PRELIMINARY FRANCHISEE INQUIRY AND APPLICATION FORM    
       
  NAME OF THE APPLICANT :
       
  CONTACT DETAILS    
  Registered Address: :
  Address 1 :
  Address 2 :
  City :
  State :
  Zip/Postal Code :
  Country :
  Tel No. :
  Fax No. :
  Email :
  Web Site :
Please tick if its same as Above    
  Business Address    
  Address 1 :
  Address 2 :
  City :
  State :
  Zip/Postal Code :
  Country :
       
  STATUS OF THE APPLICANT AND EXPERIENCE IN SIMILAR BUSINESS    
  Names of Directors/Partners  
  Status of the applicant  
  Qualification of the applicant :
  Number of directors/Partners :
       
  PRESENT BUSINESS DETAILS    
  Name/Trade Name under which business is operated :
  Nature of Business :
  No. of years in operation :
  Turnover for the last three years of the Applicant :
  If dealing in similar business (Ayurvedic Products and Services), please provide details :
       
  DETAILS OF THE PROPERTY AVAILABLE    
  Whether the property is owned/ leased/ rented by the Applicant :
  Address 1 :
  Address 2 :
  City :
  State :
  Zip /Postal Code :
  Country :
  Area in Sq. Ft. (Carpet Area) :
  If Property will be taken on Rent/Lease by the Applicant  
  - Rent Per Sq. Ft. ( in Rs.) :
  - Period for which the Property will be available for use :
  Locational Advantages of the Property
(Please specify in detail)- Nearest railway station/bus stop from the available property		 :
       
  ANY OTHER INFORMATION OF INTEREST OR RELEVANCE    
       
  The undersigned certifies that the information furnished in this Franchisee Application is a true and correct statement of my/ our situation and position on the date indicated. I/ We agree to notify you immediately in writing of any material change in said position. I/ We also authorize Ayushakti Ayurved Private limited and its representatives to make whatever investigations and inquiries that they may consider necessary to obtain and/ or verify all relevant information mentioned above or connected with my/ our Application.