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  NEW APPLICATION      [ *Note -  *  indicates Information required ]
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First Name                               *:

Age * :

Sex * :

Middle Name   :
Last Name                                *:
Father's/Husband's Name      *:
Company/Firm Name          [if any]    :
Name of Partners   :
   
Proposed Shop Address       *:
   
Village/Town/City       *:
State                                         *:
Pin/Postal Code                    *:
Shop Phone No.                        :
Panchayat          :
Ward No.           :
Police Station                :
Residential Address  [Permanent]                          *:
   
Village/Town/City       *:
State                                         *:
Pin/Postal Code                      *:
Phone  No.                            *:
Fax No   :
Police Station *:
Location of the Shop              [Nearest Prominent]      Landmark   :
Nearest MOTHER DAIRY     Selling Outlet [If any]   :
Financial Condition            [Monthly Income]   :
Proposed Outlet *:
Bank Account                           [ If any ]   :   [Type of A/C & Account No.]
Minimum Guaranteed Sales/Day   :  [ For Milk ]          
Minimum Guaranteed Sales/Day   :   [ For Milk Product ]
 

 
 

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