Distributor

Name of the Applicant

Status of the Applicant (Proprietorship/ Partnership/ Pvt. Ltd. Co./ Others) (Please attach photocopy of Partnership Deed/ Memorandum of Association/ Article of Association)

Name of Principal Partners/ Directors/ Proprietor alongwith their residential address, educational qualification and Telephone Numbers (Please attach separate Sheet, if required).

Name	Age(in years)	Educational Qualification	Residential Address & Tel. Numbers	Status

Address of the Regd. Office/ Principal Place of Business:

Telephone Nos.

:

Fax No.

:

Mobile No.

:

Email

:

Your Sale Tax Regn. No.
(Please attach photocopy of RC)

:

Your PAN No.
(Please attach photocopy of PAN Card)

:

Date of Registration/ Incorporation/
Formation of Business

:

Date of Commencement of Business

:

Items traded (retail) :

Distributors of (Please attach copies of appointment letters in case of distributorship):

Business Turnover :

(Amount in Rupees)

31/03/2017 (Audited*)	Age(in years) (Audited*)	Educational (Estimated)

From Trading Activities (Distributorship)

From Others

Total

(*Place attach photocopy of Audited Balance Sheet and P&L Account.)

Number of Retail outlets covered

:

Infrastructure facilities No. of Partners/ Directors actively
looking after the business

:

No. of Senior Sales Managers /
Supervisors

:

No. of Sales representatives

:

Vehicles used for distribution

Sl. No.	Vehicle Type	Model	Owned/ Hired

Godown Address and Tel. Nos.

:

Address	Tel. No.	Area (Sq. Ft.)	Insurance Valid Upto

Showrooms (for retail) Address and

:

Address	Tel. No.	Area (Sq. Ft.)	Insurance Valid Upto

In Future if Company launch New Products / Segments are you ready to take such distribution along with this .

Yes

No

Place :

Date :

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