Pre-Application Form For Nissan Dealership

Applicants have to fill in the complete form in each sections mentioned below.

Proposed Dealership Location(city) at :

I.a) Personal Information

Name of Applicant

Date of Birth
- - (DD-MM-YYYY)

Residential Address Plot/Building No.

Street

Area/Suburb

City

State

Pin Code

Educational Qualifications
Engg/Professional/MBA

Graduate

Under Graduate

Contact Numbers 1. (Residential : Std code - Number)

2. (Mobile : Country code - Number)

3. (Fax : Std code - Number)

Email Address

I.b) Business Information

Office Address Firm Name

Plot/Building No.

Street

Area/Suburb

City

State

Pin Code

Nature of Business Automotive IT

Finance Trading
Real Estate Hospitality
Manufacturing Others

Contact Numbers 1. (Residential : Std code - Number)

2. (Mobile : Country code - Number)

3. (Fax : Std code - Number)

Email Address
 Website Address

II.a) Existing Business Activity & Details

i)
Sr. Name of Firm Nature of Business Type of Firm % of Turnover Gross Profit Starting
No ownership 2007-08 (Lacs) (Lacs) Year

1. Automotive Private Ltd

Finance Public Ltd
Real Estate HUF
Manufacturing Proprietorship
IT Partnership
Trading
Hospitality

Others

2. Automotive Private Ltd

Finance Public Ltd
Real Estate HUF
Manufacturing Proprietorship
IT Partnership
Trading
Hospitality

Others

3. Automotive Private Ltd

Finance Public Ltd
Real Estate HUF
Manufacturing Proprietorship
IT Partnership
Trading
Hospitality

Others

4. Automotive Private Ltd

Finance Public Ltd
Real Estate HUF
Manufacturing Proprietorship
IT Partnership
Trading
Hospitality

Others

Please attach separate sheet to add more firm.

ii)
Net-worth Statement as on date :- - - (DD-MM-YYYY)

Please give figures for properties owned by self or part (share) in Rs.(Lacs)

Applicant Immediate Family (Wife/Kid)

(A) Movable Assets*

Total Movable Assets eg.: shares, jewellery, cash, FD, others

(Lacs) (Lacs)

(B) Immovable Assets*

Total immovable Assets eg.: property

(Lacs) (Lacs)

(C) TOTAL ASSETS A +B

(Lacs) (Lacs)

(D) Liabilities
 (i) Loans outstanding
(Lacs) (Lacs)

(ii) Others
(Lacs) (Lacs)

Total Liabilities (D)

(Lacs) (Lacs)

NET-WORTH C-D
(Lacs) (Lacs)

iii) Infrastructure & Setup : Applicable to automotive industry.

Particulars Show Room Workshop

Brand

Existing Location

Area (sq.ft.)

Ownership Status
Owned Leased Owned Leased

Investment - except land (Lacs)

Manpower (Nos)

Particulars Show Room Workshop

Brand

Existing Location

Area (sq.ft.)

Ownership Status
Owned Leased Owned Leased

Investment - except land (Lacs)

Manpower (Nos)

Particulars Show Room Workshop

Brand

Existing Location

Area (sq.ft.)

Ownership Status
Owned Leased Owned Leased

Investment - except land (Lacs)

Manpower (Nos)

Particulars Show Room Workshop

Brand

Existing Location

Area (sq.ft.)

Ownership Status
Owned Leased Owned Leased

Investment - except land (Lacs)

Manpower (Nos)

Please attach separate sheet to add new infrastructure details.

 iv) Financials (Working Capital)

Sr. No Bankers Name Bankers Address Type of Facility Amount (Lacs)

1. Plot/Building No.

Street

Area/Suburb

City

State

Pin Code

2. Plot/Building No.

Street

Area/Suburb

City

State

Pin Code

3. Plot/Building No.

Street

Area/Suburb

City

State

Pin Code

4. Plot/Building No.

Street

Area/Suburb

City

State

Pin Code

Please attach separate sheet to add new bank details.

II.b) Proposed Business Details

i) For the Nissan franchise what do you propose to offer:

a. Open Land
Yes No

Is it Rented or Owned

Acquired To be acquired

Location Address

Landmark

Frontage ft Depth ft Total area sq.ft.

 b. Premises
Yes No
(Non Automotive Business)
Is it Rented or Owned

Location Address

Landmark

Frontage ft Depth ft Total area sq.ft.

c. Premises
Yes No
(Automotive Business)

Sr.No. Parameters Actual available Provision for Develop later Remarks (expected Owned/Rent Land mark if any near the
today (Sq.ft.) Expansion (Sq. (Sq.ft.) to be operational proposed show room
ft.) by)

1. Showroom Area Owned

Rent

2. Workshop Area Owned

Rent

3. Total Area

Sr.No. Parameters Actual available Provision for Develop later Remarks (expected Owned/Rent Land mark if any near the
today (Sq.ft.) Expansion (Sq. (Sq.ft.) to be operational proposed show room
ft.) by)

1. Showroom Area Owned

Rent

2. Workshop Area Owned

Rent

3. Total Area

Sr.No. Parameters Actual available Provision for Develop later Remarks (expected Owned/Rent Land mark if any near the
today (Sq.ft.) Expansion (Sq. (Sq.ft.) to be operational proposed show room
ft.) by)

1. Showroom Area Owned

Rent

2. Workshop Area Owned

Rent

3. Total Area

Sr.No. Parameters Actual available Provision for Develop later Remarks (expected Owned/Rent Land mark if any near the
today (Sq.ft.) Expansion (Sq. (Sq.ft.) to be operational proposed show room
ft.) by)

1. Showroom Area Owned

Rent

2. Workshop Area Owned

Rent

3. Total Area

Please attach separate sheet to add new premises details.

ii) Images of proposed site(s)

With the application form, please attach atleast 2 images of the site(s) you are proposing.

iii) Proposed Firm Details

 Proposed Firm Name

Type of Firm Private Ltd Proprietorship

Public Ltd Partnership
HUF

iv) How much of net worth you propose to invest in the Nissan dealership ?

Total Net Worth (Lacs) Proposed to Invest for Nissan (Lacs) % of Networth to Investment

v) Kindly give your sources of funds apart from networth for investment in proposed dealership

Sr. Source Amount Time frame for

No. investing the funds

1. Owned funds
(Lacs) (months)

2. Term loan
(Lacs) (months)

3.
Others (Lacs) (months)

vi)
Business succession plan Yes No

Name

Relationship

Comments

Name

Relationship

Comments

vii) Market Information

Other Vehicle Dealership Existing in your proposed Area:

Sr.No. Product/Company/Vehicle Brand Name of Firm Avg. Sales per Month (Lacs)

1.

2.

3.

4.

Please attach separate sheet to add more vehicle brand.

III.a) Applicant experience in passenger vehicles business

III.b) In your view what are your strengths which can enable you to succeed in the Nissan dealership ?
What makes you to apply for Nissan dealership?

III.c) Brief write up on business achievements till date

III.d) Any additional information which you believe is relevant to your application

Place

Date

Signature of the _________________________

Applicant

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