Platinum Enrollment Form

VIN*

Model*

Membership for*

Membership to be taken in the name of the Owner

Membership to be taken in the name of the User related to the owner

Personal Details

Owner Name*

Date Of Birth*

Owner Mobile*

Email*

Gender*

Male

Female

Others

Edit Address

Address*

Pin Code*

Nominee Details

Nominee Name*

Nominee Contact Number*

Nominee Edit Address

Same as user

Nominee Address*

I,

agree to the terms and conditions of Hero GoodLife program

Please select if you are a member of Hero Family