Name
Business Type Proprietor
Nature of the Business Manufacturer Distributor Others
Please specify whether the business related to
Nature of the business related to Medicines Equipment Others
Address
Street
City
State
Country
Proposed premises Address
Mobile Number
Landline Number
Email Id
The Applicant / Form is an Ayurvedic Medical Practitioner
If Yes, Please specify the No.of Years of Practice
Whether planning to employ a physican Yes
Please specify the Potentiality of the Classic Ayurvedic Treatments in the proposed region Equipment
Please specify the anticipated sales volume in the specified area (INR)
Please specify the amount as Investment you willing to (INR)
Please specify how you would propose to finance the centre Own Fund
When can you start the centre
Please furnish the relevant Information if any