DEALERSHIP APPLICATION FORM Please fill up in block letters only

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Warren Ward
7 years ago
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1 DEALERSHIP APPLICATION FORM Please fill up in block letters only FOR OFFICE USE ONLY Application Form No Code : A Name of proprietor: 1 Name of the Firm : 2 Mailing address : 3 Phone No (with STD code) : Fax No : 4 Details of Bank A/c : a) Name and address of Bank : b) Type of A/c (tick ) : Savings Current Other (Please specify): c) Account No : d) Name of authorised signatory : (attach last six month's Bank Statement) 5 Name of firm/company under which dealership will exist : 6 Status of firm (tick ) : Proprietorship Partnership Limited Company Private Ltd Co (For partnership firms enclose copy of partnership Deed for Companies Memorandum Articles of Association) 7 Details of Proprietor/Partners/Directors: Affix possport size photograph and sign across Sl Name Date of Birth Father s/husband s name Marital status Name and address of associate firm(s): 9 Turnover : 10 Details of Security Deposit: DD/Cheque No: Date:Amount: Bank: Payable at : (1)

2 Application Form No : B 1 Your current business (tick ) a) Cement b) Hardware c) Paint d) Other (please specify) : e) No business 2 Last three years turnover of your firm (in Rs lacs) (I) (ii)(iii) 3 Please indicate how much you wish to invest in this dealership *Rs lacs): 4 Are you on Income Tax payer? (tick ) : Yes No Income Tax Permanent A/c Number (PAN/GR No) Attach copies of income Tax Return for last three years 5 Are you a registered dealer? Yes No (a) Sales Tax registration No : (b) VAT Registration No : C 1 Indicate number of persons employed in your firm (including active partners) D 1 If you are dealing cement specify since when have you been in the cement trade Since Specify the brands you deal in now 2 If you have discontinued dealing in any brand(s) of cement please specify the reasons thereto E 1 Do you have godown facility? Yes No 2 Indicate size and capacity of godown 3 Address of godown: Attach copy of Trade License (2)

3 Application Form No : F 1 Details of where dealership being applied for : Town: PO: District: State : Pin Code: 2 Where Municipal Corporation/Panchayat : 3 Nearest cement dealer s Name : Distance : 4 Monthly consumption of total cement of all brands in your town/city : 5 Brand-wise details : Brand Monthly Sales 6 Expected Minimum sales per month : G 1 Name of wife/husband : 2 Date of birth of wife/husband : 3 Wedding Anniversary : 4 Number of children : 5 Name of children : Sex Date of birth (I) (ii) (iii) (iv) Place: Date: Guwahati Office : Green Valliey Industries Ltd LB Plaza, 4th Floor, Bhangagarh, GS Road Guwahati , Tel : /82/83/84 Signature of the applicant(s) (with rubber stamp) Factory: Village - Nongsning, PO- Chiehruphi PS Khliehriat, Dist JaintiaHills, Meghalaya (3)

4 Application Form No : Date : To, Green Valliey Industries Ltd DECLARATION I/We do hereby declare that the information furnished herein is correct to the best of my/our knowledge and belief For any incorrect information/mis-information furnished herein and for non-compliance of company's policies formulated from time to time, I/We agree that : 1 The Company shall have the absolute right to reject my/our application for appointment as dealer 2 The Company reserves the right to terminate my/our dealership without any notice and assigned any reason 3 The Company shall have the right to forfeit or adjust the whole or part of my/our Security Deposit with them in the manner they may deem fit Witness :1 2 Full name : Address : Signature of the applicant(s) (with rubber stamp) (4)

5 Application Form No : FOR OFFICE USE ONLY Comments of sale promoter Agent/Area Manager Application form No: Code : 1 Location of business/premises : Idea Suitable Under development Not suitable 2 Godown capacity : (a) Area in sq feet: (b) Capacity in bags: (c) Construction Permanent Temporary 3 Experience and capability : 4 Financial standing and capability to invest : 5 Market reputation and credibility : Excellent Very good Good Average Poor 6 Business potential of party : (Estimated sales/month) Mt 7 Total market potential of the area :Mt/month 8 Assurance of minimum turnover:mt/month 9 Banker's reference and rating : (attach banker's letter) 10 Credit rating of party : Excellent Very good Good Average Poor 11 Approximate number of competitors stockist s in the area/town (major competitors): 12 No (name of the dealer) : 13 Interests and hobbies of the dealer : 14 Special achievement: 15 Credit limit: Remarks (if any) Signature: Name: (5)

Form DVAT 04 Cover Page [See Rule 12]

Department of Trade and Taxes Government of NCT of Delhi Form DVAT 04 Form DVAT 04 Cover Page [See Rule 12] Application for Registration under Delhi Value Added Tax Act, 2004 Please tick as applicable