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Franchise Program: Application Form


Guidelines:
  • Please enter all relevant details.
  • Please tick the appropriate answer, wherever applicable.
  • Attach your current profile, business portfolio and business card with this application form.

Photo

Note : The photo should be in jpg formate.

PLEASE WRITE IN CAPITALS LETTERS

SECTION I: PERSONAL INFORMATION

1. Qualification (beginning with the most recent):

Qualification Name of Institution Year of Passing

2. Current Occupation: (Please Tick)

A) If in service, kindly fill the following details:

Period Organization Name Designation Responsibilities

Kindly give 2 work references:

Name Designation Company Name Contact No.
Current Employer
Previous Employer

B) If in business, kindly fill the following details

Company's Name(s) Proprietary/ Partnership/ Private Ltd./ Public Ltd. Nature of Business Products/ Services offered Years in Business Number of People Employed Turnover (Rs.)
Last 3 Years

3. Are you currently associated with any professional group/association in any form?

4. Does your professional background involves any of the following? (Please tick the appropriate box)

5. Any legal proceedings pending against you in India or abroad?



SECTION II: THE PROPOSED CENTRE

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

2. Is the Proprietorship/ Partnership/ Company/ already in existence?

3. City/Town where you propose to setup the new venture

4. When do you propose to setup the new venture?

5. Do you already possess a Land/Campus/Site?

If yes, please give details of the site :

Nature of Agreement (Ownership/ Rental/Long Term Lease) Period of Lease Carpet Area Location: Commercial Area/ Residential Area (Address)

6. In case you do not have a site, do you plan to take on rent?

7. What efforts / initiatives would you put in to make this business a success?

8. State reasons why Dentedge Healthcare should consider you as a franchise?