Name of Dealer

Name of Contact Person

Address

Village

Postal Code

Distt./City

State

Phone

Fax (if any)

a) Status of the Firm

b) Name and Address of Proprietor/Partners/Directors/Karta

Name and Residential Address

Father's/Husband's Name

Contact Number

Name and Residential Address

Father's/Husband's Name

Contact Number

Name and Residential Address

Father's/Husband's Name

Contact Number

c) Year of Establishment

d) PAN Number

e) Annual Turnover

f) GST Number

g) Registered Date

h) Registered Number

a) Blood Relation

Name

Relation with Owner

Occupation

DOB

Marriage Anniversary

Name

Relation with Owner

Occupation

DOB

Marriage Anniversary

Name

Relation with Owner

Occupation

DOB

Marriage Anniversary

b) Other Than Blood Relation

Name

Relation with Owner

Occupation

DOB

Marriage Anniversary

Name

Relation with Owner

Occupation

DOB

Marriage Anniversary

Bank Name and Address

Account Type

Bank Account Number

Name of Account Head

IFSC Code

OD Limit (if any)

Investment in Cement Business

Proposed Investment in KJS Cement (l) Ltd.

Name and Address

Type of Business

Office Area (Sq. Ft)

Experience (Years)

Annual Turnover (Rs.)

a) Name of Brand and Quantity Per Month

Name of Brand

Dealer/Retailer Name

Quantity Per Month

Expected Quantity Per Month for KJS (I) Ltd.

Cheque/D.D/UTR No.

Date of Deposit

Bank Name

Deposit Amount

Any Other Information You Wish To Provide