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FRANCHISE APPLICATION FORM

The purpose of obtaining information through this Form is for us to evaluate the suitability of both parties to discuss the franchise opportunity for Burgeri. Please include as much information as possible so it will make it much easier to understand the organization background and assist us in evaluating how it can all fit in with the culture we have developed at Burgeri. Note: This is the initial phase of the process, and we may require further information as we deem necessary to evaluate the proposition from respective group.

INDIVIDUAL CORPORATE

Group Information Data

Registered Organization's Name

Main Address

Tel No

Fax

Year Established

Group Shareholders Information

Total Number of Share Holders

Sl#

Share Holder Name

% of Share

Sl#

Share Holder Name

% of Share

Group Business Portfolio

Business Name

Nature of Business

F&B (Elaborate) Non F&B

Is this is a Franchise business Yes No

Business Background and short history

Add More Portfolio

Strategic Advisors

Group Financial Statements

(Please answer all questions using “no” or “none” where necessary.Attach additional sheets as needed.)

Assets

Cash on Hand (unrestricted in banks)

Other Stocks and Bonds

Real Estate Property owned by the group in value

Other Assets

Group Franchise Plan

The primary reason group is interested in acquiring Burgeri franchise is because (Please elaborate):

Amount of capital that is available for this business. (Describe in Detail)

Area/Location/Territory for which Burgeri Franchise rights are sought at this stage?

Would group consider any other area in future? Yes No

What area(s)?

How many Burgeri outlets you wish to develop in your primary market?

Attachments

Additional Attachments submitted : (if any) - Please itemize if sharing any additional information e.g., Corporate Profile, Business plan write-ups, Market Intelligence Study etc.

Select File

Declaration

In submitting the foregoing statement the undersigned guarantees its accuracy with the intent that it be relied upon in granting a franchise to the organization and warrants that he/she has not knowingly withheld any Information that might affect organization's credibility, and the undersigned expressly agrees to notify Burgeri management immediately in writing of any material change in group's financial condition or shareholder representation, it is expressly agreed that Burgeri in granting a franchise may rely on this statement as having the same force and effect as if delivered upon the date additional franchise is granted or renewal of the franchise agreements.

The undersigned certifies that each part of the application and additional documents provided hereof and the information inserted herein has been carefully read and is true and correct.