Professional Data Form
Companies seeking Franchise are requested in fill-in this form and submit.
Name of Organisation *
Your answer
Constitution of Organisation *
Interested Segment & Product Line *
Your answer
Area of Operation *
For which geographical area would you like to have franchise rights? Eg: Mumbai, Pune etc.
Your answer
Statutory Details
Drug License No (Full) *
Your answer
GSTIN *
Your answer
Contact Details
Office Landline Number
Your answer
Office Mobile Number, if any.
Your answer
Organisation Email ID *
Your answer
Other Details
No. of MR's working in your organisation *
Your answer
Dealing with other companies, if any. *
Please list down other companies that your organisation is dealing with.
Your answer
How did you come to know about Novalife Healthcare *
Financial Details
Expected Turnover that can be achieved and the tentative investment that the company can make.
Expected Turnover in Year 1 *
Your answer
Expected Turnover in Year 2 *
Your answer
Expected Turnover in Year 3 *
Your answer
Tentative Investment *
Your answer
Details of Person-in-charge
Details of the Proprietor, Partner or Director in charge, who would be dealing with our company.
Name of Proprietor/Partner/Director *
Your answer
Date of Birth *
MM
/
DD
/
YYYY
Mobile Number *
Your answer
Work Experience *
Please provide no. of years of experience.
Your answer
Submit
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