Title
:
Mr.
Mrs.
Ms.
Miss.
Dr.
*
First Name
:
Enter your first name.
Middle Name
:
*
Last Name
:
Enter your last name.
*
Date of Birth
:
Day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Month
January
February
March
April
May
June
July
August
September
October
November
December
Year
1954
1955
1956
1957
1958
1959
1960
1961
1962
1963
1964
1965
1966
1967
1968
1969
1970
1971
1972
1973
1974
1975
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1977
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1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
Age :
Years
*
Address
:
Enter your address.
*
City
:
*
State
:
*
Country
:
Pin
:
Pincode should be numeric
*
Phone 1
:
-
-
Enter phone no.
Phone no. should be numeric
Phone 2
:
-
-
Phone no. should be numeric
*
Mobile
:
-
Enter your mobile no.
Enter valid mobile no.
*
Email
:
Enter your emai id
Enter your valid email id
Current Occupation
:
Service
Business
Both
How do you propose to set up the center?
:
Proprietorship
Partnership
Private Ltd.
Trust
Society
Public Ltd.
Is the proprietorship / Partnership / Company / Already in existence?
:
Yes
No
Location of proposed new venture
:
When do you propose to setup the new venture?
:
Immediately
Within next 3 months
Next 3 to 6 months
Do you already possess a site?
:
Yes
No
If no, do you have a site in mind?
:
Yes
No
Please give details of the site
:
In case you do not have a site, do you plan to take on rent?
:
Yes
No
If yes, within how many months?
:
How much fund are you willing to invest?
:
10 Lacs
15 Lacs
20 Lacs
More than 20 Lacs
What efforts / initiatives would you put in to make this business a success?
:
State reasons why Genius inc. should consider you as a business partner?
:
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