PoSP Registration Form

* All fields are mandatory

Personal Details

First Name *

Last Name *

Gender *

Male Female

Date of Birth *

Communication Details

Mobile *

Alternate Mobile

Email *

Address *

State *

City *

PIN Code *

Aadhaar / PAN Details

Aadhaar No. *

PAN *

Education Details

Highest Qualification *

Bank details

Bank Name *

Bank Address

Account Number *

IFSC Code*

Supported Documents (.png, .jpg, .jpeg) max file size 5 MB

Aadhaar Card Front Side * Clear

Aadhaar Card Back Side * Clear

PAN Card * Clear

Highest Qualification Cert. * Clear

Cancelled Cheque * Clear

Profile Photo Clear

Others Details

Reference

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Email: contactus@upsurebrokers.com Call: +91 90452 83235

Address: B-11, 2nd Floor, Sector 4, Noida UP - 201301

Upsure Insurance Brokers Pvt. Ltd., IRDAI Broker code - IRDAI / DB 958 / 2022, Valid Till date - 25 / 06 / 2026, Licence Number-899, CIN No.: U67200UP2022PTC164788, Principal officer name: Ankush Jain,
Contact No.: 91+ 90452 83235, Email ID: ankush.jain@upsurebrokers.com