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Franchise Registration Form

Franchise Information

Center Name * :

Enter No of Computer * :

State * :

District * :

City * :

Center Address * :

Ward/Town * :

Center Pincode * :

Center Contact Number * :

Franchise Owner Information

Full Name * :

Father Name * :

Mother Name * :

D.O.B. * :

Gender * :

Male

Female

Permanent Address * :

Mobile Number * :

Alternte Number

Email ID * :

Select Center Photo * :

Select Owner Photo * :

Security Code

Enter Security Code * :

Submit Reset

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