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STARTER’S DETAILS INFOLEAF
ACTIVE DATA SOLUTION
Contact No. +91-8872517037 +91-9568009125
Email: activedatasolution@gmail.com




First Name: Naveen Middle Name: .……………….
 
Last Name:   R …………………………......…………………..

Address for Correspondence: Tejas lake view homes, siruseri,
chennai, tamilnadu.…………………………………….………………

City: Chennai      …………………………….……………………….

State: Tamilnadu ……………………………………………………………….

Contact No:  7892196833      ….Email: Hak88877@gmail.com                             ……….

Academic Qualifications: MCA ………………………………………………………...

Current Occupation: STUDENT   ……….………………………………………………..

Date of Birth: 10-06-1996             … Sex: MALE …………………………………....

User No. 1 0 0 0 6 1 5 5 3 4.................File No.
AD
– 18734 – 2496 – 05 ………………...

Issue Date: 17 Feb 2018…….……….Last Date: 23 Feb 2018......……………………........

Bank A/c Holder Name & A/c No: Naveen R  &  120710100023114 …….…………

Bank Name & IFSC: Andhra bank & ANDB0001207 .……………....

Applicant Signature:  Naveen R                                   Dealer’s Signature:
Ravi Kumar

Payment Received: Rs. 150/-         For: Active Data Solution
                    Signature