Fill The Retailer Form

I.Basic Information:

Name of company or Organisation:
Name of the Owner / (Mr. / Mrs. / Ms.)
Permanent Address:
Phone No.:

II.Constitution of Cash Back Store:

1.Proprietorship/ Partnership/Private Limited Co/ Public Limited Co/Others:
2.(Please specify)

III.Trading History:

1. How long have you been operating:
2. How long have you been in food and allied product?
3. If yes, kindly state the product(s)
4. Monthly Turnover (Product Wise ):
5. Administrative Staff:
Sales Staff:
Helper Staff:
6.Do you have owned vehicle for distribution? (If yes) state the name (if no)


1. How much are you ready to invest in this business:
2. Do you have financing arrangement with any financial Institution(Bank or Finance House?):
3. Average monthly turnover for the part six (6) months:


1. What is the minimum business in Amount that you envisage per month product wise:
2. IMPORTANT: what area do you intend to cover as a distributor:
3. What areas do your Retailers / customers cover? Please list in order of the importance to you:


1. Are any your friends / associates / relatives / associated with ourgroup? If yes, specify Name :
Have you applied to our group before?
If yes, for,
on (date)
2. If selected / appointed, when can you start business?
3. Goods & Service Tax Registration Number: (GST)
4. Bankers name and address :
5. Weekly closing day :
6. Office Timings :
7. Delivery Address : Office/Godown

Please, note that all information in this application will be treated as confidential but we reserve the right to make enquiries regarding the status of any applicant This form is not an offer or application as a distributor. Further development will be communicated to you in due course.

VII. Declaration:

I/We, the undersigned, have gone through the terms & conditions, as mentioned herein, for my/our appointment as the Franchisee Store of the Company. I/We, fully understand the implications of the terms & conditions as given overleaf and therefore bind myself/ourselves into a legal contract with the Company as per the Indian Contract Act, 1872 and other applicable provisions and laws as may be related to this contract.

I/We understand fully that this Application Form can be used against me/us before any Court of Law/Tribunal/Arbitration proceedings, etc. I/We, state that all information as mentioned in this Application Form is true & correct to the best of my/our knowledge and information and I/We shall abide by and maintain the declarations made herein. I further agree to abide by the terms and conditions of this agreement as long as I continue to deal with the Company; I also agree to be bound by the terms & conditions & policies of supply of goods and payment thereof conveyed from time to time by the Company.

VIII. Documents Required:

1) Copy of Memorandum & Articles of Association in case Dealer/Distributor is Company registered under the Companies Act 1956.
2) Copy of List of Directors with addresses in case Dealer/Distributor is a Company registered under the Companies Act 1956.
3) Copy of Board Resolution authorising the person applying for Dealership/Distributorship and signing this Form in case Dealer/Distributor is a Company registered under the Companies Act 1956.
4) Copy of Partnership Deed in case the Dealer/Distributor is a Firm, Association of Persons, etc. along with a letter of Authority in favour of the Authorised Partner/Person.
5) List of Partners with addresses in case the Dealer/Distributor is a Firm, Association of Persons, etc.
6) Copy of Electricity/Telephone Bill showing the address of the premises from where the Distributor is operating as mentioned under above.
7) Shop Act Registration
8) GST Registration Certificate
9) Fssai Registration Certificate
10) Any other documents

A. Name of Officer / Institution of Stores Completing this Application:
Mobile No: