pin Code
*
Select Region
*
--- Select Region ---
Select State
*
--- Select State ---
Select City
*
--- Select City ---
Referral Code
Home Address
Communication Address
Vehicle wise Tag Configuration
Select Vehicle Class
*
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Color Code
Vehicle Weight Description
Quantity
Quantity
0
Total Tag Cost
0
Total FTL and SD Amount
0
Tag Cost Will Debit From BC Account
FTL and SD will be paid while Vehicle On boarding
select Vehicle Class
I am authorizing the bank to send FASTag related SMS/E-mail communication on my registered Mobile no. & E-mail ID
Customer Onboarding
CRN Number
*
Mobile Number
*
ID Proof
*
Select ID Proof
PAN
Pan
*
Title
*
--- Select Title ---
Mr.
Mrs.
Ms.
PAN Number
*
First Name
*
Middle Name
Last Name
Father/Spouse's Name
Father/Spouse Type
--- Select Father/Spouse Type ---
Father
Spouse
Mother's Maiden Name
*
Date of Birth
*
DOB
Gender
*
--- Select Gender ---
Male
Female
Transgender
Email ID
*
Address 1
*
Address 2
*
Address 3
*
(Please add Landmark for quick delivery)
Pin Code
*
Country
*
--- Select Country ---
Select Region
*
--- Select Region ---
Select State
*
--- Select State ---
Select City
*
--- Select City ---
Nationality
*
Customer Onboarding Application
*
KYC Document
Address Proof
*
--- Select Address Proof ---
Voter ID
Driving License
Passport
Address Proof
*
Address Proof Number
*
Expiry Date
*
Driving License Issuance Date
Address Proof Document
*
--- Select Address Proof Document ---
HUF Deed
Trust Deed
Society Deed
Partnership Deed
AOA and MOA
Entity Registration Certificate
Choose File
*
KYC Proof Document
*
--- Select KYC Proof Document ---
--- Select Address Proof ---
Voter ID
Driving License
Passport
Choose File
*
Tag Registration
Bank may contact you for any further details, incase required.
Add more Vehicles
Customer Details / Tag Dispatch Address
Name
*
Address
*
Region
*
State
*
City
*
Pincode
*
Mobile Number
*
Email ID
*
Referral Code
I Hereby confirm authorise bank, to send Fastag related SMS /Mail on my registered mail id and mobile no.
TAG Dispatch Address
Select the check box if Tag Dispatch Address is same as Communication Address
Name
*
Address
*
Pincode
*
Region
*
--- Select Region ---
State
*
--- Select State ---
City
*
--- Select City ---
Payment Advice
Receipt No :
Receipt Date/Time :
Application/Order No :
Registered Mobile No
Customer ID :
Customer Name
Employee/Dealer Name :
Emp ID/Dealer Code
Vehicle Class
Chassis Number/Vehicle Number
Tag Cost (Rs.)
GST (18%)
Total Tag Cost
Amount in Wallet
Dealer Seal/Signature: _______________________________________
Thank you for choosing kotak mahindra Bank FASTag.
FASTag are issued by kotak mahindra Bank. Terms and Conditions apply.
PAN :
GST Registration Number:
Registered Office :
is an agent and would be collecting fees from customer on behalf of kotak mahindra Bank. In case of any clarification please reach us through our customer care number 1860 2666 888
Print
Download Welcome Letter
Kotak NETC FASTag Registration
x
Do you Have Kotak Bank Account?
*
Yes
No
Enter Your Kotak CRN Number
*
Generate OTP
Mobile Number
*
Generate OTP
OTP
*
.
Validate OTP
