NikhRi Herbals Distributor / Super Stock

Name of the Firm

City / Town

1 Firm Details
Mailing Name Pin Code

TIN Number

CST Number

Address FSSAI Licence No.

IT PAN number

Email

State Fax

Country Name of Proprietor

Telephone 1 Partner 2 / Director 2

Telephone 2 Partner 3 / Director 3

Type of Firm Partner 4 / Director 4

Key Man

2 Distribution profile
Existing Distribution / Year of Area covered Monthly sales
Name of Company start

3
TOTAL

3 Bank Details
Name of Bank Branch Type of acc Account No

4 Godown Details
Size : Address :

5 Proposed Investment Capacity / Business Details

Avg Monthly Turn over - Current Business :

Total Investment - Current Business

Proposed Investment - If Distributor :

Proposed Investment - If Super Stockist :

6 Infrastructure details

4 Wheel motorised van 2 Wheeler motorised

3 Wheel motorised van Drivers

 3 Wheel Rickshaw Delivery boys

7 Expected Area of Operation

If Distributor

If Super Stockist

Customer's signature & Stamp Sales Channel Upline signature

Date: Date:

8 Document checklist - To be submitted in hard copies

Copy of GST registeration certificate
Copy of PAN card
SHOP AND ESTABLISHMENT License
 All figs in lacs
per Stockist Appointment Form

Current A/c Limit

c
ASM sign
 3678
268000
6264
92647.33