VIJAYEE BHAVA Application Form

A Unique Program for Entrepreneurial Leadership & Success ( All columns to be filled by the
applicant. May use extra sheet if
By K Chittilappilly Foundation space provided is insufficient)
(Photo)
Name Received on

Date of Birth Age Religion Male o Status

Female o
Place of Birth Present Place of Work Languages known Marital status No. Of
o Married children
Mother Tongue District o Single

Present Address Official Address Educational Qualifications

o Undergraduate
o Graduate
o Post graduate

Contact Nos : Professional

Email id : Qualifications ( specify)
Presence in Social media o Whatspp o Facebook
Details of Business -- Name of Organisation :
Type of Business : o Production o Trading o Distribution o Service o other - specify

Ownership of business o sole Proprietor o Partnership o Private Ltd

Brief description of business : ( Attach Brochure/leaflet etc and Registration certificate as proof of business)

Your Designation & Role in the Organisation

No. of yrs in Business: Annual Turnover ( Rs Lakhs): No.of employees:

Products/ service offered :

Markets covered : o Domestic o National o Export

Are you involved in any social activities or member of any social groups ? give details

Do you belong to a business family? give details Present stage of business

o Growing o Losing
o stagnant
Your Expectations from this program
Your Financial Background
o High
o Good
Have you been referred by any VB Alumni? If so, give details :
o Poor
If not, Please enclose letter of reference by any Responsible person from your locality
Place For Office Use
Date
Name & signature of Applicant

Filled in applications to be sent to :

K Chittilappilly Foundation, KCF Tower, Bharata matha College Road, Thrikkakkara, Kochi- 682021, email : kcfcochin@gmail.com