Renatus Wellness Pvt. Ltd.

New Signup

Sponsor and Placement Under IRD

Sponsor and Placement Under Name

Sponsor Details

Sponsor and Placement Under IRD *

Sponsor and Placement Under Name *

Personal Details

(Name and Date of Birth should be entered as per PAN)

Gender

Gender is required.

First Name *

First Name is required.

Middle Name

Last Name *

Last Name is required.

Father Name (should be entered as per PAN) *

Father Name is required.

Birth Date *

Address Details

(should be entered as per Aadhar)

Address1*

Address1 is required.
Address1 is too short.
Address1 is too long.

Address2

Pincode*

Pincode is required.
Invalid Pincode

City *

City is required.

District *

District is required.

State *

State is required.

Mobile No *

Mobile is required.
Valid Mobile Mumber

Email *

Nominee Details

Nominee Name

Relation

Birth Date

Login Details

User Name *

User Name Min 5 and Max 16 characters and contains at least one number.

Password*

Password must be 6 to 16 characters, and contains at least one number.

Confirm Password*

Confirm Password must be 6 to 16 characters, and contains at least one number.
Password and Confirm Password must be same.

I Agree & Understand :Terms and Conditions

Login Details

User Name : {{SignUp.txtUName}}

Sponsor Details

Sponsor and Placement Under IRD : {{SignUp.SponsorId}}

Sponsor and Placement Under Name : {{SignUp.SponsorName}}

Personal Details

Title : {{SignUp.ddlTitle}}

Name : {{SignUp.txtFName}} {{SignUp.txtMName}} {{SignUp.txtLName}}

Birth Date : {{SignUp.ddlDobday}}-{{SignUp.ddlDobmonth}}-{{SignUp.ddlDobyear}}

Address Details

Address1 : {{SignUp.txtaddress}}

Address2 : {{SignUp.txtaddress2}}

City : {{SignUp.txtCity}}

District : {{SignUp.txtDistrict}}

State : {{SignUp.State}}

Pincode : {{SignUp.txtPINCode}}

Mobile No : {{SignUp.txtmobile}}

Email : {{SignUp.txtEmail}}

Nominee Details

Name : {{SignUp.txtNominee}}

Relation : {{SignUp.Relation}}

Birth Date : {{SignUp.ddlDobdayNM}}-{{SignUp.ddlDobmonthNM}}-{{SignUp.ddlDobyearNM}}

Renatus Wellness
2nd Floor, #40, Santosha Nilaya,VES Convent School Road, Gervebhavipalya,Bangalore South, Bommanahalli,
Bangalore - 560068 , Karnataka

Sign Up Acknowledgement

You have been successfully appointed as our Independent Distributor with us. We warmly welcome you to the Renatus Wellness . We hope you cherish your experience with us.


Sponsor Details
Sponsor IRD :	{{Sponsor}}	Sponsor Name :	{{SponsorName}}

Login Details
Distributor IRD :	{{Idno}}	User Name :	{{UserIDNo}}
Password :	********

Personal Details
Name :	{{Name}}	Birth Date :	{{DOB}}

Address Details
Address1 :	{{Address1}}	Address2 :	{{Address2}}
City :	{{City}}	District :	{{District}}
State :	{{State}}	Pincode :	{{PinCode}}
Mobile No:	{{Mobile}}	Email :	{{EMail}}

Nominee Details
Name :	{{Nominee}}	Relation :	{{Relation}}
Birth Date :	{{NomDOB}}

This Data has been recorded with us, however in case of any change in communication or address details you may edit yourself using edit facility provided to you in your back office. In case of any more assistance required you may write to Administrator using feedback facility provided in your back office. Wish you good luck and best of retailing.