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Distributors Form
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APPLICATION FOR DISTRIBUTORSHIP CUM KYC
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FULL NAME
NAME OF APPLICANT
Business Name
If any
Postal Address
Office / Shop Address
Mobile Number
Residential Address
Next of kin
Address
Not P.O. Box
Guarantor
Contact Address
Not P.O. Box
Occupation
Bankers Name & Branch
Account Name
How long have you been operating the Account?
Have you any objection to our contacting your banker for any information?
pick one!
Yes
No
If yes please state why
I / We undertake to abide by the rules and terms of the company under which the facility will be approved
I Agree
I Disagree
Date
of agreement
Sales Rep Comments
Recommendations
0
/
Name
Sales Rep Name
RSM's Comments
Recommendations
0
/
Name
RSM's Name
Submit Form
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