Referral ID :

{fld-sponsor_id class="form-control" placeholder="Referral ID" style="width:300px"}

{err-sponsor_id}

Name :

{fld-first_name class="form-control" placeholder="Name as per PAN CARD"}

{err-first_name}

Email :

{fld-email class="form-control" placeholder="Email"}

{err-email}

Mobile :

{fld-mobile class="form-control" placeholder="Mobile"}

{err-mobile}

Nominee :

{fld-nomineename class="form-control" placeholder="Nominee"}

{err-nomineename}

Nominee Relation:

{fld-relation class="form-control" placeholder="Relation"}

{err-relation}

Captcha Code :

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Enter the code :

{fld-vcode class="form-control"}

{err-vcode}

{fld-sb class="btn px-5 btn-primary-dark transition-3d-hover"}