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AIRTEL PAYMENT BANK

Tower A, Plot No-15, Udyog Vihar Industrial Area Phase 4, Gurugram, Haryana-122015

Personal Details

Name: Father's Name: Address: Mobile No: Relation w/ Nominee: --Select-- Father Mother Brother Sister Spouse A/c Open Date: Type of A/c: --Select-- Savings Current Fixed Deposit BC Name: BC Location:

Banking Details

Account No: IFSC: Customer Id: Aadhaar No: PAN No: Photo:

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