DEALERSHIP APPLICATION FORM Please fill up in block letters only FOR OFFICE USE ONLY Application Form NO. Code: 1. Name of proprietor: 2. Name of the firm:.. 3. Mailing address:. Affix passport size photograph and across sign 4. Phone No. (with STD code):..fax NO. : E-mail : 5. 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 authorized signatory: (Attach last six month s Bank Statement) 6. Name of firm/company under which dealership will exist : 7. Status of firm (tick) : Proprietorship Partnership Limited Company Pvt. Ltd. Co. (For partnership firm enclose copy of partnership Deed for Companies Memorandum Articles of Association) 8. Details of Proprietor/Partners/Directors: SI. Name Date of Birth Father s/husband s name Marital status 1. 2. 3. 4. 9. Name and address of associates firm(s):. 10. Turnover: 11. Dealership fee charge:. 12. Details of Security Deposit: DD/Cheque No.: Date:.Amount:... Bank:. Payable at:
13. Your current business (tick) a) Cement b) Waterproofing Compound c) Hardware d) Paint e) Other (please specify) : f) No business 14. Last three years turnover of your firm (in Rs. lacs) (i)..(ii).(iii) 15. Please indicate how much you wish to invest in this dealership *Rs. Lacs): 16. 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 17. Are you registered dealer? YES NO a) Sale Tax Registration No. :.. b) VAT Registration NO.: 18. Indicate number of persons employed in your firm (including active partners) 19. If you are dealing waterproofing compounds specify since when you have been in the waterproofing trade. Since specify the brands you deal in now 20. If you have discontinued dealing in any brand(s) of waterproofing please specify the reasons thereto 21. Do you have godown facility? YES NO 22. Indicate size and capacity of godown 23. Address godown Attach copy of trade License
24. Details of where dealership being applied for: Town: P.O.:.. District: State:..Pin Code:.. 25. Where Municipal Corporation/Panchayat :.. 26. Nearest cement/waterproofing dealers name.. Distance : 27. Monthly consumption of total cement and waterproofing of all brands in your town/city : 28. Brand wise details... Brand Monthly Sales 29. Expected Minimum sale per month :.. 30. Name of wife/husband :.. 31. Date of birth of wife/husband :. 32. Wedding Anniversary :. 33. Number of children :. 34. Name of children : Sex Date of birth (i).. (ii). (iii).. (iv)... Place:.. Date: Signature of the applicant(s) (With rubber stamp) R S GROUP PRIVATE LIMITED SHIKARPUR LANDHORA HARIDWAR U.K 247667 Contact us-7248785868,info@rsgrouppvtltd.com
Date : To, R S GROUP PRIVTE LIMITED DECLARATION I/We do here by 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 noncompliance of company s policies formulated from time to time, I/We agree that : The company shall have the absolute right to reject my/our application for appointment as dealer. The reserves the right to terminate my/our dealership without any notice and assigned any reason. 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)
FOR OFFICE USE ONLY Comments of sale promoter Agent/Area Manager Application form no.: Code:.. 1. Location of business/premises : Idea Under development 2. Godown capacity : (a) Area in sq. feet: Suitable Not suitable (b) Capacity in cartoons/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..