Franchise Application Form

Fill up form & send us details for franchise approval :

(*) Fields are mandatory !

APPLICATION FORM FOR AFFILATION

State:*

District*

City / Town / Village*

Institute Information :

Name of the Institute *

Year of Establishment *

Status of The Institution*

P.O.*

P.S.*

Pin*

Postal Address of the Institute*

Institute Contact No.

Phone1 *

Phone2

Email ID *

Information About Centre Head :

Name of the Centre Head *

Position Hold of the Centre *

Address of the Centre Head*

P.S *

P.O *

Pin*

Mobile*

Email of the Centre Head*

Date of Birth of the Centre Head*

Nationality *

Religion *

Gender*

DECLARATION

I hereby certify that the context stated above are correct and true to my knowledge and belief and hereby confirm that our Organization / Society / Trust is free from any legal / official disputes whatsover.I accept that any facts stated above. I found incorrect will automatically result in cancellation for nominations associate.However I will have no right whatsover to fight / challenge legally against the judgment in any court of law. All disputes are subject to Malda Jurisdiction only.