Distributor Form

Welcome, Guest User

Section A

Personal Information

Type of applicant

Name of the main applicant

First name

Middle name

Last name

The term “main applicant” refers to the applicant who has the largest proposed shareholding, or is the majority partner / managing director in the proposed company.

Name of the co-applicant 1

First name

Middle name

Last name

Name of the co-applicant 2

First name

Middle name

Last name

Name of the co-applicant 3

First name

Middle name

Last name

Name of the co-applicant 4

First name

Middle name

Last name

Highest degree of education

Education and professional qualifications of applicant(s) & other proposed partner / directors

	Name	Relationship with main applicant	Age (Yrs)	Highest degree of eduction	Institution	Year passed
Main applicant
co-applicant 1
co-applicant 2
co-applicant 3
co-applicant 4

Contact number (Mobile)*

Primary

Alternate

Land-line

Address

Residence (Permanent)

Office

Address line 1 *

Address line 2 *

State *

City *

Pin Code

Email address *

Website

Address for the correspondence

Other information

Are you resident of the city applied for

Yes

Company information

Do you have a registered company*

Yes

Company background

Information of company held by applicant

	Name of the company	City	Nature of business (Agriculture, automotive, real estate, if other please mention)	Current CEO (self, professional, relative)
Company 1
Company 2
Company 3
Company 4
Company 5

Details of companies held by applicant*

Name of the company	Company details		Shareholders's name	Designation & role	% of share
	Type of company
		Year started (MM/YYYY)
		Total manpower employed
		No. of executives /managers
	Type of company
		Year started (MM/YYYY)
		Total manpower employed
		No. of executives /managers
	Type of company
		Year started (MM/YYYY)
		Total manpower employed
		No. of executives /managers
	Type of company
		Year started (MM/YYYY)
		Total manpower employed
		No. of executives /managers
	Type of company
		Year started (MM/YYYY)
		Total manpower employed
		No. of executives /managers

Total years of experience in distribution or C&F*

Nature of business

Business information

Existing business finanacial details*

(All figures to be mentioned in lakhs)

Name of the company	Loans			Turn over			Profit before tax (PBT)
Name of the company		Term	Working Capital	Total	2015-16	2016-17	2017-18	2015-16	2016-17	2017-18





	Total

Name of the company	Net worth			Reserves & surplus			Share capital
Name of the company		2015-16	2016-17	2017-18	2015-16	2016-17	2017-18	2015-16	2016-17	2017-18





	Total

Total assests owned by the applicants*

Current and non - current assests (Rs. in Lacs)

Type of assest	2013-14	2014-15	2015-16	2016-17	2017-18	Total
Cash in bank (saving A/C)
Fixed deposits
Shares (Listed in stock exchange)
Bonds
LLIC / ULIP (surrender value)
Any other security (NSC, Kisan vikash patra etc.)
Gold / jewellary (valuation report available)
	Total current assets
Real estate
Capital invested in business
	Total non-current assets
	Total assets (current + non-current)

Real estate details

Sr. No	Description	Owned by	Current market value (Rs lacs)	Mortgaged (Yes/No)
1
2
3
4
5
		Total

Product profile & distribution experience details

Are you already a distributor*

Yes

If the above (a) is Yes, please select the sector/product

Do you have experience in Transportation of goods to the retail / secondary distribution*

Yes

Do you have own or leased storage / warehouse facilities*

Yes

If the above (d) is yes, please provide the details of existing facilities*

Location
City name	City 1	City 2	City 3
Area in sq.mtr (Existing)
Area in sq.mtr (Planned)

Other information

Have you ever been convicted of a criminal offence*

Yes

If the above (1) is Yes, please provide details*

Have you ever been convicted of a sales / income tax / GST violation*

Yes

If the above (3) is Yes, please provide details*

Section B

Proposed Business

Name of the proposed company

Nature of the proposed company

Date of incorporation

Shareholding pattern

Shareholders's name	Relationship with main applicant	Proposed shareholding (%)	Responsibilities in proposed distributorship
1
2
3
4
5

Details of person (s) who will be managing the distributorship on day to day basis

Name	Relationship with main applicant	Designation	Experience details	Current business/occupation	Proposed role in distributorship
1
2
3
4
5

Break up of investment*

Head	Own funds	Loans	Total	Source of own funds
Head	Own funds	Loans	Total	Head	Cash	Fd's	Shares / Bonds	LIC / ULIP	Property liquidation	Others	Total
Land
Fixed investment (Infrastructure/equipments etc.)
Working capital
TOTAL

If the proposed investment will require liquidation of assests, please provide the details below:

Asset details	Current selling price (Rs in Lacs)	No of days required for liquidation	Mode of liquidation (How will be the asset liquidated)
1
2
3
4
5
TOTAL

Site details (please select from appropriate dropdown menu)

Detail	Site 1	Site 2	Site 3	Site 4	Site 5
Address
Proposed for storage
Type built-up/green field
Ownership status (owned/leased)
Acquisition status: acquired/to be acquired
Land usage (agricultural, commercial, residential, industrial )
Plot area (sqft)

Banker information

Please provide the details for banks with which applicants are/have been dealing in last five years

Name of the bank	Branch location	Duration of relationship	Type of facility (inventory funding / term loan / credit limit)	Current limit (Rs. Lacs)

Can you arrange for a LC of Rs 5Cr to start with and later increase this to Rs 20 cr in 2 years?*

Yes

Can you invest Rs 1-5 cr towards security deposit for 7 days of stock, warehousing & equipment inventory?

Yes

Attachments

Checklist for attachments

Identity

Passport Size Photo

ID Proof

PAN Card

Financials

Balance sheet - last 3 years

Profit & loss account statement - last 3 years

Bankers letter in the desired format (see section B, point 11)

Income tax & wealth tax returns

Others

Authorised person by board resolution (Attach resolution copy)

Photographs of site

Family tree of applicants

Current organization structure

Occupation and experience details of directors

Declaration

I have read, understood and agree with the terms & conditions.

I hereby declare that the above furnished details are true to the best of my knowledge.

Name

City

Date

Instructions

1.All sections should be completely filled. Only fully completed applications will be accepted

2.MEE reserves the right to reject the application if the mandatory questions are not filled

3.All figures should be mentioned in Indian rupees (lakhs)

4.The application forms will be accepted until the deadline mentioned in the advertisement

5.The selection of application is purely at the discretion of MEE management

6.MEE shall not give any reasons or explanation for selection or rejection of particular applicant

7.Shortlisted applicants will be invited for further discussions

8.MEE shall take reasonable steps to keep the information submitted by the applicant confidential

9.A candidate needs to pay Rs.5000/- (Rupees five thousand only) per district per state [+ taxes @ 18 % (Rs. 900) = Total Rs. 5900/-]

10.A candidate can apply for multiple districts. For each additional district he/she needs to pay Rs.5000/- (Rupees five thousand only) per district per state [+ taxes @ 18 % (Rs. 900) = Total Rs. 5900/-]

Checklist for attachments

1.Financials

a)Balance sheet - last 3 years

b)Profit & loss account statement - last 3 years

c)Bankers letter in the desired format (see section B, point 11)

d)Income tax & wealth tax returns

2.Others

a)Photographs of site

b)Family tree of applicants

c)Current organization structure

d)Occupation and experience details of directors

NOTE:

Please attach a certificate from your main banker in support of your financial strength and investment capability.

This document should certify the following :

1.The number of years you have been banking with that bank.

2.Facilities being extended by the bank - inventory finance.

3.Indicate if any collateral is held by bank for the loans.

4.Bank’s rating for all the firms.

5.Turnover of your current account.

6.Credit limit from bank.

7.The average monthly balance in your account

FAQs:

1.For any help in the form, please call our call centre 998 377 4445.

2.For any clarifications regarding the product, please write to enquiry@myecoenergy.in. MEE will get back to you within 5 working days.

Attachments Pending

Checklist for attachments

Identity

Passport Size Photo

ID Proof

PAN Card

Financials

Balance sheet - last 3 years

Profit & loss account statement - last 3 years

Bankers letter in the desired format (see section B, point 11)

Income tax & wealth tax returns

Others

Authorised person by board resolution (Attach resolution copy)

Photographs of site

Family tree of applicants

Current organization structure

Occupation and experience details of directors

Product	Price	Quantity	total
HDPE/FRP tank with dispense	$22.00	2	$44.00
HDPE/FRP tank with dispense	$22.00	2	$44.00
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Section A

Section B

Attachments

Attachments Pending