JACKPOT
Application Form


Photograph
1
2
3
4
Name
       
Age & Date of Birth
       
Education
       
Occupation
       
Television Programmes Participated
       
Hobbies & Special Interest
       
Relationship
       
Addresses

 

     
Telphone Numbers
       
Mobile No.
       
Any Other Relevant Details
       
Signature
       

                                                                  Date :                                   Place :

---"-------------------"--------------------"-----------------"-----------------"------------
 
 
Send your completed application to :
                               
Medimix's Jackpot
TELLY ZOOM
G2, Ashwin Apartments
D-40, R V Nagar 4th Street,
Anna Nagar East,
Chennai - 600 102
                                              
 

Terms and Conditions

  • The four participants should not be related to each other but should be known
    to each other.
    Eg : Club members, Colony or Association members, residents of the same
    Apartment, Complex, Employees of the same office or acquaintances etc.,

  • The programme is oriented towards women and applications with 3 female
    and 1 male participant will be preferred.

  • Incomplete applications will be summarily rejected.

  • The application should be sent along with the recent passport size colour
    photograph
    of each participant / pasted to the application form.

  • The applicants will be informed in advance, the date and venue for the preliminary
    interview and all four participants should attend without fail.

  • The participants shall make their own arrangement for traveling and stay for the
    interview and shooting (if selected). The expenditure incurred by the participants
    will not be reimbursed at any stage.

  • Persons above 15 years alone can take part in this programme. Every effort should
    be taken by the participants to ensure that the programme is made interesting and
    lively.