Application Form for Balmerol Distributorship

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Industrial Distributorship

Automative Retail Distributorship

Name of the firm:

Name of authorised contact person/s:

Age:

Date of Birth:

Nationality:

Address of the firm:

District:

State:

PIN:

Mobile:

Email id:

Nature of the firm:

Others (Specify):

Please attach documentary evidence:

VAT/TIN registration number

PAN number of the firm/owner (attach.copy)

Lube Licence No. (where mandatory eg. WB)

Trade Licence No.

Next Step

Nature of Business:

Annual turnover of last 2 financial years:

Details of capital employed in the business:

Latest Copy of IT return enclosed:

Yes

Balance Sheet of the last 2 F.Y. enclosed:

Yes

Geographical area of influence of the firm (where they have strong presence / infrastructure):

Details of experience in Lubes/Related industrial distributorship of products like Tyres / Batteries / Auto spares etc. Applicants with no business experience may enclose a detailed project report on their plans for the operation of Balmerol Automotive Industrial distributorship in case allotted. (Enclose separate sheet if necessary):

Next Step

Address of the Godown:

District:

State:

PIN:

Total area sq.ft./sq.mtrs:

Covered area (as above) sq.ft./sq.mtrs:

Open area sq.ft./sq.mtrs:

Whether owned/leased:

If leased, the period of validity of lease:

Details of Delivery Vehicles:

Whether Owned/Leased:

Make/Model:

Year of registration:

Capacity:

Details of Sales Personnel on Rolls:

Name:

Age:

Qualifications:

Duration of Service:

Next Step

Availability of Infrastructure:

Fixed line telephone:

Yes

Attach bill copy:

Mobile:

PC (Configuration, Make / Brand):

E-mail id:

Availability of Working Capital (in Rs. lakhs):

I / We have read and fully understood the Terms and Conditions contained in the agreement governing my/our appointment as Balmerol Industrial Distributor and agree to abide by them. As a token of our acceptance, 1/ We enclose all pages of the agreement containing the Terms and Conditions duly signed along with rubber stamp.

(Proof of documents attached or information furnished with the application to be produced in original whenever asked for.)

DECLARATION:

I/We hereby certify that the information fumished above is true to my/our knowledge. Any wrong information/suppression of facts will disqualify me / us from being considered for the Balmerol Industrial Distributor.

Name of the document

Place:

Signature:

Name:

Date:

Official Seal:

Automative

Commercial Vehicle

Agricultural

Motocycle Oil

Passenger Car Motor Oil

Auto N CNG

Grease Transmission Oil

Greases

Industrial

Auto Anciliary

General Machinery

Indian Oil

Cement

Power

Steek

Sugar

Infra

Others

Speciality

Marine

Food Grade Lubricants

Bio-Degradble Lubricants