Introducing kee MUal-mela-t-y alae team eels M a= |an-|C@a-\) ae) 1-1 APPLICATION FORM (All Forms to be duly filled & sent to Registered Office) (For Office Use) (For Office Use)Reffance PROSPECTIVE DEALER/DISTRIBUTOR APPLICATION A Prospective Dealership/Distributorship Application ("Application") must be completed by each prospective owner of an Campa Cola Industries. Please allow approximately 1 to 2 weeks time to review and process your Application, Understand that under no circumstances does the submission of your Application to Campa Cola Industries Pvt Ltd (CCIPL), subsequent review and processing imply in any manner Campa Cola Industry's intention to approve you as an Campa Cola Dealer/Distributor. The Applicant shall not be deemed to be accepted and approved by Campa Cola Industries until unless the complete execution of Campa Cola Dealership/Distributorship Agreement takes place. No employee or agent or partner of Campa Cola Industries has the authiroty to waive or otherwise deviate from the foregoing procedures and should any deviation from the Appli- cation procedure occur, the waiver or deviation from the Application procedure shall not be bindind upon Campa Cola Industries. Further, the CCIPL can reject application form of any prospective applicant without assign- ing any reason. No query in this regard will be entertained. DECLARATION: 1 [Name ofindividual applying iobe an Owner] (the "Applicant") an interested in submitting the Application to Campa Cola Industries for the purpose of the evaluation of my qualifications and credentials to own and/or operate a dealer/distributor of Campa Cola Industries Pvt Ltd.nefiance Application No. To, DEALERSHIP/DISTRIBUTORSHIP Mec your Aix your The Managing Director, APPLICATION FORM ‘nent rei atipe Campa Cola Industries Pvt Ltd. Pra Frog C35 Swastik Mill Compound. La = V. N. Puray Marg, Chembur Mumbai - 400071 Tenant Ponca’? Note: This form is to be filled by the main candidate(s) or in consultation with the main candidate(s) and other key person. PERSONAL INFORMATION (Please fil the form in CAPITAL LETTERS) Applicant - 1 (Owner) FirstName: || DOOOOS0000 OOOUOUOO0o LastName: | [|_| OOO LOI Father's/Guardian’s Name OO UO Passport / Voter ID Number: [TIS Gender: [Einate| Female Date ot: [| LI Aadhar Number: oor Resitenc ites: [| oor Ponti ory Col Cou State: Do Dol Mobile | Phone: IIE ILI Correspondence Address: Omni r incs OUI HU ] Oty Oo OOo OO J prone: IILIOIOU OOOO HO woot: III) Fem ee ee Applicant - 2 (Owner) First Name: IOC IOC 1001 Last Name: JOO IDOI JOO Date of tr: IIE) ender: [vem] Passport Voter Number [| || [| goo oor ‘Aadar Number: IOI INDIO IMO Address: DOI OO OO | ev ODOOODOOOO0000 OO O000000 OOOO J Site: Oot OO Pin Code: ] Mobile IANO Prove:| JILL [ Cl ]OWNERSHIP PROFILE Please provide information on your proposed ownership structure, including each individual and legal entity that will potentially ‘own and/or control beneficial ownership interests and/or hold major management positions in the proposed dealership business. (Please take photocopy of FA-2 & FA-3 if applicants are two and fillthese pages separately) In addition, please identify a majority owner who will personally be at the centre to actively control the day-to-day operations and administration of the franchise centre on afulltime basis. S.No. Name Percentage of ‘Active / Inactive Total Ownership 1 % 2 % 100% (Indicate NA where Not Applicable) NOTE: Any additional or other individual with direct or indirect beneficial ownership interest in the franchise business must be explained on a separate attachment and such person must submit a separate FA2- FA3 duly filled pages and be approved as. aan owner by Campa Cola Industries Pvt Lt, if applicable. QUALIFICATIONS (Ordor: Picase mention latest qualification first) Degree / Diploma / Certificate Universityiinstitution | Subjects / Stream ‘% Marks Rank | CGPA Year of Passing BUSINESS EXPERIENCE (If Any) (Indicate NA where Not Applicable) ‘Name of Organization Nature of lnvelvement Profit | Product/Service Gr No. of Employees (Indicate NA where Not Applicable)| Form] Application No. FINANCIAL INFORMATION & OBJECTIVE ASSESSMENT Note: This form is to be filled by the main candidate(s) or in consultation with the main candidate(s) and other key persons. STRUCTURE OF THE BUSINESS ENTITY FOR FRANCHISE OPERATIONS [1] Proprietorship Fim —[] Partnership Fim —[-) Private Limited Company]. Limitec Company (1) Other (Specify) INVESTMENT CAPABILITY C1 12-18 Lacs (J 15-20 Lacs 1 20-25 Lacs (1 28-50 Lacs (1 80 Lacs-1¢r YOUR OBJECTIVE (J Dealership ——-(] Distbutorship DEALERS DISTRIBUTORS CENTRE PREFERENCE ASSESSMENT: Please fill the target location details, where you would prefer to have an Campa Dealership/Distributorship. This in- formation will be used to match you to potential opportunities. CHOICE OF CITY FOR CENTRE: PROPOSED LOCATION/AREA WITHIN THE CITY: PLEASE ELABORATE ON THE REASONS FOR CHOICE OF LOCATION: IN CASE THE ABOVE CITY / TOWN IS NOT AWARDED TO YOU FOR DEALERSHIP OPERATION, WOULD YOU LIKE TO. BE CONSIDERED FOR ANY OTHER CITY | TOWN? O ves 1 no if Yes, please give you preferences S.No. Name ofthe Gity Town Reasons for choosing this City Town {inorder preference) (indicate NA where Not Applicable)AVAILABILITY OF FUNDS FOR CAMPA DEALERSHIP/DISTRIBUTORSHIP (Taking all promoters together) Funds From Own Sources: Name of Investor / Fund ‘Amount available to Invest Time required to Mobilise Funds Gi INR Lakhs) (Na. of Daye) (Indicate NA where Not Applicable) Funds From Other Sources: (Please mention available credit facilities ete. also) Name of Investor / Fund ‘Amount available to Invest Time required to Mobilise Funds (INR Lakhs) (No.of Days) (Indicate NA where Not Applicable) BECOMING A DEALER/ DISTRIBUTOR OF CAMPA 1, WHY DO YOU WANT TO BECOME A DEALER/DISTRIBUTOR OF CAMPA? CURRENT INFRASTRUCTURE, WHICH CAN BE MADE EXCLUSIVELY AVAILABLE FOR RUNNING CAMPA DEALERSHIP Promises (Place to run centre) already available: OO Yes U1 No IF Yes, please provide nature of premises: [1] owned Premise [[] Single Ownership [] Multiple Ownership -—[[] Rented / Leased Joint In case of Owned Premises, please furnish details for the same: Carpet Area / Build up Area (In Sq. Ft): (Please tick mark 2s relevant) (800-1200 (1 1200 - 1800 (1 1800 - 2200 (1 More than 2200 Number of Floors / Storey: (Please tick mark as rlovant) [1 only Basement [| Basement+G.F [| GR +R [1 Allof the aboveApplication No... PROFESSIONAL PROFILE Note: This form is to be filled by the main candidate(s) or in consultation with the main candidate(s) and other key persons. Name: Designation: BUSINESS DETAILS (Details sbout current business/professional setup) Name of the Organization: Form of Organization: (1 Proprietary [_] Partnership [_] Private Limited [] Limited [_] Others (Please specify: Nature of Organization: C1 Joint Sector [| Cooperative [] Private Sector —_[_] Others (Please specify: Major Products / Services: Outstation Branches/Centres LD yes LJ No (if Yes, please attach a list of addresses of the branches) Total Assets (In INR): Total Sales Tummover (In INR): Number of Managers: ‘Total Number of Employees: WORK EXPERIENCE Please give a brief idea of the assignments and responsibilities handled, including change of position within one company: Organization | Designation | Number of years of Job Responsibility (Indicate NA where Not Applicable)BANK ACCOUNT DETAILS BY WHICH YOU WILL DO TRANSACTION WITH US IN FUTURE refance 'S No. AIC Holder Name Name of Bank Last Four Digit of AIC No LIST OF ENCLOSURES WITH THIS APPLICATION FORM 1. Copy of Memorandum/Articles of Association (For Private Limited), If applicable. DAttached Partnership Deed, If Applicable. DAttached Certificate of Registration of Firm. DAttached GST Certificate (For Existing Firm) Dattached Property Ownership Documents/ Rental Agreement ClAttached Letter of Deployment of Wor ©erneneeon Photocopy of Pan Card /Aadhar Card, 10. Candidate Profile PPT with Location Map. 19 Capital from Candidate. C1 Attached Copy of Income Tax Returns filed for the last 3 years. C1 Attached Voters Card of Applicants) Residential Proof of Applicants. [1 Attached CDAttached CDAttached DECLARATION Not Available (Not Available TC Not Available CNet available CNet available CD not available Not Available CNet Available Not Available CNet Available (To be Applied (To be Applied 7b be Applied C7 be Applied (To be Applied CTo be Applied [To be Applied (7 be Applied (To be Applied (To be Applied 17 We declare thatthe details and information provided by me /us herein above are true tothe best of my knowledge and belief. Date: Name: Name: (appicart-1) (apeant-2) Place: Signature: Signature’ (appicent-1) (aspicant-2) Application Status: [[] Complete] incomplete (FOR OFFICE USE ONLY) Financial Profile Strongth: 1 23456789 0f) Remarks: