PHOTOGRAPH

M-2, Tower Square,

Near Sapna Sangeeta ,
Indore (M.P.) 452001
Telephone:- 07314979945
Website:- www.marketingefortune.co.in

1. Name of the applicant (in block letters)* First

Name
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Last Name
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2. Name of the applicant father (in block letters)* First
Name
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Last Name
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3. Name of the firm (with which name applicant wants to work)*

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(A) Registration Number/ROC

(Not applicable to individuals and HUFs. Mandatory for ‘company’ Company should
mention registration number issued by the Register of Companies. Other applicant may
mention registration number issued by any State of Central Government Authority)

(B) (PAN No.)*

4. Telephone Number*
0

5. Mobile Number *

0
0
 6. E-Mail ID : (in block letters)*

……………………………………………………………………………..

7. Date of Birth / Incorporation / Agreement / Partnership of trust Deed / Formation of

Body of Individuals / Association of Persons* / / (DD/MM/YY)

8. ADDRESS -:

(A) Official Address

Name of the office

:…………………………………………………………………………………………………

Flat/Door/Block No
…………………………………………………………………………………………………

Name of the Premises/Building/Village

………………………………………………………………………………………………...

Road/Street/Lane/Post Office
…………………………………………………………………………………………………

Area/Locality/Taluka/Sub-Division
………………………………………………………………………………………………..

Town/City/District

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(B) Residential Address

Flat/Door/Block No.

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Name of the Premises/Building/Village

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Road/Street/Lane/Post Office

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Area/Locality/Taluka/Sub-Division

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Town/City/District

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9. Worked Experience: (If works/working with any other Teleshopping Company)

Name of the Companies:

1. …………………………………..

2. …………………………………..

3. …………………………………..

10. Delivery Points (covered by delear)

1. …………………………………..

2. ………………………………….

3. ………………………………….

4. ………………………………….

11. Bank Account Details:*

Account Holder’s Name:

……………………………………………………………………………………

Bank Name:

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Account No. :

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Type of Account:

CURRENT……………………………….SAVINGS…………………………….

Branch Code:

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MICR Code:

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NEFT/RTGS Code:

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12. Declaration:*

I do hereby solemnly affirm that the

particulars and information given above are true and correct to the best of my knowledge and
belief and no part of it is false and that I have not with-held or concealed any fact of
information. In case any part of the information given above is found to be false or incorrect,
my dealership is liable to be terminated without notice. And I promise to follow all the rule
and regulation draft and signed by me in the contact between me and company under the
Indian Contract Act 1872.

13. Identity Proof:*

(Copy of any of the following: PAN Card/Depository Account Statement/Bank Account

Statement/Bank Pass Book/Rent Receipt/Passport/Voters Identity-Card/Driving
License/Certificate of identity signed of Parliament or Member of Legislative Assembly or
Municipal Councilor or Gazetted Officer.)

14. Address Proof:*

(Copy of any of the following: Electricity Bill/Telephone Bill/Depository Account

Statement/Bank Account Statement/Bank Pass Book/Rent Receipt/Passport/Voters Identity-
Card/Property Tax Assessment Order/Driving License/Certificate of address signed by
Member of Parliament or Member of Legislative Assembly or Municipal Councilor or
gazette Officer.)

Date:

Place:

Recommended by:

Signature (Applicant)*