Centre Application

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Franchise Application

Title (Dr/Mr/Miss/Ms) *
Full Name *
Address *
Telephone / Mobile Number *
Email
Date of Birth *
Gender *
Married *
Passport Size Photo *

SECTION I: PERSONAL FACT SHEET

1. Educational Qualification (Most Recent First)
Qualification Year of Passing Name of Institution
2. Current Occupation (Please Tick)
To be filled in by those in service
Name of the Current Employer
Designation
Previous Work Experience
Period Organization Name Designation Responsibilities
To be filled in by those in business
Company Name(s) Type Nature Products/Services Years People Turnover
3. Does your professional background involve any of the following?




4. Are you currently associated with any professional group/association?

SECTION II: THE PROPOSED CENTRE

1. How do you propose to set up the center?



Is the Proprietorship/Partnership/Company already in existence?
2. City/Town *
State *
3. When do you propose to setup?
4. Do you already possess a site?
5. If no, do you have a site in mind?
6. Please give details of the site
Agreement Lease (From - To) Area Location + Address
7. If you do not have a site, do you plan to take on rent?
8. How much funds are you willing to invest?
9. Efforts/initiatives
10. Reasons to consider you
Date *
Signature (Upload) *

Live Location

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