Cc Consent Form

Consent form for Kadambini 1. Client Code

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2.

Name of the Collection Center

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3.

Address

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4.

Pin Code No

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5.

Phone No with STD Code

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6.

Mobile Number

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7.

Name of the Contact Person

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I ……………………………………. hereby confirm our participation in Kadambini Tie-Up and will offer 10% discount on all the tests (excluding international send out) I Further understand that above said discounts will be given out of my CC’s margin

Dated: - ……………………..

____________________________ (Signature of the Collection Center)

___________________________ (Stamp)

PS: Please ensure above said form duly signed & stamped should reach to Ms. Shalini Sharma, Asst. Manager Corporate Communication, Retail Marketing at SRL Ranbaxy, 275/276, Piccadilly House, New Delhi-110065. Phone No- 011-42295365, [email protected] on or before 31st August, 06.