PERSONAL DATA FORM

PERSONAL DATA FORM

Personal details :

Name:

Mr. / Ms. / Dr.___________________________________________________

Home Address:

_______________________________________________________________

Tel (Res):

__________________________

(E-mail):

_________________________

Tel (Off):

__________________________

Fax :

_________________________

Date of Birth:

__________________________

Education :

_________________________

Business Owned / Managed :

Please give a brief description of the business owned / managed by you :

1.Business name:

_______________________________________________________________

2.Address

_______________________________________________________________

3.Business Type

_______________________________________________________________

4.Experience
(Business / others)

_______________________________________________________________

5. Products / Services	Organisation associated with :
_________________________________	_________________________________
_________________________________	_________________________________
_________________________________	_________________________________
_________________________________	_________________________________

6. Seeking Business Opportunities in the following areas : (List preference)

1. ________________________________________________________________

2. ________________________________________________________________

3. ________________________________________________________________

7.Not interested in :

1. ________________________________________________________________

2. ________________________________________________________________

3. ________________________________________________________________

Comments: ________________________________________________________

(You may furnish additional information about your business or your specific interests in a separate sheet which could help us understand you better).

8. Infrastructure

a) Management	______________________________________
b) Manpower	______________________________________
c) Premises (Size / Location)	______________________________________
d) Office Equipments / Plant & Machinery	______________________________________
e) Business Network	______________________________________
f) Indicative Investment Size Rs.	Rs. ________________ $ _________________
g) Quantum of additional funds that can be arranged (if required) :
	Rs. ________________ $ _________________

9.References:

1.____________________________________________________________

____________________________________________________________

2.____________________________________________________________

____________________________________________________________

10. Comments :

_____________________________________________________________

__________________________________________________________________________________

______________________

Signature(s)