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Application No:

APPLICATION FOR MEESEVA FRANCHISEE AUTHORIZED AGENT

Contact No: .

Mail ID: .

Applying for the Municipality / Corporation : Tirupati [ ]; Chittoor [ ]; Nagari [ ];

Punganur [ ] ; Palamaner [ ]; Madanapalli [ ]

Applying For The Location / Area :

[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 [ ] ; NO [ ]

IF YES, Room Size / Area [in Sq.ft.] : Width: Ft X Length: Ft =_______Sq.ft.

Give Full Address Of The Room :

Details, If any existing business in this Room :

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 : Applicant Name :

Applied Municipality: Applied Location:

Sign: