Consignee Agent / Super Distributors / Authorized distributors:-

Firm Name
Postal Address:-

WH In charge of the Dealer :- Name - Ph NO:-

Email Id
Fax No
Bank Detail:-
Bank Name Scheduled Bank Y/N
Postal Address of Bank

Telephone No of the Bank-

Account No:- O/D Facility:- Y/N
Account Since Years:- O/D Limit:-
Regulatory License Detail (Xerox copy of the all to be attached)
Form 20B No:- Dated:- Valid Till:-
Form 21B No:- Dated:- Valid Till:-
GSTIN NO:- Dated:- Valid Till:-
PAN NO:-

Firm Detail
Partnership / Proprietorship / Ltd Co

Partner/Proprietors Detail
S NO Name & Address Contact No % Share Holding

Top 5 Companies with the Proposed AD

S No Name of Associated Monthly Credit Inventory

the Since Billing in Period Holding in
Company (Lakh) Days
 To be filled by the FF
SNO
1 Turnover of the Proposed AD / SD
/ SS
Credit Period offered by him to his
customers
Approximate Worth of the AD
Nature of Property (Owned /
rented)
Market Reputation
Competitive Product Being Sold by
the proposed party
No of Existing Distributors in the
town
Current business Per Month
Expected increase in Business
Is he having CA&F of any company
If yes then Names of the company
WH Space available with him in Sq
Ft
No of Existing Staff
IT Infrastructure
A) Computer
B) Internet connection
C) ERP Experience
D) Printer
Transporter Availability
Is he having his own Transport for
Local Delivery and any existing tie
ups
No of Existing Sub dealers
Is he having credit facility with any
bank (Letter of Bank credit limit)
Enclosures to attach-
a) Copy of Drug License
b) Copy of PAN Card
c) Copy of GSTIN NO
d) WH Floor layout Plan
e) Cancelled bank Cheque
f) Last two years audited Financials
Proposed by Reviewed By Approved By