Franchisee Application Name of the Applicant : Mobile Number : E-mail Id : State : Andaman-Nicobar Andhra Pradesh Arunachal Pradesh Assam Bihar Chandigarh Chhatisgarh Dadra Nagar Haveli Daman,Diu Delhi Goa Gujarat Haryana Himachal Pradesh Jammu And Kashmir Jharkhand Karnataka Kerala Lakshadweep Madhya Pradesh Maharashtra Manipur Megalaya Mizoram Nagaland Orissa Pondicherry Punjab Rajasthan Sikkim Tamil Nadu Tripura Uttar Pradesh Uttranchal West Bengal Address : City : District : Pincode : Please Tick which you already have: OfficeInternetComputer with Printer and ScannerMan PowerFaxBank AccountPan CardContacts Select Franchisee Model : Basic Premium Super Model Deposit Amt Commission PIN Options & Limit Basic Rs.1,00,000/- 3% PIN selection as per requirement & Limit as per Deposit Amount. Premium Rs.2,50,000/- 3.5% PIN selection as per requirement & Limit as per Deposit Amount. Super Rs.5,00,000/- 4% PIN selection as per requirement & Limit as per Deposit Amount. I hereby submit our franchisee application and confirm that we meet all the above requirements as per your terms and condition. Generate New Image Type image code.