MIPL : PROPOSAL FORM FOR DEALERSHIP | Mitra Industries Pvt. Ltd.

Step 1

1.A. Category For Dealership (* Required)

TM
PD
STENT
GOVT. DEALER
ALL OF THE ABOVE

1.B. Type Of Dealer (* Required)

2. Name Of The Company (* Required)

3. Address (* Required)

4.A. Telephone Number (* Required)

B. Mobile Number (* Required)

5. Year Of Incorporation Upload Year Of Incorporation Document(max. 10MB) (* Required) Not Applicable

Step 2

6. Names Of Proprietor / Partners / Directors (* Required)

Sr. No.	Name	Address
1

7. Particulars Of Active Partners / Directors Not Applicable

Sr. No.	Name	Age	EDU. Qualification	Other Partnership (if any) Held
1

7.A. Have you or your Partners / Directors or Members of your family, been distributors for Mitra Industries Products? If so, please give details (* Required)

8. Did Any Of The Partner Leave During The Last 3 Years (* Required)

Yes

Sr. No.	Name & Address	Date Of Leaving	Reasons
1

9.A. Name Of The Responsible Contact Person Of The Proprietor / Partner / Director (* Required) B. Telephone (Office) (* Required) C. Telephone (Res.) (* Required) D. Mobile No. (* Required)

Step 3

10. Banker`S Name & Address (* Required)

Name

Branch Address

Account No.

IFSC Code

11. What Is The Total Investment In The Organization (Please Give The Total Capital, Employed Including Loans Etc.) (* Required)

12.A. GST Reg. No. & Date (* Required) Upload GST Reg.(max. 10MB) (* Required)

B. Drug License No.(20B) (* Required) Upload Drug License 20B (max. 10MB) (* Required)

Drug License No.(21B) (* Required) Upload Drug License 21B(max. 10MB) (* Required)

C. PAN No. (* Required) Upload PAN Card(max. 10MB) (* Required)

D. Upload Aadhar Card(max. 10MB) (* Required)

Sr. No.	Name	Upload Aadhar Card
1

E. Email ID (* Required)

Step 4

13. Total No. Of Persons Employed (Mention Seperately For Technical Support/Marketing/Sales) (* Required)

Technical Support (* Required)

Sales / Marketing (* Required)

Supply Chain (* Required)

14. Particulars Of Principal Employeees - Second In Command (Including Any Relatives Of Partners Working) (* Required)

Sr. No.	Name	Age	EDU. Qualification	Date from which working
1

15. Details Of Storage Space / Facility Available. (Please Provide The Storage Area Of Measurement Preferably In Square Feet / Cubic Feet) (* Required)

Office Area	Square Feet
Godown	Square Feet
Stacking Facility Available	Yes / No	Yes No
Open Space / Gallery	Fill Details
Cold Storage	Yes No
Photograph Of Premises

16. Temperature to be maintained as per regulatory requirement

Step 5

17. Territory Of Your Operation (* Required)

18. Main / Current Line Of Business (* Required)

19. Major Products You Deal With (Please Mention Year Since When You Have Been Associated With Compnay)

Sr. No.	Product Name	Year Since
1

20.A. Dealership Relinquished During Last 3 Years Not Applicable

Sr. No.	Name of The Company	Main Products	Date of taking over Dealership	Date of leaving dealership
1

B. Sales Turn Over For Last Three (Consecutive) Years (* Required) Upload CA Certified And Self-Attested Certificate Document(max. 10MB) (* Required)

Final Step

21. Value In Rupees Of Business You Expect To Generate On Your Own (* Required) Upload Supported By Monthly Sales Projection On Letter Duly Stamped And Signed Document(max. 10MB) (* Required) Not Applicable

22. Any Other Information You Wish To Add (* Required)

23. Order Value (* Required)

24. The Distributor Must Share Their Stock Statement Along With Secondary Sales Data On A monthly Basis With The Concern RSM And Area Head In The Prescribed Format For All The MIPL Products

All partners shall take the printout of Final Proposal Form along with Documents and sign & stamp each page and send it to Dealer Management department at
Mitra Industries Pvt. Ltd., A-181 Okhla Phase-1, New Delhi-110020