Please take a few minutes to fill out information on yourself, and the services/additional information that interest you. We will get in touch with you as soon as we receive your inquiry. Don't forget to provide your email address in the form below.

Date :

 

Citizen Of :

 

Date Of Birth :

 

Last Name :

First Name :

Middle Name :

Other names known by :

(Country & City Code) Telephone Home :

 

(Country & City Code) Fax :

 

(Country & City Code) Mobile :

 

Present Address :

Address :

City :

State/Province :

Postal Code or Zip :

Country :

E-Mail :

Spouse's Last Name :

Spouse's First Name :

Spouse's Middle Name :

Citizen Of :

 

Date Of Birth :

 

Other names :

 

EDUCATIONAL BACKGROUND

School :

COLLEGES

College 1 :

College 2 :

College 3 :

College 4 :

UNIVERSITY'S

University 1 :

University 2 :

University 3 :

                                    BUSINESS INFORMATION(All spaces below must be completed)

Self Employed

Employed By

No Year :

Address :

City :

State :

Pin Code :

(Country & City Code) Telephone (Business) :

Position :

Nature Of Business :

                                                        REFERENCES(Excluding Relatives)

Reference Name :

Address :

(Country & City Code) Telephone :

                                                      PERSONAL INFORMATION

Income from present occupation Rs :

per year

Other income Rs :

per year

If other Income, explain :

Personal Bank Details

 

Bank Details 1 :
(Branch/Address/City/State/Province)

Bank Details 2 :
(Branch/Address/City/State/Province)

Bank Details 3 :
(Branch/Address/City/State/Province)

                                                   SPECIFIC DATA

Would this business be your sole source of income? :

Yes

No

Own Home or Rent? :

Rent

Own

If Own,Current Value Rs :

Mortgage Rs :

Your Total Assets :

Your Total Liabilities Rs :

Your Net Worth Rs :

Amount of cash available for investment :

Amount of Financing Available Rs :

If qualified,when would you be ready to invest in your Franchise? :

Will you be the sole owner of this business? :

Yes

No

If Names are to be Included on the Franchise Agreements,
Please have these individuals fill out a seperate application.

Estimated training date should you choose to invest? :

                                Area for additional information if any :

I understand that the granding of a franchise is at the sole discretion of Franchisor Vasudeva Vilasam Aryavaidyasala Pvt Ltd,Fort Trivandrum.Everything i have stated in this application is true and i understand that the information provided by me will be relied upon by the Franchisor.

Date :

Name :

 

Date :

Spouse's Name :

Kindly Send the application form to :-
If interested,Kindly contact,
Vice President(Franchise),
Vasudeva Vilasam Aryavaidyasala Pvt Ltd.
Fort, Trivandrum 695023,Kerala India.Tele:+91 471 4091000,Fax:+91 471 4091010.
Email : franchisee.vvnh@gmail.com