Firm Details
Name of Firm:

Year of Incorporation of Firm / Commencement of Business:
Registration No. And Date under Shop Establishment Act:

Distributor Details
Distributor Location:

Territory of Distributors:
Market
Market Potential:
[Per Month(MT)]
Address and Details
Firm Mailing Address:

Shop No/Plot No/Building Name:
Road No / Name:

Area / Locality / Nearest Landmark:
City / Village Name:

Taluka / District / State:
Contact Details:

Phone:
Email:

PAN No Company:
VAT Registration No and Date:

Service Tax Registration No and Date:
Details of Proprietor / Partners/ Directors
Sr. No Details Residence Address & Phone No.
1 Full Name
  Date of Birth
  PAN No
  Status in Firm
Sr. No Details Residence Address & Phone No.
2 Full Name
  Date of Birth
  PAN No
  Status in Firm
Sr. No Details Residence Address & Phone No.
3 Full Name
  Date of Birth
  PAN No
  Status in Firm
Details Regarding the Existing Business of the Party
Present Business:
Nature of Business:
Quantity/Volume:
Annual Turnovers of Last 3 Years:
Bankers
Sr. No Details Bank Address
1 Bank Name
  Banker Since
  A/c No.
  A/c Name
  Name of Autho. Signatory
  Limit if any
Sr. No Details Bank Address
1 Bank Name
  Banker Since
  A/c No.
  A/c Name
  Name of Autho. Signatory
  Limit if any
Sr. No Details Bank Address
1 Bank Name
  Banker Since
  A/c No.
  A/c Name
  Name of Autho. Signatory
  Limit if any
Proprietor / Main Partner / Director’s Ownership of assets
Sr. No Details
1 Name of Proprietor/ Partner/ Director
  Shop
  Residence
  Vehicle
  Total
Capacity to Arrange funds for Proposed Business
Own Funds:
Borrowed Funds:
Total: