JMPL : PROPOSAL FORM FOR DEALERSHIP | J. Mitra & Co. Pvt. Ltd.

Step 1

1.A. Category For Dealership (* Required)

IVD
GOVT. DEALER
INSTRUMENTS
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. Relationship Of Proprietor / Partner / Director (* Required)

Sr. No.	Name Of Proprietor / Partner / Director	Partner / Director to whom related	Nature of Relationship
1

8. Particulars Of Active Partners / Directors Not Applicable

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

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

Step 3

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

Yes

10.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 4

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

Name

Branch Address

Account No.

IFSC Code

12. Transporter Type

Transporter

Self

Name

Contact No.

Address

13. What Is The Total Investment In The Company/Partner (Please Give The Total Capital, Employed Including Loans Etc.) (* Required)

14.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 5

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

Technical Support (* Required)

Sales / Marketing (* Required)

Supply Chain (* Required)

16. 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

17. 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

18. Type Of Refreigeration Facility Available (Please Give Details) (* Required)

Sr. No.	Refrigerator Make	Year Of Manufacture	Capacity In Ltrs.	Temp. Maintained 2˚c To 8˚c	Photograph Of Refrigerator
1				Yes No

Step 6

19. Territory Of Your Operation (* Required)

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

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

Sr. No.	Product Name	Year Since
1

22.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

23. 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

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

25. Order Value (* Required)

26. The New Distributor Must Share Their Stock Statement On A monthly Basis With The Concern RSM And Area Head In The Prescribed Format For All The Jmpl Products (* Required) :

Yes

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
J. Mitra & Co. Pvt. Ltd., A-180/181 Okhla Phase-1, New Delhi-110020