LIMO PLUS - Member Registration

Who is your referrer

Placement Sales Executive

Name with initials

Full name

Delivery Address

Permanent Address

Town/City

Select ID Type

ID Number

Date of birth (MM/DD/YYYY) Enter your birth day (MM/DD/YYYY)

Mobile Number

Home Tel Number

E-Mail

Beneficiary Name

Relation Ship Of Beneficiary

Mothers Maiden / Family Name

Select Bank

Select Bank Branch

Bank Account No

Name Registered with bank

Password Enter password at least 8 characters and 1 digit

Confirm Password Enter same password to verify