Jno 1922 RMU Ragistration Form final

Doc. No. QF/COMM/01
RMU REGISTRATION FORM
TM
e
gn
Si
d
o
t
se o
os Ph
Cr
d
Photo
1+1
*USE CAPITAL LETTERS ONLY
General Profile
Business Name
Shop/Establishment Address
Location
City
District
State
Pin Code
Permanent Address
Location
City
District
State
Pin Code
Fixed Line Numbers
S
T
Mobile Number
D
Email ID (To be registered with Oxigen)
Contact Person
Designation
Type of Company (Please Tick) Proprietor/Partnership/Pvt. Ltd./Limited/Any Other
TIN/TAN/Service Tax Registration No.
Details of Investment in Oxigen (Rs. Lacs)
Registration fee (Non-Refundable): (a)
Security Deposit (Value in Rs.): (b)
Stocks (Rs.) (c)
Stock Details (Numbers)
Oxi Shaan
Oxi Smart
Online ID
Trading Balance (Working Capital in Rs.) (d)
Total Investment (a+b+c+d) (in figures)
Total Investment Amount (In words)
Demand Draft No.
_______________________________________________________________________________________________________________
Date
D
D
RTGS/NEFT-UTR
M
M
Y
Y
Bank Name ___________________________________________________
From Bank
________________________________________
(DD should be drawn in favour of “Oxigen Services India Private Limited”, payable at Gurgaon) for RTGS/NEFT - Use IFSC - SBIN0003190
Note: No Cash or Cheque would be accepted.
Upon successive discussion with the company official Mr. _____________________________________, who explained me/us the business model, working & commercials, I/We
are hereby interested in the distribution / RMU Service (Retail Management Unit) of Oxigen at _______________________________________ & become Oxigen RMU as
per terms and conditions explained to me/us and detailed in the RMU agreement.
RMU Sign & Stamp
RMU Type (Please Circle)
Main RMU
OMTS RMU
Oxigen Services (India) Pvt. Ltd. | Building No.94, Sector 32, Institutional Area, Gurgaon-122 001, Haryana (India). Customer Care Number.:0120 7151000
Registered Office:G-4, Community Centre , C Block , Naraina Vihar , New Delhi 110028 (India), CIN – U74999DL2003PTC121961,Tel:- +91 124 7161100, Fax: +91 124 4362151,
E-mail: [email protected] | Website: www.myoxigen.com | An ISO 9001: 2008 Certified Company
TM
Name of person who will look after Oxigen Business
Designation
Banking Details: Bank Name
Bank Address
City
Pin Code
A/C No.
MICR Code
Nominee Details:
Name of Nominee
Relationship of Nominee
Bank Account No.
Bank Name (Nominee)
Bank Address (Nominee)
Current Business Profile
Particular
Business 1
Business 2
Business 3
RMU Evaluation Parameters Good
Type of business
Qualification
In business since
Experience in Business
Investment in
`Lacs per annum
Market Reputation
No. of field staff (FoS)
No. of back office team
No. of outlets serviced
Area of operations
Office Size
Average
Poor
Remarks
Credibility
Financial Capability
Office Infrastructure
Field Resources
Backend Support
Overall Rating (Descriptive)
Office Space own or rented
Resource Commitment For Oxigen
Field Staff
Backend
Oxigen Services (India) Pvt. Ltd. | Building No.94, Sector 32, Institutional Area, Gurgaon-122 001, Haryana (India). Customer Care Number.:0120 7151000
Registered Office:G-4, Community Centre , C Block , Naraina Vihar , New Delhi 110028 (India), CIN – U74999DL2003PTC121961,Tel:- +91 124 7161100, Fax: +91 124 4362151,
E-mail: [email protected] | Website: www.myoxigen.com | An ISO 9001: 2008 Certified Company
TM
Documents To Be Enclosed (Checklist)
1. Bank Statement for last 6 months
2. Income Tax Return Copy for last 2 years
3. Bankers Certificate Issued On Bank’s Letter Head
4. Notarized Affidavit required in case the proprietor does not have a Bank account in the name of the firm or business name.
5. PAN Card Copy (Self Attested)
6. Proof of Address: Telephone Bill/Electricity Bill/Bank Account Statement/Ration Card/Rent Agreement Duly Registered/Letter from any recognized
public authority
7. ID Proof : Aadhaar Number (Preferred)/Voter’s Identity Card/Passport/Pan Card/Driving License
8. One Cancelled Cheque (For RTGS Purpose)
9. 2 Photographs
10. TIN/TAN/Service Tax Registration No. & Certificate (if applicable)
In case of Partnership Firm or Pvt. Ltd./Ltd. Firm
Copy of Partnership Deed (In case of Partnership Firm)
c
Registration Certificate (In case of Pvt. Ltd./Limited Firm)
c
Authority Letter From Board of Directors in Favour of the Person Signing Agreement with Oxigen (In case of Pvt. Ltd./Limited Firm)
c
I, hereby, accept/confirm that TB deposit shall be done through bank transfer/electronic mode only.
RMU Sign & Stamp
Stamp
___________________________________________________
Signatures
For official use only
ZM Remarks _______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
TM/ZM Name _____________________________________________________________________________
RM Name & Signatures
TM/ZM Signature _________________________________________________________________________
Approved By E.D. - Retail
c
Yes
c
No
Commercial Department (KYC) Confirmation _______________________________________________________________________________
_______________________________________________________________________________
Oxigen Services (India) Pvt. Ltd. | Building No.94, Sector 32, Institutional Area, Gurgaon-122 001, Haryana (India). Customer Care Number.:0120 7151000
Registered Office:G-4, Community Centre , C Block , Naraina Vihar , New Delhi 110028 (India), CIN – U74999DL2003PTC121961,Tel:- +91 124 7161100, Fax: +91 124 4362151,
E-mail: [email protected] | Website: www.myoxigen.com | An ISO 9001: 2008 Certified Company

Download Report