KUDUMBAM REGISTRATION FORM

RS Name

RS Code

HUL Outlet Code

HUL Outlet Name

Town Name

TSO Name

RSSM Name

Outlet Requirements
Who is the decision Maker at Outlet? Tea Master Owner
Name of Owner
How old into the HTS business ?
Name of Tea Master (if necessary):
Outlet Address -

Pin Code*

Mobile Number Prepaid Post Paid

Date of Birth* Day Month Year

Home Town / Village

Child Name 1

Child 1 DOB Day Month Year Class

Child Name 2

Child 2 DOB Day Month Year Class

For Official Use

Salesman Name Mob

Distributor Name Mob

TSO Name TSO Signature

TSO Mob No

For Call Centre Use

Registration Complete Y N Membership No.

Date of Verification Signature