Sureclean® Pte Ltd

25 Bukit Batok Crescent

The Elitist #09-11
Singapore 658066
Tel : +65 68998643 | Fax : +65 65153864
Website : www.sureclean.com.sg

FRANCHISE APPLICATION FORM

Thank you for your interest in the Sureclean® Franchise. As part of the process, we require you to complete this form and return it to us by email.
All information that you provide will be kept strictly confidential. Please use separate sheets of paper if the space provided is insufficient.
The processing time for the application would take about 2 weeks.

For enquiries, please email franchise@sureclean.com.sg or contact franchise support team at (+65) 68998643 or HP (+65) 96648345

(I) APPLICANT INFORMATION (For individuals, please fill in applicable fields)

Franchise operations to be owned by : Self Group Corporation

Applicant Name : ( Individual / Company )

Country of Incorporation : Registration No. :

Year of Incorporation :

Mailing Address : City : State :

Postal Code : Country :

Contact Person : ( Dr / Mr / Mrs / Ms / Mdm )

Designation : Email :

Tel ( Business ) : Mobile :

Fax : Website :

Private & Limited Liability Public Listed & Limited

Entity Type : ( State Exchange : )
Unlimited Liability Others, please specify :

No. of Employees : Share Capital ( USD ) :

Main Business Activities Last FY Revenue ( USD ) :

(II) FRANCHISE INFORMATION

Country / Area of Interest to operate Sureclean® Franchise : 1st choice

( Kindly note that franchising opportunities is not available for
Singapore market ) 2nd choice

Franchise Rights Interest : Single Unit Area Franchise Master Franchise

Why are you / the company interested in the Sureclean®

Franchise ?

How did you hear about Sureclean® Franchise programme?

Do you or the company have access to landlords or own any

commercial properties in the specified locations ? ( Please specify
remaining lease periods, if any)
Does your company or shareholders / related companies a. Hygiene & Disinfectants Yes No
have past experience or are currently engaged in the
following business? b. Manufacturing and / or
( Please tick ) Distribution of Hygiene & Yes No
Disinfectant products

c. Other Hygiene & Disinfectant Yes No

Business

If YES to any of the above, please provide details of the business (company name and relation, bramd, type of food sold, services provided, etc.)

If NO to all the above, please provide details of past and existing experience for the last 5 years

Yes If YES, please highlight brand/business, including tenure and

Do you / the company have any business activity:
Franchise expereince ?
No

(III) INVESTMENT CAPITAL

Funds available to invest in this USD100,000 to USD500,000

Franchise :
USD500,001 to USD1,000,000

Above USD1,000,001 (Please specify amount : )

Main Bank :

Bank Manager :

Current Net Worth :

(IV) OTHER INFORMATION

Are you / the company willing to set up a separate entity solely to Yes No
conduct Sureclean® business ?

Please provide any other relevant information that will enable the
Franchisor to better assess you / the company's suitability to be a
Sureclean® Franchisee :

To enable the Franchisor to assess the busines strategies and the

market potential of Sureclean® in respect of your chosen territory,
please elaborate, about the reasons behind your favourable
assessment of the specific location being suitable for Sureclean®'s
type of business.

On behalf of myself or my company, I confirm my / our genuine interest in the Sureclean® Franchise and declare that all information provided herein
is true and accurate to the best of my knowledge. I understand that any misrepresentation or ommission of information may affect the outcome of the
grant of the Sureclean® Franchise.

Signature : Date :

Name : Designation :