ITC Limited.
DISTRIBUTORSHIP APPLICATION FORM please paste your
passport-sized
photograph here
Guidelines:
1. Please enter all relevant details. Do not keep any details vacant/unfilled.
2 .In case of questions with multiple options, please tick the appropriate answer.
3. In case you wish to provide any additional information, please attach a separate sheet.
4. Attach your current updated CV and business card along with this application form.
Gender: M F (circle as appropriate)
Married: Y N (circle as appropriate)
__
SECTION I: PERSONAL FACT SHEET
Educational Qualification (begging with the most recent):
Qualification Year of Passing Name of Institution
Current Occupation: (Please Tick)
a) Service b) Business c) Both
1
ITC Limited.
To be filled in by those in service
Name of the current employer:
Designation:
Previous Work Experience:
Period Organization Name Designation Responsibilities
All information provided here will be kept strictly confidential and will not be used for any other purpose
To be filled in by those in business:
Company Proprietary/ Nature of Products / Years in Number of Turnover (Rs.)
Name(s) Partnership/ Business Services Business People
Private Ltd./ offered Employed
Public Ltd. Last 3 Years
Does your professional background involve any of the following? (Please tick the appropriate box)
1. Marketing/Sales 2. Health Care
3. Education/Training 4. Profit Center Management
5. Small Business Mgmt. 6. Other (Specify)
Are you currently associated with any professional group/association?
Yes No
If yes, give details:
2
ITC Limited.
SECTION II: THE PROPOSED CENTRE
How do you propose to set up the center?
Proprietorship Partnership Private Ltd.
Public Ltd. Society Trust
Is the Proprietorship/Partnership/Company/Already in existence?
Yes No
If yes, what is the name of the Business/Firm/Company
City Town where you propose to setup the new venture
located in the state of
Which Division do you want ?
Division (A)FMCG Division (B) Division(C) Division(D)Personal Care
TOBACCO Stationery
Do you already possess a site?
Yes No
All information provided here will be kept strictly confidential and will not be used for any other purpose
If no, do you have a site in mind?
No Yes
Please give details of the site:
Nature of Period of Tiled/Carpet Area Location:
Agreement* Lease Commercial Area/
Ownership/ Residential Area
Rental/Long Term (Address)
Lease
3
ITC Limited.
From:
To:
In case you do not have a site, do you plan to take on rent?
Yes No
If yes, within how many months?
8. How much funds are you willing to invest?
5-10 Lakh 10-20 Lakh 20-30 Lakh
What efforts/initiatives would you put in to make this business a success?
State reasons why ITC Limited Meds kills should consider you as a business partner.
Date: Signature:
All information provided here will be kept strictly confidential and will not be used for any other purpose