Stockist Appointment Form DATE: STOCKIST CODE: HQ; Name & Address Mobile no Land line no. Fax Name (S) Of Proprietor / Partners / Directors Residential Address : Date Of Incorporation Type Of Business Wholesale Retail Both Area of Godown (Sq. Ft.) Distance from Nearest Stockist (Km) Name of Person Address Turnover(In Lac) Central & State Sales Tax No Drug Licence No Bankers Name & Addres Credit Facility From bankers(Rs.In Lacs) From bankers(Rs.In Lacs) Given To (No.Of Days) Doctors Chemists Total Annual Turnover Capital Employed Fixed Assets Net worth Name OF Company No.Of Yrs Avg.Stock Holding Annual Turnover Avg.Stock Maintained Payment Policy Avg.No.Of Purchases Date On Statement Prefered Approved Transporters No. Of Salesman Details Of Delivery Vehicles Details of stockiest ship Discontinued if any with reasons: To be filled in by ZSM DSM RSM Existing Stockiest information in same town Sr. no Name Operation Since Avg.O/S of last To be filled in by Depot C&F Agent Total Sale in No Of Months O/S As On Date Total Above Any Other information Signature Of Depot Manager/ C & F AGENT With Date Reason For new stockiest If Replacement, against whom Benefit you shall derive out of this appointment Expected average monthly sales from new stockiest in next 6 months If Additional appointment the nearest stockiest Proposed initial O/S limit Comments on financial stability Name Of Districts Covered % of sale to wholesale % of Retails Sales Total No.Of Chemists/Retailers covered No.Of Nursing Homes Covered No.Of Major Institutions Covered No.Of Chemists/Retailers Blacklisted I/We Declare that the above is true to the best of my /our knowledge I/We Also agree to abide by your terms and conditions. Applicant's Signature with Rubber stamp I have personally visited the party and verified the information submitted in the forms I confirm the correctness of the same Comments From TBM From RBM From BH TBM Sign: RBM Sign : BH Sign Send
