Annexure-A
(Stockist Appointment Form)
1. Name of The Firm _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ _ _ _ _ _ _ _ _ _ _ _ _
2. Constitution [Please tick ( √ )] Partnership Proprietorship
3. Inception Year _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
4. Name of Proprietor / Partners
S/No. Name Designation Mobile No. / Contact No.
1 Proprietor / Partner
2 Partner
3 Partner
4 Partner
5. Dealing Person / Contact Person:
S/No. Name Designation Mobile No. / Contact No.
1
2
3
6. Mailing Address _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ _ _ _ _ _ _ _ _ _ _ _ _ _
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ _ _ _ _ _ _ _ _ _ _ _ _ _
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ _ _ _ _ _ _ _ _ _ _ _ _ _
P.O. _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Dist _ _ _ _ _ _ _ _ _ _ _ _ _ PIN Code _ _ _ _ _ _ _ _ _ _ _ _ _
State _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
7. Office Tel No. _ _ _ _ _ _ _ _ _ _ _ _ _Fax No._ _ _ _ _ _ _ _ _ _ _ _ _email _ _ _ _ _ _ __ _ _ _ _ _ _ _ _ _ _ _ _
8. Drug License No. 20B _ _ _ _ _ _ _ _ _ _ _ _ _ 21B _ _ _ _ _ _ _ _ _ _ _ _ _Valid upto_ _ _ _ _ _ _ _ _ _ _ _ _ _
9. TIN VAT No. _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _Date_ _ _ _ _ _ __ _ _ _ _ _ _ __ _ _ _ _ _ _
10. Transport Preferred for supply of goods:
(a) _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ (b) _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
11. Courier Preferred
(a) _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ (b) _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
Annexure-B
(Stockist Appointment Form)
1. Number Retailers Dealing _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ _ _ _ _ _ _ _ _ _ _ _
2. Credit Period to Retailers_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ _ _ _ _ _ _ _ _ _ _ _ _
3. Number of Employees_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Number of Delivery Staffs_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
4. Market Catered (a)_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _(b) _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _(b) _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
(d)_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _(e) _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _(f) _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
(g)_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _(h) _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _(i) _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
5. Delivery Vehicle [Please tick ( √ )] Available Not Available
Details of Delivery Vehicle (If Available) _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
6. Existing Company Work Details:
S/No. Company Name Dealing from (Year) Average Monthly Sales
1
2
3
4
5
6
7
7. Last Three Year Turnover:
(a) Financial Year_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Turnover (Rs.)_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
(b) Financial Year_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Turnover (Rs.)_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
(c) Financial Year_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Turnover (Rs.)_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
8. Bank / Banks Dealing With:
(a) _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
(b) _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
9. Allied Business (If Any) _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
10. Proposed investment to be Made for “Joss Biotec Private Limited” Rs._ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
Annexure-C
(Stockist Appointment Form)
Permanent Address of Proprietor / Partners
Mobile No. / Contact
S/No. Name & Permanent Address of Proprietor / Partners Designation
No.
Name:
Address:
1 Proprietor / Partner
Name:
Address:
2 Partner
Name:
Address:
3 Partner
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ _ _ _ _ _ _ _ _ _ _ _ _ __ _ __ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
The information given in Annexure-A, Annexure-B & Annexure-C is true and correct to best of my
knowledge.
Applicant Name: _ _ _ _ _ _ _ _ _ _ _ _ _ _Designation: _ _ _ _ _ _ _ _ _ _ _
Place: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _Date: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Signature & Seal of Applicant
Annexure-D
(Stockist Appointment Form)
Basic Policies of the Company “JOSS BIOTEC PRIVATE LIMITED”
1. Applicant / Stockists are not supposed to do any kind of cash or goods transaction with any
employee of the company; unless you are advised to do so in writing on company’s letter-
head duly signed and stamped by a competent authority.
2. Applicant / Stockists are not supposed give any extra scheme bonus, gift or special rate to
any of your customer unless you are advised to do so in writing on company’s letter- head
duly signed and stamped by a competent authority.
3. If at all the Applicant / Stockist is doing such above mentioned transaction (Point no.1 & 2), it
will be solely on their head, Company will not be liable for that.
4. Applicant / Stockists are supposed to forward their esteemed orders either on their letter
head with seal & signature or on company’s order book with seal & signature.
5. Applicant / Stockists are requested to convey information about dumped & short expiry
stocks to company on time to time basis.
6. Expiry / Breakage claim of goods, after 6 months from the date of expiry will no be
entertained by the company.
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ _ _ _ _ _ _ _ _ _ _ _ _ __ _ __ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
I / We have gone through the basic policies (Annexure-D) of the company “JOSS BIOTEC PRIVATE LIMITED”
and I / we will abide with it.
Applicant Name: _ _ _ _ _ _ _ _ _ _ _ _ _ _Designation: _ _ _ _ _ _ _ _ _ _ _
Place: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _Date: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Signature & Seal of Applicant
Check List
[For Company’s Field Executives, if satisfied put tick mark ( √ )]
1. All columns of Annexure-A, Annexure-B, Annexure-C, Annexure-D & Annexure-E are filled.
Any column which is Not Applicable, please write N.A. in the given space / column.
2. Ensure signature and seal / stamp with date, of the applicant in both Annexure ( Annexure-C &
Annexure-D)
3. Following Documents Obtained:
a. Photocopy of Applicants Wholesale Drug License (20B & 21B)
(If expired please get photo copy of renewed license)
b. Photocopy of Applicants TIN Vat No.
4. Applicant Firm’s undated blank cheque with seal & signature obtained in favour of “JOSS
BIOTEC PRIVATE LIMITED”
Annexure-E
(Stockist Appointment Form)
TO BE FILLED BY COMPANY’S FIELD EXECUTIVES ONLY
1. Why New Party Required __________________________________ ___________
____________________________________ _________
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
2. Market Reputation of Party _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
3. Credit Worthiness of Party _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
4. Party Willingness _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
Recommended by:
Name _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ _ _ _ _ _ _ _ _ _ _ _ _
Designation [Please tick ( √ )] M.S.R. A.S.M.
Place _ _ _ _ _ _ _ _ _ _ _ _ _ _ Date_ _ _ _ _ _ _ _ _ _`_ _ _ _ Signature
Forwarded by:
Name _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ _ _ _ _ _ _ _ _ _ _ _ _
Designation [Please tick ( √ )] A.S.M. D.S.M. B.D.M.
Place _ _ _ _ _ _ _ _ _ _ _ _ _ _ Date_ _ _ _ _ _ _ _ _ _`_ _ _ _ Signature
Comments From [Please tick ( √ ) D.S.M. B.D.M.
_ _ _ _ _ _ _ _ _ _ __ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ _ _ _ _ _ _ _ _ _ _
_ _ _ _ _ _ _ _ _ _ __ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ _ _ _ _ _ _ _ _ _ _
_ _ _ _ _ _ _ _ _ _ __ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ _ _ _ _ _ _ _ _ _ _
_ _ _ _ _ _ _ _ _ _ __ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ _ _ _ _ _ _ _ _ _ _
_ _ _ _ _ _ _ _ _ _ __ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ _ _ _ _ _ _ _ _ _ _
_ _ _ _ _ _ _ _ _ _ __ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ _ _ _ _ _ _ _ _ _ _
Annexure-F
(Stockist Appointment Form)
For Office Use Only
1. Status of Party Approval [Please tick ( √ )] Approved Not Approved
Reason of Non Approval (If Not Approved) _ __ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ _ _ _ _ _ _ _ _ _ _
_ __ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ _ _ _ _ _ _ _ _ _ _
_ __ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ _ _ _ _ _ _ _ _ _ _
2. Business Terms [Please tick ( √ )] Advance Payment Credit Against PDC
If Business against PDC or Credit:
a. Credit Days_ _ _ _ _Days (In Words _ __ _ _ _ _ _ _ _ _ __ __ _ _ _ _ _ _ _Days)
b. Credit Limit Rs. _ __ _ _ _ _ _ _ _ _ _(In Words Rupees _ __ _ _ _ _ _ _ _ _ __ __ _ _ _ _ _ _ _ _ _ _ _ _Only)
c. Billing Locked if Payments Overdue from_ _ _ _Days (In Words _ __ _ _ _ _ _ _ _ _ __ __ _ _ _ _ _Days)
3. Other Remarks
_ _ _ _ _ _ _ _ _ _ __ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ _ _ _ _ _
_ _ _ _ _ _ _ _ _ _ __ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ _ _ _ _ _
_ _ _ _ _ _ _ _ _ _ __ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ _ _ _ _ _
_ _ _ _ _ _ _ _ _ _ __ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ _ _ _ _ _
_ _ _ _ _ _ _ _ _ _ __ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ _ _ _ _ _
_ _ _ _ _ _ _ _ _ _ __ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ _ _ _ _ _
Competent Authority
Name _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ _ _ _ _ _ _ _ _ _ _ _ _
Designation _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ _ _ _ _ _ _ _ _
Place _ _ _ _ _ _ _ _ _ _ _ _ _ _ Date_ _ _ _ _ _ _ _ _ _`_ _ _ Seal & Signature
