Distributor Application Form
Basic Information: -
Name of the Applicant Distributor
(Mr./ Mrs./ Ms.)
Permanent Address: -
Town: City: State:
Phone No. Mobile No. Fax No.
National Tax Number (N.T.N):
Constitution Of Dealer/Distributor
Proprietorship/ partnership/ private:
Limited Co/Public Limited Co/Others
(Please specify)
Manpower
Administrative Staff: Numbers:
Sales Staff:
Details of Technical Staff: Numbers:
Business Associations(s):
Any of Your Sister Concerns/ Group Cos. Dealing with Chemicals /Lubricants? Yes/No
If Yes Please Mention Details:
Name Address& Nature Of Product Since Approx. Turnover
Phone Nos. Business (Year) (In Lakhs)
Products/Cos. being handled (please attach additional sheet, if required)
Name of Company Status Area Covered Product Approx. Turnover
(In Lakhs)
Sales Record
Qty sold in last year Sales Turnover (last 3 yrs)
Company Brand Reference Lubricants Cutting Indl Bearings Industrial Others
Tools Spares components
Financial Details
Firm/Company's Financial Position (As on _________________________)
Liabilities (Rs. / in lakhs) Assets (Rs. / in lakhs)
Share Capital Investment
Reserves & Surplus Fixed Deposit
Loans Properties
Creditors Vehicles
Advance from Customers Stock
Others Advances Debtors
Total Total
Are Accounting Procedures computerized : Yes/No. If yes, the package/software:
Infrastructure
Office Space: Sq ft Godown Space: Sq ft
Outlet Area if any Sq ft
Location of the office: Main market/Secondary market/Outside main township
Address of the Sales Counters:
Tel. Nos. Fax Nos.
Sales Tax No Date
Other modes of delivery
Goods:
You are interested in Distributorship/Dealership for: Please tick
Lubricants - Industrial Lubricants - Automotive Lubricants – Speciality
Territory
Name of Town/ Districts for which Dealership/Distributorship is applied
Investment
How much investment are you prepared to make for our products?
Lubricants Indl Staff/ Office / Rs.____________
Storage space Rs.____________
Vehicle for distribution Rs.____________
Bank Guarantee Rs ______________________
Documents to be Provided:
1) Copy of N.I.C. (Nadra)
2) Copy of N.T.N. Certificate
3) List of Partners with addresses in case the Dealer/Distributor is a Firm, Association of Persons,
etc.
4) Copies of last 6 months bank statements.
5) Passport Size Fresh Pictures (3 Copies)
6) Any other documents ____________________
Declaration
I/We, the undersigned, have gone through the terms & conditions, as mentioned herein, for my/our
appointment as the Dealer/Distributor of the Company. I/We, fully understand the implications of the
terms & conditions as given overleaf and therefore bind myself/ourselves into a legal contract with
the Company and other applicable provisions and laws as may be related to this contract. I/We
understand fully that this Application Form can be used against me/us before any Court of Law/
Tribunal/Arbitration proceedings, etc. I/We, state that all information as mentioned in this Application
Form is true & correct to the best of my/our knowledge and information and I/We shall abide by and
maintain the declarations made herein. I further agree to abide by the terms and conditions of this
agreement as long as I continue to deal with the Company; I also agree to be bound by the terms &
conditions & policies of supply of goods and payment thereof conveyed from time to time by the
Company.
Signature of The Applicant: ____________________
Berlin Petroleum Pvt LTD
Country Office
Hayat Palaza Opposite Koh-i-Noor Textile Mills Main Peshawar Road Rawalpindi Pakistan
Fax ; 0092-51-2315265
PABX- 0092-51-2315047-9
Email;
[email protected]Website;- www.berlinpetroleum.com
