LEISHNA PACKAGE DRINKING WATER & RESEARCH CENTRE ( A unit of BLL Enterprises Private Limited) APPLICATION FORM FOR DEALERSHIP We are very much thankful for your interest in becoming a Dealership of “Leishna Package Drinking Water & Research Centre” Imphal, Manipur (India). We seek partners who are interested in actively promoting and selling our products. To initiate our review process, please complete the attached form and supply the additional information requested. Forms to complete: 1. Details of Company /Firm 2. Dealer Profile 3. Business Details Required additional materials needed: 1. Registration Certificate of Company/Firm 2. MOA , AOA /Partnership Deed of Company/Firm 3. Authorisation Letter of Company/Firm 4. Business Registration Certificate 5. Income Tax Documents 6. Sale Tax Documents 7. PAN card of Company/Firm Please complete the attached application form and once completed, it has to be couriered /by hand to the address given below. Once all materials are transmitted to BLL Enterprises Pvt.Ltd; it usually takes about one week to get everything processed and reviewed. At that time we will contact your designated representative with further information and notification . Thanks with regard BLL Business Department Tel & Fax: 0385-2443597 Corporate Office : BLL Enterprises Pvt.Ltd BabuparaNear MLA Quarters, Imphal West District, P.O.Imphal_795001,Manipur (India) Production Centre: Leishna Package Drinking Water & Research Centre Nilakuthi, Village No-20, P.O.Mantripukhri, Pin_795002,Imphal East District,Manipur(India) Email: [email protected], [email protected] , web site:www.leishna.com Page 1 of 6 Leishna Dealership Form APPLICATION FORM FOR DEALERSHIP A. DETAILS OF THE COMPANY / FIRM 1.Name: 2.Office Address: 3.Tel: 4.Fax: 5.Email: 6.Corporate Status: Public Ltd. / Pvt. Ltd. / Partnership / Proprietary. 7.Established Since: 8.Name (s) of the Managing Director: 9.Name of Working Partners / Proprietor: 10.Residence Address (es) and Tel. Nos. Of the Managing Director/ Working Partners / Proprietor: 11Person handling day to day operations: B.SHOWROOM 1.Location: 2. Size / Area: 3. Details of Branch Office (s): C. GODOWN / WAREHOUSE FACILITIES 1. Location: 2.How far this is from City Centre / Main Market: 3. Size / Area (Sq. meters): 4. Godown Located within / outside the Octroi Limits: 5.Rate of Octroi levied: Page 2 of 6 Leishna Dealership Form D. SELLING ORGANISATION 1. Person authorized to take decisions along with Designation: 2. No. of Sales Staff : Travelling : Support: TOTAL: E. FINANCIAL STATUS 1.Working Capital: Own (Rs.): Borrowing (Rs.): Total (Rs.): 2.Capital likely to be invested in Market Products: 3. Bank Details: i.Name of Bank (s): (1) (2) (3) 4.A/C No. (s): 5.Address of Branch: 6.C.C. Limit (Rs. Lacs): 7.Can we refer to your bankers: 8.Sales Tax Registration No.: Central: Local: 9.TIN No.: F. BUSINESS DETAILS 1.Date of Commencement of Business: 2. Details of Existing Business (s): Sl.No. Year Products Last Year’s Turn over (Rs.Lacs) As Distributor/ Dealer/Stockist Page 3 of 6 Leishna Dealership Form 3. Total Turnover in last 3 years (Rs. Lacs): Financial Year Turnover ( Rs.Lacs) 4.How many retailers / dealers network in operations (Nos.): 5.Do you have any vehicle to supply the material to Retailers / Dealers: Yes / No - Make: 6.Presently dealing in any competitors product (s): Yes / No 7. If yes, provide following details? i. Year of start of operation of competitor product (year): ii. Competitor’s name (s): iii. In case of acceptance of our proposal, what would you propose to do with your existing competitor product?: G. GENERAL 1. Were you ever a Distributor or a Dealer of our company?: Yes / No 2. Reasons for Giving up the Distributorship / Dealership: 3. Are you associated with any of our Group company?: Yes / No 4. If yes, please give details: H. TERRITORY 1. State / Market territory of Present Business: 2. Territory desired for selling Original Products: Signature : ______________________ Name: ______________________ Designation: ______________________ Date: ______________________ Place: ______________________ Rubber Stamp / Company Seal Page 4 of 6 Leishna Dealership Form FOR OFFICE USE a.Overall Impression of the Applicant: Very Good / Good / Average / Below Average b. General Market Impression: c. Other Remarks / Observations: d. Recommended: Yes / No e. State / Market Territory Assigned: Very Good / Good / Average / Below Average Proposed By: Date: Approved By: Date: Page 5 of 6 Leishna Dealership Form Applicant must sign this page Applicant hereby certifies warrants and acknowledges to BLL ENTERPRISES PVT. LTD.that: 1. The applicant has made full disclosure of all the information required in this application and all information requested of, and given by, the applicant and contained herein is true and correct in each and every particular. 2. The applicant is not suffering from, or is aware of, any legal disability that would prevent the applicant from being appointed by the company as an Authorized BLLDealer / Distributor /Stockist. 3. Any obligations undertaken or expense incurred by the applicant in submitting this application and /or in contemplation or anticipation being appointed by the company as an authorized BLL Dealer /Distributor /Stockist shall be undertaken or incurred entirely on the applicant’s own behalf. 4. No representation(s) or statements(s) has/ have been made to be applicant by or on behalf of the company, or by any employee, servant or agent of the company,concerning the appointment, or possible appointment of the applicant as an authorized BLL Dealer /Distributor /Stockist. 5. By submitting this application, the applicant will not become and authorized BLL Dealer /Distributor /Stockist nor will it place any obligations whatsoever upon the company to appoint the applicant as an authorized BLL Dealer /Distributor /Stockist. 6. This application will be used by the company for the purpose of recording the applicant’s interest in being appointed as an authorized BLL Dealer /Distributor /Stockist and for no other purpose whatsoever. 7. By submitting this application, the company has indicated that he/she shall be in no way obliged bound to accept an offer of appointment as an authorized BLL Dealer /Distributor/ Stockist from the company and that the contents of this application shall be information of a confidential nature. Name of Applicant: …………………………………… Signature of Applicant: …………………………………… Date: …………………………………... Page 6 of 6 Leishna Dealership Form