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Name of the Firm:
Type of the firm:
(Please select the suitable option or mention in remark column)

   
Name of Director/ Proprietor/ Authorized Person:
Mailling Address:
Contact No:
Mobile No:
Fax No:
Email ID:
Current area of working:
(Please specify the name of District)
Proposed Area of Working:
(Name of the districts shall be targeted for Aksma)
Name of the companies with whom current business exist:
Current Turnover / Month in Rs.:
Proposed Turnover with Aksma Laboratories Pvt. Ltd.:
Major compositons marketed in your area:
Your specific business requirement (if any):

  



 
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