APPLICATION FOR APPOINTMENT AS AUTHORISED CEMENT DEALER ACC LIMITED
Ref: ACC/SURPR/ACD.
1. Place (S) where dealership is required – Town _______________________________.
Tehsil__________________________ District______________________________.
2. Name in Full Mr. / Mrs / MS. _____________________________________________.
3. Full Postal Address:
(a) Shop _________________________________________________.
_________________________________________________.
(b). Godown _________________________________________________.
_________________________________________________.
(c ). Residence _________________________________________________.
_________________________________________________.
4. Telephone No. STD Code : ______ - ________________. Mob No._______________.
5. (a) Is your firm:
Proprietorship / Partnership / Joint Hindu Family.
(b). Mention the name(s) of the proprietor / partner / karta :
Name Percentage Share (%).
________________________________ _________________
________________________________ _________________
________________________________ _________________
________________________________ _________________
(if partnership / JT. Hindu Family Firm, Please send true copy of the partnership deed.)
6. How long have you been established in the place where dealership of desired : _________ Years.
(Please enclose nativity certificate)
7. (a). Are you our dealer at any other place ? (Yes) (No)
(Appointment letter may be enclosed)
(b). Have you made any previous application ? (Yes) (No)
(if so, please send a copy of our reply to you).
8. What is the approximate consumption of cement per month in your tow ?
Total: ____________ MT. / Month.
Brand : _______________ ______________ ______________ ________________ ____________.
9. How much cement business do you guarantee per month : _______________MT.
10. Are your or anyone connected with you in the building contracts Business : (Yes) (No).
Details : ___________________________________________________________________________.
11. Have you any contacts with Revenue Authority, Govt. Official, Prominent Businessmen etc: (Yes) (No).
Please give their full name designation and address in case we wish to make any reference.
12. Have you at any time handled our (ACC) Cement directly or as a dealer with any of our dealers: (Yes)
(No)
Details : __________________________________________________________________________.
Or have you handled or presently handling any other brand of cement : (Yes) (No).
Details: ___________________________________________________________________________.
13. Your present business. Give particulars of the firm or industry you represent.
Year Estd. Business Current Yr . Sale (Rs.) Last Yr. Sale (Rs.)
14. Any other Information you may like to give in support of your request:
CREDIT APPRAISAL
15. How much money can you set apart Exclusively for cement business per month : Rs. ________________.
16. (a) Is your house owned by you or rented : (Owned) (Rented)
(Please enclose photo copy of ownership papers.)
Details : _____________________________________________________________________________.
(b) Is your godown owned by you or rented : (Owned) (Rented)
(Please enclose photo copy of ownership papers.)
Details : _____________________________________________________________________________.
(c) Is your shop owned by you or rented : (Owned) (Rented)
(Please enclose photo copy of ownership papers.)
Details : ____________________________________________________________________________.
17. Kindly enclose your last 3 years audited balance sheet and give details: Enclosed / Not Enclosed.
18. Name & Address of your bankers:
___________________________________________________________.
(Please enclose introduction letter from them.)
19. Details of liabilities including loans as on.
1.____________________________________________________________________________________.
2.____________________________________________________________________________________.
3.____________________________________________________________________________________.
20. Are your purchasing cement on credit ? if yes, mention no. of days of credit availed and sources thereof. :
21. Are you in a position to give any security for the credit: (Yes) (No)
Particulars of Security Market Value (Rs.)
Bank Guarantee : ________________________________________________________________.
Others :_________________________________________________________________.
: _________________________________________________________________.
Is there any other charges on the Security ?: (Yes) (No)
If yes , to what extent ? ____________________________________________________________.
22. Credit facility desired from ACC :
(1). No of Days : ___________________________.
(2). Amount not exceeding Rs. : ___________________________.
(3). Security to ACC : ___________________________.
23. REFERENCE :
Name & Address of two Referees:
(1). ________________________________ Address : ___________________________________.
(2). ________________________________ Address: ___________________________________.
24. Enclosures : Enclosed
(1). Audited copies of Profit & Loss Account and Balance Sheet for Last (Yes) (No)
Three Years.
(2). Latest Income Tax Clearance Certificate. (Yes) (No).
(3). Photocopy of Sales Tax Certificate (Yes) (No).
TIN No. _______________________________. PAN No. ________________________________.
(4). Partnership Deed. (Yes) (No)
(5). Nativity Certificate. (Yes) (No)
(6). Ownership Paper :
(a). House : (Yes) (No)
(b). Residence : (Yes) (No)
(c.). Godown : (Yes) (No)
(d). Shop : (Yes) (No)
(7). Introduction letter from your banker. (Yes) (No)
25. Declaration:
We declare that all the particulars and information given in this form are true and complete. We
further confirm that there has been no insolvency proceedings against us/ our partners/directors. We agree to
abide with the terms and conditions of ACC as decided from time to time.
Signature________________________________.
Partner / Director/ Proprietor
Rubber Stamp.
PLACE : ____________________________
DATE :____________________________.
