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Regd Office : Anchor Electricals Private Limited, 3rd Floor, B Wing, I -Think Techno Campus, Pokhran Road No 2,
Thane (West), Thane - 400 607 (CIN) U31200MH1981FTC128292

Proprietor/ Partners
Recent Photograph

1. Agent : Direct : Agent code : Dealer Code. :
2. Branch : _______________________ 3. Service Exe. Code _______________ 4. Unit No. ___________________

5. Delivery Lead Time (Days) _____________________________

6. Dealership For : Modular Non Modular Wire & Cable Tape Fan

CFL Choke Patti Smart Anchor Home Automation

Switch Gear LED All Others

Other Associate Firm Dealing with Anchor (if Any) -Dealer code. Name: __________________________________

Past relationship with Anchor (if Any) : Y/N __________________________________

Any Legal case with any company in last 5 years? Yes/ No. If Yes, Details..______________________________.

A. Dealer/ Distributors Information :-

1.] Type of Organization: Proprietor Partnership Pvt. Ltd. Others

Firm/ Company Name : _______________________________________________________________________________________________

Address: _________________________________________________________________________________________________________


____________________________________________________________________________________ Pin Code : ___________________

Tel. No. (L.L.) ____________________, Mob. No. _______ ________ Email : ______________________________ Fax. No ___________

Firm PAN No : _____________________ Establishment Date:______________________________

GST NO ____________________________________________________ GST Date _______________________________

(M) Shop details Owned Rented

2.] Bankers Details :

Bankers Name : ______________________ A/C. No. : _______________________ A/C Type : ______________IFSC Code______________

Account Name : ________________________________Bank Tel. No.: ________________________ Fax : ____________________

Bank Address : __________________________________________________________________ Pin Code ____________________

B.] Personal Details : (Director /Proprietor/ Partner)

Name:1] - __________________________________________________Name:2] - _________________________________________________

Father's/Husband's Name : _______________________________________

Father's/ Husband Name : ____________________________________
Designation : ____________________ Designation : _______________________________________________
D.O.B. ____________________ Age. : _______________ D.O.B. ____________________ Age. : ____________________________
Residence Address : ______________________________________ Residence Address : _________________________________________
________________________________________________________ ___________________________________________________
________________________________________________________ ___________________________________________________________
Pin : __________________, Resi. Tel. No. __________________ Pin : __________________, Resi. Tel. No. ________________________
Email : ______________________________________________ Email : _____________________________________________________
PAN Card No : _____________________ PAN Card No : _______________________________________
Aadhar card No : _____________________ Aadhar card No : _______________________________________
(M) Residence details Aadhar card Driving License Passport Copy
C. ] Party Reference: (Agent, if reference by Agent)
Dealer Code Firm Name Name of Dealer Place Tel. No Stamp & Sign

1 ) _____________ _______________________ ___________________ _______________ _______________ ______________

2 ) _____________ _______________________ ___________________ _______________ ________________ ______________

Certificate of copies of others companies being a Dealer OR Distributor OR a Channel.

D.] Sales Performance (Electrical Products or any other Products, Name of the Products)
1.] Are you Distributor OR Dealer of any other Company ( Yes / No ) ___________________________________________

2.] Total Sales Turnover in Rs. LACS : last FY : ________________________ , Last to Last FY :_________________________
3.] Bank Facality OD OCC CC Against : _________________________________
1.] Anchor total sales turnover in Rs. LACS : last FY: _________________ , Last to Last FY :_____________________________
(Applicable only in case of entity change or business name change)

Other Brands Details :

No. Of Sub
Sr. Product Dealer/ Distributor Other Brands ANCHOR Avg. Sales/ Month
1 Modular
2 Non Modular
3 Wire & Cable
4 Tape
5 Fan
6 Switch Gear
9 Choke Patti
Other Electrical
Other Non-Electrical

4.] Godown Facility Available-( Yes/ No) : ____________ Godown Coverage in Sq. Feet : __________

E. ] Deposit Information : ("MICR at PAR Cheques, Only Nationalised or Scheduled Bank CTS cheques accepted. )

Dealer Deposit Rs. _______________ Cheque/ DD No. ______________ Cheque / DD Date : ____________ Bank _______________________

Minimum Two Blank Cheque Drawn in Favour of M/s Anchor Electricals Pvt. Ltd. To be issued by the dealer without filling in Date & Amount with authority to Anchor to Fill in the Date
and outstanding Amount claimed by Anchor, if the dealer makes default in payment of outstanding dues, without any further reference to the dealer. (Authority letter draft to be
accompanied by this form. Change in banker or Closure of bank account to be informed within 7 days and replacement of cheques along with authority letter). The Dealer shall not close/
change the Bank account through which below cheques were issued to Company without obtaining prior written permission and shall issue fresh cheques from new bank account.

Cheque No. 1) _______________ Bank : __________________________Cheque No. 2) _______________ Bank : _______________________

I hereby declare that the details furnished above are true and correct to the best of my knowledge and belief
and I undertake to inform you of any changes therein, within 7 days. In case any of the above information is found to be
false or untrue or misleading or misrepresenting, I am aware that I may be held liable for it. I shall be abide the Terms and
Conditions annexed to this Dealer Appoitment Form.

Sign + Stamp of Proprietor/ Partner Sign + Stamp of Partner Sign + Stamp of Partner
[ For Office Use Only ]
( F) Credit Limit : ____________ ______________ ____________ ___________
Suggested By : ( S.H. ) ( Z.S.M..) (S.A.H. ) ( N.S.H.)

Sign & Date

Name : Agent Unit Head ASI S.H. Z.S.M. R.A.C. Project Head

Sign & Date

Name : C.C.D. S.A.H. N.S.H. Legal Dept.

Sign & Date

Name : D.F. M.D.

For Account Department

Date of Appointment : Register ID : __________________________
* If required, please use supplementary sheet for giving details of all Directors/Partners with Photograph.
G. ] Dealer Undertaking :
“Company”: Means Anchor Electricals Private Limited (AEPL)
“Dealer”: Means the Dealer whose name is mentioned herein on the face of this document
“Conditions”: Means the terms and conditions set out in this document agreed in writing by the Dealer
General Terms and Conditions
1. Dealer’s Obligation : The Dealer shall promote and sell Company’s products and use its best efforts to maximize the sale of Company's Product. The Dealer shall
maintain at all times a minimum inventory of Company’s products commensurate with the needs of the market. The Dealer agrees to maintain or employ adequate staff to
maintain a level of expertise necessary to demonstrate, promote and support the sale of the Company's products. Dealer shall make all the payments inlcuding but not limited to
the Company's Product purchased by the Dealer from the Company on time.

2. Company’s Propriety Information and Trade Secret : The specification (s) and design (s) of the products (including the copyright, design right or other intellectual
property in them) shall as between the parties be the property of the Company. The Dealer agrees to treat as confidential all information supplied by Company and not to use this
information for any purpose other than promoting and selling the Company’s products.

3. Eligibility to various scheme/ discounts: The details of the incentives/discounts/schemes will be communicated to the Dealer by the Company from time to time in writing.
No claim of the Dealer under any such incentives/discounts/schemes based on any oral communication to him on behalf of the Company shall be entertained by the Company.
The Dealer shall not be eligible for and shall not claim any incentive/discount/scheme etc. if he commits breach of any of the terms of this contract or defaults in payments due to
Company as per the terms of payment.

4. Payment Terms: The Dealer shall make payment to the Company as per the payment terms as may be informed by the Company from time to time. The Company reserves
the right to reverse/revoke the cash discount agreed on invoice and levy interest @ 24% per annum in case the Dealer fails to make the payment as per payment terms within
stipulated period. The Dealer agrees and acknowledges that in case of a cheque bounce, the Company shall raise the debit note to and collect the bank charges from the Dealer.
Further, the Dealers agrees and acknowledges that the Company will stop supplying the products in case the payment is not received within 90 days from the date of receipt of

5. Credit Limit: The credit limit shall be given to the Dealer as per the norms of the Company. The Dealer may request modifications in the credit limit in writing to the Company.
The decision of the Company in this regard shall be final.

6. Applicability : The conditions shall apply to all contracts for the sales of Products by the Company to the Dealer to the exclusion of all other terms and conditions which the
Dealer may purport to apply under any purchase order confirmation of order or similar documents.

7. Company’s Liability : The Company shall be under no liability whatever to the Dealer for any indirect loss and/or expense (including loss of profit) suffered by the Dealer
arising out of a breach by the Company of this contract

8. Breach of Contract : In the event of any breach of this contract by the company, the remedies of the Dealer shall be limited to damages. Under no circumstances shall the
liability of the Company exceed the price of the Products. No waiver by the Company of any breach by the Dealer shall be considered as a waiver of any subsequent breach of
the same or any other provision. The Company shall have lien on the Company's Products sold to Dealer till entire payment for the same is made by the Dealer to the
Company. Company shall have right to cease the Products for which payment was not made by the Dealer.

9. Return of Company’s Intellectual property upon termination : Upon termination of this contract for any cause, the Dealer shall promptly return to the Company or
otherwise dispose off, as the Company may instruct, all samples, patterns, instruction books, technical pamphlets, catalogues, advertising material, POP material, signboard
and other materials, documents and papers whatsoever provided to the Dealer and which the Dealer may have in his possession or under his control. The said material shall
always remain the property of the company and the Dealer shall hold the same till termination of this contract.

10. Termination of Contract : This Contract may be terminated by the either Party without assigning any reason by giving 30 days written notice to other Party.This Contract
may be terminated by the Company immediately if Dealer actions discredit the Company or violate these terms and conditions, or if the Dealer makes representation or give any
warranty in respect of the Company's products other than those contained in the Company’s conditions. Termination shall not affect obligation of the Parties arising out of this
11. Modification of Terms : The Company shall have the right to change, amend alter or revise these Terms and Conditions from time to time without prior notification.

12. Arbitration and Jurisdiction : In case any dispute, the same shall be referred to the sole Arbitrator to be appointed by the Company, as per the provisions of the
Arbitration and Conciliation Act 1996. The Place of Arbitration shall be Mumbai. Language of the Arbitration shall be English. The Courts at Thane shall have exclusive Jurisdiction
in all matter arising under this reference.

13. Compliances : The dealer hereby understands, acknowledges and admits that the Company and its Parent company are law abiding entities and their respective Policies,
Rules & Regulations and Code of Conducts do not allow violation or breach of any Law, Code, Rules and Regulation by themselves or any of their associates including Dealer.
Therfore dealer hereby assures and undertakes to the Company that the Dealer by itself OR through any third Party shall not indulge in any such act or omission that may
amount to violation OR breach of any Law, Code, Rules and Regulation in any manner whatsoever directly OR indirectly and the Dealer hereby agrees to indemnify the
Company and its Directors, Associates and Employees in this regards.

14. Panasonic Code of Conduct : Dealer undertakes to follow Panasonic Code of Conduct and sign the Business Association Undertaking attached with this form.

15. Non Discrimination and Sexual Harassment

Company firmly believes in equal employment opportunities and is committed to creating a healthy working environment which would enable its employees to function/ work
without any fear of prejudice, gender bias and sexual harassment and is also committed to protect all its employees from sexual harassment of every kind and have a policy in
place. The abovementioned policy is applicable to all the employees of Company and also applies to a third party/ contractor/ vendor/ service provider/ customer/ Dealer in
respect of all allegations of sexual harassment made by Company’s employees/ any third party/ contractor/ vendor/ service provider/ customer/ Dealer against a Dealer, if the
sexual harassment is alleged to have taken place within or outside Company’s premises.

The Dealer shall ensure that they comply with Company’s Sexual Harassment Policy and abide by the provisions of The Sexual Harassment of Women At Workplace
(Prevention, Prohibition and Redressal) Act, 2013. Non -Compliance of this clause shall lead to stringent action by Company including but not limited to immediate termination of
this Agreement and/ or appropriate legal action wherever applicable.

I have read the above mentioned Terms and Conditions and agree to the terms and conditions.

Name : _____________________________
Date : _____________________________ Sign & Stamp of Dealer
Dt. ___________


Anchor Electricals Pvt. Ltd.

3rd Floor, "B" Wing,
i Think Techno campus
Pokhran Road no-2,
Thane - 400607

We are handing over to you cheques duly and validly signed by us bearing numbers as mentioned hereinbelow:

Of ___________________________________________ Bank. The cheques are issued by us towards the

amount which would be outstanding in the course of transaction. The said cheque can be deposited by you towards
our outstanding dues. You are authorized fill the blanks and to deposit the same towards recovery of your dues
which we undertake to honour. The cheque / cheques have been voluntarily knowingly and consciously issued by us.

If the above said cheques are dishonoured after deposition then you can initiate appropriate legal action
against us in the Court of Law.

Thanking you,

Yours faithfully,

( Proprietor Stamp & Sign)

Encl : Chq. No.- 1) ________________, 2) __________________.

We acknowledge the receipt of the above cheques.

Yours faithfully,

For Anchor Electricals Private Limited

Ethics & Business Conduct Certification

This is to certify that ___________________________________________________________(Name of the firm/company)/ its employees or its

representatives in its dealings with Anchor, or its other agents/ representatives/ strategic partners and its employees conducting business with Anchor
Electricals Private Limited ( Anchor).

Shall conduct all its dealings with Anchor, its management, employees and other business associates, in an ethical manner and shall not try to
1 influence the decision of any Anchor employee in an unethical or coercive manner;

2 Shall not give or accept any favours, any gifts, sponsorship or any entertainment that is outside of normal business dealings.

Shall not have any other business or personal arrangements (outside of this contract) with any Anchor employee, either directly or indirectly
3 through other associated companies or partnerships/ arrangements with our knowledge or authorized by us.

Shall not have any other dealings with Anchor or its employees, where there are possible instances of any conflict of interest that may cloud
4 the judgment or decision of Panasonic or its representatives/ employees.

Shall always refrain from giving or attempting to pay illegal gratification/bribes/kickbacks. Any attempts to provide such personal gratification
5 to any employee of Anchor shall be viewed in a very serious manner and where there is confirmation of such instances, it may lead to:
(i) Cessation of all business dealing including termination of Agreement(s) with Anchor;
(ii) Blacklisting with Anchor and its associates/affiliates for any future business;
(iii) Levy of a financial penalty;
(iv) Reporting of matter to law enforcement agencies;
(v) Appropriate legal action, where necessary;

Shall provide all possible assistance to investigate any possible instances of unethical behavior or Code of Conduct violations by any employee
6 of Anchor or an employee of the Business Associate.

Shall immediately notify to Anchor if it becomes aware or has reasonable grounds to believe that (a) it (including its directors, employees and
agents) has committed an actual or potential breach of Clauses 1, 2, 3, 4 and/or 5 or (b) Anchor’s directors, employees or agents could be in a
position of actual, potential or suspected conflict of interest or engaging in unfair or dishonest activities in respect of any transaction or
7 business activity of the Business Dealings

8 Shall inform to Anchor via compliance.india@in.panasonic.com if it has any concerns under Clause 7

Place: Signature:
Date: Name:
New Dealers Opening- Documents Check List Date: _________________

Sr ID & Residence Proof Requirement

1 Aadhar Card (all persons) Mandatory
2 PAN Card (all persons) Mandatory
Passport Copy/ Driving License / Voter ID Optional
Business Proof
3 GST Registration Copy (GSTR-06) Mandatory
4 Bank Statement (Last six months) - upto period at the time of submission of Form by Dealer Mandatory
5 Income Tax Return with Balance Sheet and Profit & Loss Account (last 3 years) Mandatory
6 Rent Agreement if shop is on Rent or Property Tax Receipt if Shop is owned Mandatory
7 PAN Card (if Partnership or Pvt Ltd) if applicable
8 Partnership Deed if Partnership Firm if applicable
9 AOA & MOA in case of Pvt. Ltd. if applicable
11 List of Authorised Signatories for the firm (Name and relationship) if applicable

In addition to the above list of documents, following is the mandatory requirement

Dealer Application Form should be duly filled with Seal and Sign.
Two Blank CTS Cheques of Nationalised Bank/Scheduled Bank
Dealer Deposit of Rs.25,000/-