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Apply for Franchisee

Partner with us to expand healthcare access

1 Position Applied

Franchise₹12,000Franchise

District Franchise₹100,000District

Block Franchise₹12,000Block

State *

District applied for *

Block applied for *

Fee payable: ₹12,000

2 Personal Details

Full Name *

Father's / Husband's Name *

Age *

Gender *

Caste Category

Mobile Number *

Aadhaar Number

PAN Number

Highest Qualification *

Experience

3 Address

Full Address *

Village / Mohalla

Panchayat *

Block *

State *

District *

Post Office

Police Station

Pin Code *

4 Photo & Declaration

Passport size photo *

JPG / PNG, max 2 MB

I declare that the information given above is true to the best of my knowledge. I authorise Green Life Family and its representatives to call or SMS me.

Not able to pay now? Your application is saved – pay later from Pay Pending Fee.

Apply for Franchisee

1 Position Applied

2 Personal Details

3 Address

4 Photo & Declaration

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