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Sri Sresti Marketing Solutions,

16-3-32/C, Kowtha street, Purnanandampet, VIJAYAWADA-520003. Mob:9247110759 www.srisms.com

Agent Application

Name of the Person________________________________________________

Address: ________________________________________________________

_______________________________________________________________

_______________________________________________________________

Education:_________________________________________________________________________

Signature of the candidate: ______________________ Phone: _______________________________

Area covering______________________________________________________________________

Area Allotted_______________________________________________________________________

Date of joining: __________________ Status: ______________________ ______________________

Parents Name______________________________________________________________________

Experience: _______________________________________________________________________

Presently doing in: __________________________________________________________________

Membership amount paid by: Cash / DD No._______________________ ______________________

Remarks: _________________________________________________________________________

Referred By: ___________________________ No: ________________________________________

Name of the Nominee______________________________________________

Address: ________________________________________________________

_______________________________________________________________

_______________________________________________________________

Education: ______________________________________________________

Signature of the candidate: ______________________ Phone: _______________________________

Area Allotted_______________________________________________________________________

Date of joining: __________________ Status: _____________________________________________