Business Name *

Office Address *

Own / Rented? *

Own

Rented

Landline no. with STD code *

Emails of Owner's *

Status of Company *

Proprietary

Partnership

Pvt. Ltd.

Ltd.

Date of Establishment *

GST No. *

Ownership

1

Name of Proprietor/Partner/Director *

Residence Address *

Mobile No. *

Pan-card Number *

Aadhar Number *

2

Name of Proprietor/Partner/Director *

Residence Address *

Mobile No. *

Pan-card Number *

Aadhar Number *

Sales Turnover

Rupees in Lacs

FY 2017-18 *

FY 2017-16 *

FY 2016-15 *

Supplier References

1

Name of Company *

Contact Person *

Contact Number *

Available Credit Limit *

2

Name of Company *

Contact Person *

Contact Number *

Available Credit Limit *

3

Name of Company *

Contact Person *

Contact Number *

Available Credit Limit *

Bank Details

Bank Name & Branch *

A/C No. *

IFSC code *

Please attach following documents to above form:

Shop Act, Certificate of Incorporation (if applicable). *

GST certificate *

Company PAN card copy *

Owner’s Aadhar card copy *

Bank statement - last 6 months *

Declaration *

"I, do hereby declare that the particulars furnished above are true and correct to the best of my knowledge and belief. We agree to pay the bills on time as per agreed payment terms. We agree to pay the interest & other charges in case of delay or default in payment from our side."

Dealer Information

Ownership

1

2

Sales Turnover

Rupees in Lacs

Supplier References

1

2

3

Bank Details

Please attach following documents to above form: