Franchisee Association Query Form

Franchise Query Form

* Indicates required field

Applicant Name *

First

Last

Mobile Number *

Email *

Upload any Govt. ID Proof of the Applicant *

Max file size: 20MB

Applicant's Qualification *

Medical & Allied Health Sciences Graduate Other UG Medical & Allied Health Sciences PG Other PG UGC Recognized Doctorate

Upload the Highest Academic Proof of the Applicant *

Max file size: 20MB

Applicant's Acupuncture Qualification *

Certificate Course Diploma Course Advanced / Master Diploma Course Any other Course

Upload the Highest Acupuncture Qualification of the Applicant *

Max file size: 20MB

Teaching Experience of the Applicant *

0-1 years 2-5 years 6-10 years 10 years +

Address Intended to Start the Centre *

Line 1

Line 2

City

State

Zip Code

Country

Carpet Area in Sq.ft *

Upload the Exterior Photo (from Road View) *

Max file size: 20MB

Upload the Interior Photo ( Classroom View ) *

Max file size: 20MB

Is there a Clinic attached for Practical Demonstrations? *

Yes No

Upload the Clinic Photo *

Max file size: 20MB

Submit

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