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KADAMAKUZHY P.O.
VALLAKKADAVU
KATTAPPANA SOUTH PO
PIN: 685515
E-mail:benoy@live.in
1) What levels of education have you completed (please specify school and major):
High School, Some College, Professional Degree, Bachelors Degree, Masters Degree, Doctorate.
Higher Secondary
_____________________________________________________
2) Who is your current employer and occupation? (What job pays your bills now?)
4) Please circle those that apply: Married, Separated, Boyfriend / Girlfriend, Single, Engaged
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How long have you been in your current relationship? Married, 27-04-2009
8) What is the next milestone in your life if you do not make it to the Show?
When I was in Gujarath, I was the victim of Earth Quake. So many people died. At the
time of earth quake, I was taking bath in the morning. That time I was afraid.
________________________________________________________________________________________
12) What makes you a great contestant for ‘Deal or No Deal’ (“Show”)?
________________________________________________________________________________________
________________________________________________________________________________________
13) Besides the Show, what game show would you be the best contestant for and why?
________________________________________________________________________________________
14) List all TV game/talk/reality shows/contests which have already aired or which may air
within the next
year, on which you have appeared, and whether or not you won any prizes. If you have NOT
appeared on
any such shows, please state this. Do not leave the space below blank.
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Show Name Air Date Amount Won
15) Below please list the people you would like to appear with you on the show to help support
you:
Supporter #1:
Telephonel # : __9946548001,
9447232154______________________________________________
Why do you want this Supporter with you on stage? _____He’ll guide
me_______________________
Supporter #2:
Telephone # : _9496300584________________________________________________________
Why do you want this Supporter with you on stage? _________She’ll be always with me for
any time
Supporter #3:
Telephone # :
_9846017686_____________________________________________________________
Please list any additional supporters you may wish to appear with you on camera
(along with the same
information asked above) on the back of this page.
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16) Have you ever been charged/accused with any crimes? _____No_______________________
17) If YES, please describe in detail, tell us when and where the event occurred, and what the
outcome was including FIR/Case
numbers:______________________________________________________________
19) If YES, please describe in detail, tell us when and where the event occurred, and what was
the sentence /
punishment:__________________________________________________________________________
20) Is there any pending litigation against you? _______No__________. If YES, please describe
when and where
the event(s) occurred, the other party (ies) to the lawsuit(s), whether you were the plaintiff
or defendant,
the nature of the case(s), and what the outcome was for each
case_______________________________
21) Is there anyone among your family, friends, or work colleagues that would object to your
appearing on
television? (NO) (Circle One). If YES, please identify all such persons, including your
relationship
I agree and accept that in the event of any death or injury or bodily harm caused to me at the
time of auditions/ shooting of any episode of the Show/ Program, Endemol India Private
Limited and Sun TV Network Limited shall not be responsible for the same.
I agree that the selection will be at the sole discretion of Endemol India Private Limited and
Sun TV Network Limited and it is understood by me that the rules are subject to changes
without any notification.
I hereby acknowledge that: (i) I have read the Terms and Conditions attached herewith and
agree to be bound by the same and the eligibility requirements; (ii) I have answered the
previous questions honestly, completely and accurately; (iii) if any of the above information is
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found to be false or incomplete, this will be grounds for dismissal from the selection process for
the Show, and/or from the Show itself, if selected. Further Endemol India Private Limited and
SUN Network Limited reserve the right to change/ modify the terms any time without any prior
intimation.
Date: 06-10-2010
Place: Kattappana
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