Name in full

Name of father / husband

Age

Date of Birth

Occupation

Permanent Address

Village

Taluk

Address for Communication

Phone

Mob

Fax

E-mail

Resident

Non Resident

(If, employed, designation & address

Requirements

a. Apartment no

Floor

a. Built up area

Car Park

Yes

No

Cost

Total Cost

All payments should be by Demand Drafts payable at Ernakulam or crossed Payee Cheque in favor of 'Platinum Superstructures Pvt Ltd.'

I have  read and understood the annexed Terms and conditions.  I hereby agree to the general conditions.

Place

Date