Application No:

APPLICATION FOR MEESEVA FRANCHISEE AUTHORIZED AGENT

Applying for the Municipality / Corporation : Tirupati [ ];

Punganur [ ] ;

Applying For The Location / Area

Contact No:

Mail ID:

Chittoor [ ];

Nagari [ ];

Palamaner [ ];

Madanapalli [ ]

[for DeGS Sanctioned Locations only]

APPLICANT NAME

APPLICANT FATHER / HUSBAND NAME

APPLICANT PARMANENT ADDRESS

APPLICANT PRESENT ADDRESS

APPLICANT Educational & Tech., Qualifications:

Experience if any

GENDER

RELIGION & CASTE

ANY Room is available at applying Location

YES [ ] ;

IF YES, Room Size / Area [in Sq.ft.]

Width:

Give Full Address Of The Room

Details, If any existing business in this Room

NO [ ]
Ft X Length:

Ft =_______Sq.ft.

Signature of the Applicant

Application will reach on or before 15.06.2015 to
the Project Manager, HCL Infosystems Ltd., C/o. Mee Seva, Municipal Office Premises, Tirupati

Acknowledgement
Application No
:
Applied Municipality:

Applicant Name :
Applied Location:

Sign: