Convergence Company Registration Form

Company Login User Name (As Desired) * One lowercase letter, One number, Minimum 6 characters

Registered Company Name *

Is the company registered with the Registrar of Companies of the Ministry of Corporate Affairs? If so, please mention the CIN *

Company Profile - A short write-up (Mentioning Brand name and Website if any) *

Industry *

Name of CEO / MD *

Address - Head Office *

Mobile / Landline *

E-mail *

City *

State *

Pincode *

Name *

Designation *

Mobile No. *

Landline *

E-Mail (Company Domain) *

Name *

Designation *

Mobile No. *

Landline *

E-Mail ID (Alert will go to this Email ID) *

Customer Care Contact Number *

Email ID *

Uploading Authorization Letter *

Uploading Company Undertaking Letter *

I have read and accept the Terms of Service

I have read and accept the Privacy Policy

I have read and accept the Disclaimer

We have read and understood the Terms of Service, Privacy Policy and the Disclaimer as available on the website. We accept and agree to abide by the same.

Name and Designation of Authorised Signatory

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