For Internal Use Only
CIL Location ________________
Mbai-400 007.
Tel:
Code
022-67291300
Allotted:
Lotus Corporate Park, D Wing 601,602,602G,
Graham Firth Steel Compound, Western Express
Highway, Goregaon (East) ,
Mumbai-400 063.
Tel: 022-67114444 FAX NO. 022-67114445
_______________
Date of Registration: __________
E-mail: [email protected]
Website: www.compuageindia.com
DEALER REGISTRATION FORM
Please Stable
two Recent PP
Size Photo of
Prop/Partner/
Directors with
Name Written
on the backside
of the Photos.
Please Stable
two Recent PP
Size Photo of
Prop/Partner/
Directors with
Name Written
on the backside
of the Photos.
Type of Organisation: - Proprietor / Partnership Firm / Private Ltd. / Public Ltd.
Name of the Organisation: - M/s. __________________________________________________________
Registered Office: -
City: Phone No. : -
Branch Office:-
State:Mobile No. : -
Fax No. :-
Email :Premises Details: Owned / Rented / leased No. of Years
Area
Sq Ft.
Sales Tax LST / TIN: - _____________________________ CST: - _______________________________
PAN No. :- ____________________________
Name and Residential address of the Prop. / Partner / Director
(Please attach separate sheet, if more than two)
1) _______________________________________ 2) ______________________________________
_______________________________________ _______________________________________
Phone: - _______________________
Phone
1
: - ___________________
Passport No: - __________________
Passport No: - ___________________
Business Profile: - No of years in IT Industry _________ Year. None ITS Industry ___________ Year.
Products Currently
Dealing In
Procured
Credit
Amount (In Lacs)
No. of Days
Financial Details: A) Capital Employed ________________ B) Average Inventory _________ (Lakhs)
C) Turnover (Last Fin Year): ITS Industry _________ (Lakhs) Non ITS Industries ________ (Lakhs)
D) Name & Address of the Bankers: - _________________________ E) Account No: - _________
F) Type of Facility Enjoyed with the Bank: - OD ______________ (Lakhs) / CC ____________ (Lakhs)
Declaration:Mr. / Ms. _______________________ The, Proprietors / Partner / Director of M/s. ______________
do hereby declare that the particulars furnished above are true and correct to the best of my Knowledge
And belief.
Date:
Place:
Signature & Seal
Enclosures: - (Please Put Tick Mark)
1) Memorandum & Articles of Association / Partnership Agreement
3) Copy of Passport- Proprietors / Partner / Directors
2) CST & LST Registration proof
4) Proof of Income Tax PAN
5) Latest Audit Accounts with Income Tar return Acknowledgement copy
6) Bank Statement of the Previous 6 Months.
7) Photograph of Proprietors / Partner / Directors
FOR INTERNAL USE ONLY:CIL Sales Person Name: - _____________________ Code: - ______________ Sign:-__________
If Credit, Amount of Credit recommended: ______________ (Lakhs) ______________ (Days).
Customer Types:- (Tick from Below)
(1) Sub Distributor (2) System Integrator/Network Integrator (3) Reseller (4) PC Assembler (5) IT Retail
(6) Large Format Retail (7) CE Retail (8) CE Channels (9) Telecom Retail (10) Telecom Channel
(11) OEMs-IT (12) OEMs UPS.
Date:
Signature of Branch Manager
Remarks of ZM: Date:
Signature of Zonal Manager
Lotus Corporate Park, D Wing 601,602,602G,
Graham Firth Steel Compound, Western Express
Highway, Goregaon (East) ,
Mumbai-400 063.
Tel: 022-67114444 FAX NO. 022-67114445
E-mail:
[email protected]Website: www.compuageindia.com
CHANNEL MASTER DATA UPDATE
Branch Name :
Please Staple Two Passport Size Photo of the
Authorised Persons (Prop. / Partner / Directors)
Branch Code :
Name & Address:
Name of the Proprietors / Partner / Directors : 1._______________________________________
2. ______________________________________
3. ______________________________________
LST / CST Nos. with area code
: ________________________________________
________________________________________
Pan No. (Proprietors / Partner / Directors): ___________________________________________
Email Address of:
Proprietors / Partner / Directors / Company : 1. _______________________________________
Telephone Nos. Office-(With area code)
: ________________
Name and Residential Address of the Proprietors / All Partner / Directors with Telephone Nos.
(Attach Separate Sheet, If Required)
1._______________________________________________________________________
_________________________________________________________________________
3
2.________________________________________________________________________
________________________________________________________________________
Place:
Signature with Seal
Date:
