[Company Logo Image]


            STATUS HOLIDAY  pvt.Ltd.                                    Shri sankheshwaraparshvanath namah

405-406,maherpark-B,Athwaget,Ring Road,surat-2.            APPLICATION  FORM

TEL/FAX:(0261)476536                                                    Application   No.

e-mail :statusho@wilnetonline.net                                        


Dear sirs,

I wish to become member of status holiday Pvt. Ltd '' FORTUNET '' I have understood the package. red the terms and condition & agree to them . the concept of FORTUNET has been clearly explained & understood by me and  I was to become on independent agent of the business.

First Name                        Middle Name                             Last Name


Birth Date                        Name of Spouse                         Birth Date (of spouse )


Occupation                      Organisation                               Destination/Department


Office Address

Resi. Address

Contact Nos. ( Phone/Fax/email/mobile )

Payment( Rs )   Detai ( cash/Cheque/D.D/CreditCard )* Payment in favour of STATUS HOLIDAY PVT.LTD. A/c Fortunet.

                                                                     Member's Singnature with date

                                FOR  OFFICE  USE ONLY


Introduced by ( JC )                NO.     


( SC )                                    NO.


Application Date       Acceptance Date     Valid till       Approved  By  ( MM Name & Sing )

                                  APPLICATION   ACKNOWLEDGMENT

Name                                                                     Application No.

Payment ( Rs )        Detail ( cash/ cheque/D.D /Credit Card )

*Payment subject to realisation                      For  STATUS HOLIDAY Pvt. Ltd.

                                                                                  Authorised  Singnatory.



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Last modified: September 25, 2000