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To Be a Direct Seller _UNIQUEFORCE HEALTH CARE PRIVATE LIMITED

I hereby declare that:

✔ I have read and understood the policies of the Company which has been mentioned on the Company website.

✔ I have not paid any Entry/Subscription Fee for the registration/enrollment as a direct seller.

✔ I am above 18 years and citizen of INDIA.

✔ I have been made aware of Uniqueforce Health Care Business Plan and the rules & regulaion and Code of business ethics.

✔ I am eligible to execute contract as per india contract act 1872, and I am not convicted, bankrupted and unsound mind.

✔ I hereby declare that the information stated above is true, complete and correct to the best of my knowledge and I am completely liable for any consequence if arises.

Referal Id *

Referal Name *

Join Leg *

SG RG

Applicant Name *

Father/Husband's Name

Gender

Male Female

Date of Birth *

Mobile Number *

State *

City *

Pincode

State code *

Address *

Nominee's Name *

Nominee's Dob *

Relationship with primary applicant: *

Bank Name *

Branch Name *

Account Number *

IFSCode *

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To Be a Direct Seller _UNIQUEFORCE HEALTH CARE PRIVATE LIMITED

I hereby declare that: