Name Of the Applicant *
Father/Husband’s Name *
Location for Mega Store*
District*
State*
Pincode*
E-Mail*
Mobile No*
Does Applicant have any other business, if yes then detail *
Proposed area*
Expected Investment*
If Associated with any Political/Social/Religious Institution then give Detail
Detail of existing nearest Patanjali Chikitsalaya and Arogya Kendras* 1. 2. 3.
Number of Patanjali Kendras in the Name of Applicant or his family/Relatives
If Mega Store, Number of Mega Store
If Chikitsalaya, Number of Chikitsalaya
If Arogya Kendras, Number of Arogya Kendras
If Distributor, Number of Distributor
I Agree with Term and Conditions
