Nextgen Franchisee Application

* Fields are compulsory

Personal Details

Mobile Number *

Do you have a PAN Card? *

Yes

PAN Number *

Pan Card Image Upload *

JPG/PDF File(Size less than 5 MB)

Entity Type *

Applicant Name *

Title *

First Name *

Middle Name

Last Name *

Gender *

Male

Female

Other

Date of Birth *

Current Occupation *

Specially Abled? *

Yes

How did you come to know about Vakrangee Kendra? *

Are you an Ex Employee? *

Yes

Ex Employee Name *

WhatsApp Mobile Number *

Email Address *

Franchisee Address Details

Current Address (As per Address Proof)

Address Line 1 * Maximum of 35 characters allowed.

Address Line 2 Maximum of 35 characters allowed.

Landmark

Maximum of 35 characters allowed.

State *

District *

Village/Town/City *

Pincode *

Permanent Address Same as Current Address

Address Line 1 * Maximum of 35 characters allowed.

Address Line 2 Maximum of 35 characters allowed.

Landmark

Maximum of 35 characters allowed.

State *

District *

Village/Town/City *

Pincode *

Address Proof Type *

Address Proof Number *

Scanned copy *

JPG/PDF File(Size less than 5 MB)

Proposed Vakrangee Kendra Detail

Is the kendra location identified? *

Yes

Address 1 *

Address 2

Landmark

Locality *

State *

District *

Village/Town/City *

Pincode *

Referred By

Employee Name *