UCMAS (INDIA) PVT. LTD.

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Regd. & National Corporate Office : No. A1,1857, 13th Main Road, 6th Avenue, Anna Nagar west, Chennai - 600 040. Tamilnadu, India. Tel : 044-2618 2396 (5 Lines). Fax : 044-2618 1706 / 0143 Email : admin@ucmasindia.com Website : www. ucmasindia.com / ucmasindianac.com

FOP 20 Rev 01

CLASS A

FRANCHISE APPLICATION FORM

Mr/Ms. W/o./ S/o./ D/o. Age :

Date : D

Name
(In Block Letters) Date of Birth Qualification Marital Status Residential Address

PP SIZE PHOTO

Married Street Taluk District

Single : : :

Gender : Male

Female

Town / Village : State : Pincode : Mob : Fax: Place : Street : Town : Taluk : District : State Mob : Mr. & Mrs. Address Mr. & Mrs. Address :

Telephone No. E-Mail

Place
where you are wish to start

Telephone No. Reference

Promotion Planned

Newspaper Presentations

Banners Direct Selling Investment :

Posters Handouts Working Capital :

Infrastructure How did you come to know of UCMAS Are you an UCMAS Franchisee / CI

Space :

FOR OFFICE USE ONLY Franchise Code No. : Franchisee Fee Rs.......................... Receipt No...................... Dated......................... Vice President

Signature of Franchisee

Approved by CMD