Application Form

I'm Interested For

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SUPER STOCKIEST (20LTR JAR) SUPER STOCKIEST (PACK SIZE) SUPER STOCKIEST (BOTH) MEGA DISTRIBUTOR (20LTR JAR) MEGA DISTRIBUTOR (PACK SIZE) MEGA DISTRIBUTOR (BOTH) DISTRIBUTOR (20LTR JAR) DISTRIBUTOR (PACK SIZE) DISTRIBUTOR (BOTH) HO RE CA

I'm Interested For Division

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PACKAGE DRINKING WATER JUICE DIVISION CSD BEVARAGE DIVISION COSMETIC DIVISION PERFUME DIVISION HYGINE DIVISION

Distributor Details

Name of Distributor

Zone

City / Town

PIN Code

District

State

We request to be appointed as distributor of your brand.

WE GIVE OUR TRUE AND CORRECT PARTICULARS BELOW:

1. Firm & Billing Details

A. NAME OF THE FIRM

B. BILLING ADDRESS (All fields are mandatory)

Line 1

Line 2

Line 3

Nearest Landmark

Phone Number 1

Phone Number 2

Email ID

District

State

C. GODOWN ADDRESS (All fields are mandatory)

Line 1

Line 2

Line 3

Nearest Landmark

Phone Number 1

Phone Number 2

Email ID

District

State

2. Key Person Details

Name of Key Person

Designation

3. Business Details

A. Year of Starting Business

B. No. of Employees

C. Last Year Annual Sales Turnover Rs. (Lakhs)

D. Nature of Business (Mention names of existing agencies)

Company / Brand	Since (Month & Year)	Volume Per Month	Area

Distributor Beat Plan

Name of Distributor Form

Sales Officer

Sales Executive

District

Day	Route Road, Lane, Para, Area Details	No. of Retailers	Weekly Market Off Day

6. Bank Details

Bank Name

Branch

A/C No.

A/C Type

IFSC

7. Document Details

GST No.

GST Dated

FSSAI No.

FSSAI Dated

Tax Payers Identification No. (TIN)

TIN Dated

Permanent Account No. (PAN)

PAN Dated

8. Closed Day of the Week

Photocopy of Documents Submitted

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GSTIN TRADE LICENSE PAN AADHAAR FSSAI CANCELLED CHEQUE

Document Attachments

Please upload the required supporting documents. Accepted formats: PDF, JPG, JPEG and PNG. Maximum file size: 10 MB per document.

GST Certificate