Bajaj Bridge Force Enrollment Form

All the Personal Information provided by the Applicant remains Confidential & is not used for any Marketing & Promotion related Activities by Bajaj Electricals Limited

Full Name*


Date of Birth*

Current Age (Years)*

Phone number*

Email ID*

Residential Address*

Approximate No. of Flats in your Housing Society*

Nearest Railway Station*

Pin Code*

Educational Qualification*

Current Occupation*

Current Yearly Income (Approx)*

Current Family Income (Approx)*

Have you ever been an Insurance Agent or a part of Multi-level Marketing like E-Biz / Amway / Tupperware ?*

Have you ever Sold Home Appliances (Eg Lighting, Fans & Kitchen Appliances) ?*

Do you have the below mentioned gadgets & are you comfortable using them? (Click the box/es)*

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