AIC Ambassador Program - AutoimmunityCare

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Official Ambassador Application

Apply for Ambassador Access

Please complete your verification & banking details below. Applications are reviewed within 24–48 hours.

1 Personal Details

Full Name *

Email Address *

Phone / WhatsApp Number *

Full Residential Address *

2 KYC & Tax Verification

Required for regulatory compliance and tax reporting in India. Encrypted using AES-256.

PAN Card Number *

Aadhaar Number *

3 Bank Account Payout Details

Monthly commission payouts will be deposited directly to this account.

Account Holder Name *

Bank Name *

Bank Account Number *

Confirm Account Number *

IFSC Code *

UPI ID (Optional)

4 Social Media Profiles & Network

Please provide your social media profiles so we can verify your audience reach.

Instagram Profile / Handle

Facebook Profile / Page Link

LinkedIn Profile Link

X (Twitter) Profile / Handle

Estimated Audience Reach / Followers *

Have you purchased from Autoimmunity Care before? *

Yes, I am an existing customer No, I am a new advocate / influencer

Previous Order ID / Details (if applicable) We will automatically cross-check your email and order history in our database.

5 Proposed 10% Pool Split Preference

Select your preferred split between customer discount and your ambassador commission (total pool = 10%). Upon approval, your initial coupon code will be generated with this split.

Customer Discount

5% OFF

10% Total Pool

Your Ambassador Commission

5% Commission

5% Customer Discount

Use the - and + buttons to adjust the discount percentage (0% to 10%).

6 Security & Agreement

Security Verification: What is 3 + 2? *

I have read and agree to the AIC Ambassador Terms & Conditions. *