AGENT CRM
BSE EBIX POS Registration
Email ID
*
Username
*
Password
*
Required min 8 Character with alphanumeric, capital and 1 special character
Example - BseEbix@12
Confirm Password
*
Title
*
--- Title ---
Mr.
Ms.
Mrs.
Full Name
*
Gender
*
--- Select Gender ---
Male
Female
Transgender
Date of Birth
*
Marital Status
*
--- Select Marital Status ---
Married
Single
Divorcee
Widow
Contact Number
*
Address
*
--- Select State ---
ANDAMAN AND NICOBAR ISLANDS
ANDHRA PRADESH
ARUNACHAL PRADESH
ASSAM
BIHAR
CHANDIGARH U.T.
CHHATTISGARH
DADRA AND NAGAR HAVELI
DAMAN AND DIU
DELHI
GOA
GUJARAT
HARYANA
HIMACHAL PRADESH
JAMMU AND KASHMIR
JHARKHAND
KARNATAKA
KERALA
LAKSHADWEEP U.T.
MADHYA PRADESH
MAHARASHTRA
MANIPUR
MEGHALAYA
MIZORAM
NAGALAND
ODISHA
PONDICHERRY U.T.
PUNJAB
RAJASTHAN
SIKKIM
TAMIL NADU
TELANGANA
TRIPURA
UTTAR PRADESH
UTTARAKHAND
WEST BENGAL
--- Select City ---
Pin Code
*
Qualification
*
--- Select Qualification ---
Minimum SSC
Graduate
Post Graduate
PAN Number
*
GST Number
Only GST number in name of PoSP as Individual and not any Company GST number
Example - 29AAGCB7383J1Z4
GST Certificate
Channel
*
--- Select Channel ---
Mutual Fund
Ebix
Others
Coordinator Code
I agree to BSE EBIX's
Terms & Condition
.
If you are already registered as an Insurance Agent/PoSP, your registration may not go through.
Submit & Next
If you have already registered with BSE EBIX
click here
to Login.
