Gendawa Franchisee / Member Registration Form Please fill up the form properly.Kindly note this form will be filled by District Head or Reference Person Only after informing Gendawa Marketing Team. Please enable JavaScript in your browser to complete this form.Registered As *Gendawa FranchiseeGendawa FranchiseeGenBond MemberName *FirstLastResidential AddressShop Name (If already have retail medical) *Shop AddressDrug License NumberState Name *Andhra PradeshAssamArunachal PradeshBiharGoaGujaratJammu and KashmirJharkhandWest BengalKarnatakaKeralaMadhya PradeshMaharashtraManipurMeghalayaMizoramNagalandOrissaDistrict *AhmednagarAkolaAmravatiAurangabadBeedBhandaraBuldhanaChandrapurDhuleGadchiroliGondiaHingoliJalgaonJalnaKolhapurLaturMumbai CityMumbai SuburbanNagpurNandedNandurbarNashikOsmanabadPalgharParbhaniPuneRaigadRatnagiriSangliSataraSindhudurgSolapurThaneWardhaWashimYavatmalCity *Contact Number *Email *Reference From *Enter the name of our District Head / Reference PersonDistrict Head / Reference Person Email *Submit