ENROLLMENT FORM PHOTO

PART A : PERSONAL DETAILS

Name : ________________________________________________________________

Address :
_______________________________________________________________

_______________________________________________________________________

Contact No : _______________________ Email ID :

____________________________

Gender :- Male Female Date of Birth :

________________________

Educational Qualification :
_________________________________________________

Hairdressing Qualification :
________________________________________________

Past Experience : ________________________________________________

PART B : SALON DETAILS

Name :
_________________________________________________________________

Contact No :
_____________________________________________________________

PART C : IDENTIFICATION DETAILS (for office use only)

Reg _NO : ____________________________ Date of Issue :
______________________

PART D : FEES (for office use only)

Mode of Payment : PDC– In the name of JUICE HAIR MARKETING PVT
LTD

Payment Details :
Sr Chequ Chequ Chequ Pan Card Name of the Bank
N e No. e e no
o. Dated Amou
 nt

I / We, the undersigned, hereby declare that we have read and

understood the terms and conditions and the instructions applicable to
JUICE HAIR ACADEMY and agree to be bound by the same at all times.

Date : _____________ ________________________

Signature of
Student