Maya Drivers' Registration
Maya ambulance service's driver's registration form
What will you sign up as?
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Ambulance Driver
Ambulance Owner
Will you require financial assistance?
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Yes
No
For your signatures, passport photograph, your Aadhar card, PAN card, license, etc
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Take photo with device
Upload images from device
Referral ID
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Next
Personal Details
Take passport photograph
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Upload passport photograph
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600 x 600 pixels (Maximum file size: 1 MB)
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of
Full name
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Father's Name
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Address
Street Address
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PIN Code
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Post Office
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Please Select
Head/Branch/Sub - post office
Village/Locality
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Please Select
others
Select 'others' to if village/locality is not listed
Specify Village/Locality
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Sub District Name
District
State
Date of Birth
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-
Day
-
Month
Year
You may fill in the date manually (in the specified format)
Gender
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Male
Female
Others
Phone number
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Alternate number
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Email
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Next
Identification Documents
Aadhar Card
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Aadhar card (front)
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Aadhar card (back)
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Aadhar card (front & back)
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Upload two images: front of Aadhar card, back of Aadhar card
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of
PAN Card
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PAN Card (front)
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PAN Card (front)
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Upload one image: front side of your PAN card
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Driving License Number
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Driving License (front)
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Driving License (back)
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Driving License (front and back)
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Upload two images: front of License, back of License
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Commercial Driving License?
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Yes
No
License Expiration Date
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-
Day
-
Month
Year
Qualification
Present Occupation
Past Experience
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Next
Bank Account Details
Account Holder's Name
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Account number
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Confirm (re-enter) account number
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IFSC
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Please use UPPERCASE letters
Bank Name
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Branch Name
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Take photo of PASSBOOK or CANCELLED CHEQUE
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Upload photo of PASSBOOK or CANCELLED CHEQUE
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If any case of accident/crashes
If any case of police
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Reference #1
Person to be contacted when necessary*
Name
*
Father's Name
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Address
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
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Please enter a valid phone number.
Take photo of signature
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Upload photo of signature
*
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of
Reference #2
Name
*
Father's Name
*
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Please enter a valid phone number.
Take photo of signature
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Upload photo of signature
*
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This certifies that this application was completed by me, and that all entries on it and information in it are true and correct to the best of my knowledge
Take photo of signature
*
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*
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Submit
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