Registration

Applicant Information
Astrology Franchise Application
Name:
IC No/Passport No:
Date of birth:	Time of birth: Hr Min	Age:
Religion:	Contact No: (R)	Contact No: (HP)
Current Address:
Postcode:	City:	State:
Occupation
Self-employed	Nature of Business:
Under employment	Name of Company:	Position:
Address:
Postcode:	City:	State:
Phone:	Fax:	E-mail:
Annual income:
Co-applicant’s Information
Name:
IC No/Passport No:
Date of birth:	Time of birth: Hr Min	Age:
Religion:	Contact No: (R)	Contact No: (HP)
Current address:
Postcode:	City:	State:
Co-applicant’s Occupation
Self-employed	Nature of Business:
Under employment	Name of Company:	Position:
Address:
Postcode:	City:	State:
Phone:	Fax:	E-mail:
Annual Income:
Capital
Availability of Investment Fund:
	Maximum Cash Amount: RM
	Maximum Loan Amount: RM
Territory Location
Proposed / Applied Location:
Have you operated a franchise business before?
	If yes, name of the franchise:
	If yes, is the franchise still in operation?
	Date of franchise start operation:
	Has the franchise agreement ceased? Date of ceasation:
Disclaimer and Signature
I certify that my answers are true and complete to the best of my knowledge. I understand that false or misleading information in my application would not be entertained.
Checklist (COMPULSORY to be attached with the submission of Franchise Application Form): Passport size photos of applicant & co-applicant Photocopied Malaysian identity card or passport of applicant & co-applicant