Consultant Application Form

MCA No...........................................
Modicare Limited
5, Community Centre,
CONSULTANT APPLICATION + AGREEMENT FORM New Friends Colony-110025
Phone no. 011-66623000
Sponsor No.
Azadi Call Center: 011-66274100
CIN-U72200DL1973PLC110617
Sponsor Name

PLEASE FILL THE FOLLOWING IN CAPITAL LETTERS FIRST NAME SURNAME DATE OF BIRTH

Consultant’s Name Mr/Ms ___/___/_____

Co-Applicant’s Name Mr/Ms ___/___/_____

Address

City State Pin

Telephone (Please mention STD Code)

Mobile E-mail

Nominee Mr/Ms Relationship

Address

Witness Name Mr/Ms Witness Signature

The undersigned Consultant acknowledges that he/she fully understands all the *terms and conditions mentioned herein in
this Application and in the SMAP and hereby agrees to comply by all terms laid down. The Consultant fully understands the
implications of the terms and conditions and therefore binds himself/herself into a legal contract with Modicare as per the
Indian Contract Act, 1872 and other applicable laws. Further, the Consultant acknowledges and agrees that he//she shall
read and abide by the SMAP (as amended from time to time) and the Direct Selling Guidelines,2016 issued by the
Department of Consumer Affairs and all amendment thereto (which shall also govern the conduct and mode of business of
the Consultant under the present contract).
Any amount payable to the Consultant as Commission / Bonus by the Company is inclusive of all taxes, by whatever name
they are called, including Service Tax, VAT, Income Tax, GST, Professional Tax, Surcharge, Cess and other taxes. These
taxes shall be payable by the Consultant as and when they are required to be paid as per prevailing laws.
(Please attach a photocopy of your Aadhar card, PAN card and Bank Pass Book for entry in system)
I hereby conrm that I have personally explained to him/her about the Company’s policies and activities as per “SMAP”.
He/she is willing to become a Modicare Consultant after understanding the same.

Dated Sponsor’s Signature

Applicant’s Signature Co-Applicant’s Signature

1st Copy: Company I 2nd Copy: Applicant I

*TERMS AND CONDITIONS
CONSULTANT APPLICATION + AGREEMENT FORM

• This form is an application and an agreement to appoint an individual as a self-employed and independent
Consultant. This form read with “SMAP” (Samir Modi Azadi Plan) shall together be construed as a validly
entered Contract and the Consultant and Modicare shall be bound by the terms and conditions herein.

• Each applicant should be at least 18 years of age at the time of application, to become a Modicare
Consultant.

• The Contract between the Consultant and Modicare is on a principal-to principal basis. The signing of this
Form / Application by a Consultant does not bind the Consultant as an employee or agent of the Company.

• Consultants are not permitted, under any circumstances to advertise, market or deal in any manner with
any product and/or services, which are not approved by Modicare in their network.

• The Consultant shall not make any claim that is not consistent with claims authorised by Modicare.

• The Consultant shall attend the mandatory orientation session given by Modicare regarding provision of
fair and accurate information on all aspects of the direct selling operation, remuneration system and
expected remuneration for newly sponsored Consultants. The date of such an orientation session will be
available to the Consultant on Company’s website.

• The Consultant shall take appropriate steps to ensure protection of all private information provided to
him/her by a consumer.

• Husband and wife, desirous of becoming Consultants have to be sponsored under a single membership. If
the spouse is already a Consultant, then the other must join as a part of the same business membership.

• A Consultant who does not adhere to these rules can be suspended, pending inquiry or terminated from
the membership.

• The registration is non-transferable and non-returnable.

• In case of any grievance or complaint received by the Consultant from a Consumer regarding any product
of Modicare sold in pursuance of this contract, the Consultant shall refer such complaint to the Grievance
Redressal Committee of Modicare which shall address such grievances within 30 (Thirty) days. The
Decision of the Grievance Redressal Committee in respect of such complaints shall be final.

• The Consultants shall mandatorily provide his/her bank account details to Modicare. If the Consultant’s
bank account details are not updated with Modicare and if the Consultant is entitled to monthly
commission between Rs. 100 to 499 then Modicare will issue a product voucher against such accrued
commission amount.

• The Consultant hereby authorises Modicare to sent Text Massages related to Modicare Business on
his/her registered mobile number with Modicare.

• All disputes are subject to the jurisdiction of New Delhi, India.