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