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*Full Name 
D.O.B  
Birth Place
Contact
*Email   
Address
 
Pincode
Partnership 
INFRASTRUCTURE FOR PARTNER OPERATIONS 
Whether having any premises 
CHOICE OF CITY FOR PARTNER CENTRE 
Choice of city for partnership center
Population of city
How many centers are there in the city
INVESTMENT 
 
How much money do you propose to invest in centre? 
Please explain why you want to be associated with us
EDUCATIONAL BACKGROUND 
Education Uni./Institute Subjects Passing year Percentage/CGPA
Post Graudation
Graudation
HSC
SSC
Any other certification
PRIOR WORK EXPERIENCE (IF ANY) 
Nature of Involvement Name of Organization Nature of Business Year(from) Year(to) Turnover (lacs) Products No. of Emp
OTHERS 
Mode of Information




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