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For Internal Use Only

CIL Location ________________


Mbai-400 007.
Tel:
Code
022-67291300
Allotted:

Lotus Corporate Park, D Wing 601,602,602G,


Graham Firth Steel Compound, Western Express
Highway, Goregaon (East) ,
Mumbai-400 063.
Tel: 022-67114444 FAX NO. 022-67114445

_______________

Date of Registration: __________

E-mail: info@compuageindia.com
Website: www.compuageindia.com

DEALER REGISTRATION FORM


Please Stable
two Recent PP
Size Photo of
Prop/Partner/
Directors with
Name Written
on the backside
of the Photos.

Please Stable
two Recent PP
Size Photo of
Prop/Partner/
Directors with
Name Written
on the backside
of the Photos.

Type of Organisation: - Proprietor / Partnership Firm / Private Ltd. / Public Ltd.


Name of the Organisation: - M/s. __________________________________________________________
Registered Office: -

City: Phone No. : -

Branch Office:-

State:Mobile No. : -

Fax No. :-

Email :Premises Details: Owned / Rented / leased No. of Years

Area

Sq Ft.

Sales Tax LST / TIN: - _____________________________ CST: - _______________________________


PAN No. :- ____________________________
Name and Residential address of the Prop. / Partner / Director
(Please attach separate sheet, if more than two)
1) _______________________________________ 2) ______________________________________
_______________________________________ _______________________________________
Phone: - _______________________

Phone
1

: - ___________________

Passport No: - __________________

Passport No: - ___________________

Business Profile: - No of years in IT Industry _________ Year. None ITS Industry ___________ Year.
Products Currently
Dealing In
Procured

Credit
Amount (In Lacs)

No. of Days

Financial Details: A) Capital Employed ________________ B) Average Inventory _________ (Lakhs)


C) Turnover (Last Fin Year): ITS Industry _________ (Lakhs) Non ITS Industries ________ (Lakhs)
D) Name & Address of the Bankers: - _________________________ E) Account No: - _________
F) Type of Facility Enjoyed with the Bank: - OD ______________ (Lakhs) / CC ____________ (Lakhs)
Declaration:Mr. / Ms. _______________________ The, Proprietors / Partner / Director of M/s. ______________
do hereby declare that the particulars furnished above are true and correct to the best of my Knowledge
And belief.
Date:

Place:

Signature & Seal

Enclosures: - (Please Put Tick Mark)


1) Memorandum & Articles of Association / Partnership Agreement

3) Copy of Passport- Proprietors / Partner / Directors

2) CST & LST Registration proof

4) Proof of Income Tax PAN

5) Latest Audit Accounts with Income Tar return Acknowledgement copy


6) Bank Statement of the Previous 6 Months.
7) Photograph of Proprietors / Partner / Directors
FOR INTERNAL USE ONLY:CIL Sales Person Name: - _____________________ Code: - ______________ Sign:-__________
If Credit, Amount of Credit recommended: ______________ (Lakhs) ______________ (Days).

Customer Types:- (Tick from Below)


(1) Sub Distributor (2) System Integrator/Network Integrator (3) Reseller (4) PC Assembler (5) IT Retail
(6) Large Format Retail (7) CE Retail (8) CE Channels (9) Telecom Retail (10) Telecom Channel
(11) OEMs-IT (12) OEMs UPS.

Date:

Signature of Branch Manager

Remarks of ZM: Date:

Signature of Zonal Manager

Lotus Corporate Park, D Wing 601,602,602G,


Graham Firth Steel Compound, Western Express
Highway, Goregaon (East) ,
Mumbai-400 063.
Tel: 022-67114444 FAX NO. 022-67114445
E-mail: info@compuageindia.com
Website: www.compuageindia.com

CHANNEL MASTER DATA UPDATE

Branch Name :

Please Staple Two Passport Size Photo of the


Authorised Persons (Prop. / Partner / Directors)

Branch Code :
Name & Address:

Name of the Proprietors / Partner / Directors : 1._______________________________________


2. ______________________________________
3. ______________________________________
LST / CST Nos. with area code

: ________________________________________
________________________________________

Pan No. (Proprietors / Partner / Directors): ___________________________________________


Email Address of:
Proprietors / Partner / Directors / Company : 1. _______________________________________
Telephone Nos. Office-(With area code)

: ________________

Name and Residential Address of the Proprietors / All Partner / Directors with Telephone Nos.
(Attach Separate Sheet, If Required)
1._______________________________________________________________________
_________________________________________________________________________
3

2.________________________________________________________________________
________________________________________________________________________

Place:

Signature with Seal

Date: