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| DETAILS FOR DOCUMENTATION |
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| Name " & Replace (Request("name"),"'","''") &" , | " & Replace (Request("co-name"),"'","''") &" |
| Age & Date of Birth( Purchser) " & Replace (Request("age"),"'","''") &" , " & Replace (Request("Day"),"'","''") &"/" & Replace (Request("Month"),"'","''") &"/" & Replace (Request("Year"),"'","''") &" |
| Age & Date of Birth( Co-Purchser) " & Replace (Request("ageC"),"'","''") &" , " & Replace (Request("DayC"),"'","''") &"/" & Replace (Request("MonthC"),"'","''") &"/" & Replace (Request("Year"),"'","''") &" |
| Profession " & Replace (Request("pro"),"'","''") &" | Profession(Co_profession) " & Replace (Request("proC"),"'","''") &" |
| Relationship with Purchaser " & Replace (Request("relation"),"'","''") &" |
| Residential Status " & Replace (Request("rb"),"'","''") &" | Pan " & Replace (Request("pan"),"'","''") &" |
| Name of Father/ Husband " & Replace (Request("fat"),"'","''") &" |
| Permanent Address |
| " & Replace (Request("address"),"'","''") &" |
| Kara | " & Replace (Request("kara"),"'","''") &" | | Village | " & Replace (Request("village"),"'","''") &" | | Taluk | " & Replace (Request("taluk"),"'","''") &" | | Dist | " & Replace (Request("dist"),"'","''") &" | | Pin | " & Replace (Request("pin"),"'","''") &" | | Phone | " & Replace (Request("phone"),"'","''") &" | |
| Address for communication |
| " & Replace (Request("com_address"),"'","''") &" |
| Phone (O) | " & Replace (Request("phoneO"),"'","''")&" | | Mobile | " & Replace (Request("mob"),"'","''") &" | | Phone (R) | " & Replace (Request("phoneR"),"'","''") &" | | Fax | " & Replace (Request("fax"),"'","''") &" | | email | " & Replace (Request("email"),"'","''") &" | | | | |
| Name & Address of Contact Person in Cochin (if any) |
| " & Replace (Request("cohinAdd"),"'","''") &" |
| Mobile | " & Replace (Request("mobCochin"),"'","''") &" | | Phone | " & Replace (Request("phCochin"),"'","''") &" | | Fax | " & Replace (Request("FaxCochin"),"'","''") &" | | email | " & Replace (Request("emailCochin"),"'","''") &" | |