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Full Name(Required)

S/O, D/O, W/O(Required)

Age(Required)

Aadhar Number(Required)

Permanent address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Bstore Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Email id(Required)

Date Of Partnering With Daksh Innovations LLP/ inception of Bstore(Required)

Amount Paid For B-Store Franchise INR (Rs)(Required)

Phone(Required)

Consent

I/We hereby declare that the details furnished above are true and correct to the best of my/our knowledge and belief and I/we undertake to inform you of any changes therein, immediately. In case any of the above information is found to be false or untrue or misleading or misrepresenting, I am/we are aware that I/we may be held liable for it.

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