JVS Comatsco Industries Pvt. Ltd.

STOCKIST APPLICATION FORM

1 2 3 Name of the firm Constitution of the firm Name & Residential Address Proprietor / Partners / Directors Shop Address
39/D, Swastik House, J.N.Road, Gultekdi, Pune-411 037, Maharashtra, India. Ph.+91-20-6601 6008 / 09 Fax.+91-20-2645 4524 email: info@ecolite.in www.ecolite.in

(Autoclaved Aerated Concrete Blocks)

: : : Proprietary / Partnership / Pvt. Ltd. (Please tick)

Tel. No./Fax/E-mail ID 5 Name of Person in charge Signatory Telephone No. (STD Code) 6 7 8 9 10 Year of Establishment & Last Year Turnover (Rs.) Authorised Agency Products Dealing in Local Sales Tax & CST Nos. & Date PAN No. & TIN No. Bankers Name and Particulars Name & Address with Branch Code A/c. No. 11 Security Deposit Details

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We confirm that above information is correct and true, any change in the constitution of our Firm will be intimated within 15 days of such change. Date :

Place:

Signature with Stamp

#Enclosed Xerox copy of Partnership Deed / Memorandum & Articles of Association L.S.T. & C.S.T.Certificate Copy/ Photographs (2) #Deposit DD., Pan Card Copy For Office use :
Name of SE/AM/Sr. AM & Territory No. Remarks of SE Is the appointment made with your approval Have you visited the outlet : Yes / No : Yes / No

Has the policy been explained : Yes / No Party Code No. :

SE

DIRECTOR