Chitfund

Your Name :
Designation :
Organization :
E-Mail :
Phone :(Include Country/Area Code):
Fax :(Include Country/ Area Code) :
Street Address :
City :
State :
Zip :
Country :

What is your organisation Profile :
Your status in organisation :
Are you connected with the field of finance :	Yes No
Have you subscribed to chits before, give details :
What is your monthly Income :
What is your families Monthly Income :
Do you possess a car, give detail of make :
Car is :
Business :	Yes No
You stay in a house that is :
What is the monthly outflow that you would like to contribute towards chits :
What do you tentatively plan to do with the fund :
What is the tentative time frame when you might require the fund :
Any Comments ? :