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PROFESSIONAL DATA SHEET
Company Name * :
Party Name * : Designation * :
Address* :
Landline No. : Mobile No. * :
Email ID * : Fax No. :
Drug Wholesale License No.* :
Please send Scanned copy of Drug License / VAT / CST to info@minovalife.com - to Activate your account.
CST No.* : TIN No.* :
Career Summary & Work Experience :
Interested segments & Product lines (Antibiotics, Paediatrics, Gyneac, ect) :
Products interested to market (Brands) :
Area of Operations (Districts) :
Expectation of Business First 3 Months
After 3 Months (Per month in Rs.) : After 1 Year (Per Month in Rs.) :
Working System Self (Yes/No)
No. of Medical Reps :
Your tentative investment for business (in Rs.) :
Dealing in Other companies if any :
C`form & Road Permit available (yes/on) :
How did you come to know about MINOVA LIFE SCIENCES Pvt Ltd ?* :
* Mandatory           [ X ] 
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CORPORATE OFFICE

Minova Life Sciences Pvt Ltd.
No. 194/31/2/74 & 75, 3rd Floor, 

Beretena Agrahara, Hosur Rd, behind Metro wholesale, Konappana Agrahara, Electronic City, Bengaluru, 

Karnataka 560100

Tel : +91-080-26606842

Mobile : +91-9900059304, +91-9845329972
Email : info@minovalife.com

 

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