kal The great Indian taste in an all new avatar! APPLICATION FORM (CR ome aM eR eae ele Rela)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: ! ‘ [Name ofindividual applying to be 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.ee ‘Application No. to, DEALERSHIP/DISTRIBUTORSHIP Hay eyo “The Managing Director, APPLICATION FORM sean ist wert peor Campa Cola Industries Pt Ltd. prota Potoges 35 Swastik Mill Compound. re rer VN. Puray Marg, Chembur Mumbal - 490071 “eat Ropheant2 Note: This form isto be filled by the main candidate(s) or in consultation with the main candidate(s) and other key person. PERSONAL INFORMATION (Please fll the form in CAPITAL LETTERS) Applicant 1 (Owner) rritene: OOOO UOOUOOOOOOooOoooOoooOoooOoOooOo Lest Nore: IIo Faberatuartens tone: CICICICI Date of i IIIS onder: [Eat [Fema Passport/ Voter ID Number: [||| || ‘adr Number Io Residence Adress: Oeeatnh ION ey QOODOO0O0000 stat 000 Mobile: [ Phone: | Correspondence Address: (~~) (Peseta is Resins Ms) | LI ] Cy. IOO00I ] Sete: ooo Pin Code | Phone: oo Moti: | Applicant -2 (Owner) FirstName: [Ld oooooocococoooooooooocoo LastName: | Ooooot Date of Birth: [|| Gender: [Male] Female Passport / Voter ID Number ooo ‘sadher Number: 1001 ‘Address: JOO I iy. IOQO001 | ] l State: IOOOOCIL Pin Code: Mobile lig PhoneReliance 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-Sif applicants are two and fillthese pages separately) {In addition, please identify 2 majority owner who will personally be at the centre to actively control the day-to-day operations ‘and administration ofthe franchise centre on a fulltime basis. S.No. Name Position / Title Porcontage 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 separale attachment and such person must submit a separate FA2- FA3 duly filled pages and be approved as ‘an owner by Campa Cola Industries Pvt Ltd., if applicable. QUALIFICATIONS (Order: Please mention latest qualification frst) Degree / Diploma /Certificate | Universityinstitution | Subjects /Stream | % Marks /Rank/CGPA | Year of Passing (Indicate NA where Not Applicable) BUSINESS EXPERIENCE (if Any) Name of Organization | Nature ofivoivement | From | To. | Tumever | Pront | Product/Service | No. of Employees reese ear | ene | dmteny | fone (Indicate NA where Not Applicable)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. [11 Proprietorship Firm — [] Partnership Firm — ["] Private Limited Company [_]_ Limited Company [other (Specify) INVESTMENT CAPABILITY [J 12-15 Lacs ) 15-20 Lacs (J 20-25 Lacs [J 25-50 Lacs (1) 50 Lacs-1 cr YOUR OBJECTIVE (1 Dealership [1 Distributorship 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? Oo Yes 1 No I Yes, please give you preferences: ‘S.No. ‘Name of the Gity Town Reasons for choosing this City / Town Un order of preference) (Undicate NA where Not Applicable)Reliance 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 (GnINF Laks) (No.of Days) (Indicate NA where Not Applicable) Funds From Other Sources: (Please mention available credit facilities etc. also) ‘Name of investor / Fund ‘Amount available to Invest ‘Time required to Mobilise Funds (Un 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 No If Yes, please provide nature of premises: J owned Premise] 1 int In case of Owned Premises, please furnish details for the same: gle Ownership] Multiple Ownership. [[] Rented / Leased Carpet Area / Build up Area (In Sq. Ft.) (Pease tick mark as relevant) C 800-1200 C1200 - 1800 1 1800 - 2200 (1 More than 2200 Number of Floors / Storey: (Please ick mark as rlovant) (J onlysasement [[] Basement. [] GR+RF. (0 Aliofthe aboveApplication No. Name: Designation: 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. BUSINESS DETAILS (Details about current business/professional setup) Name of the Organization: Form of Organization: 1 Proprictary [] Partnership [1] Private Livited [[] Limited [] others Please specity ) Nature of Organizatior (1 Joint Sector Major Products / Services Outstation Branchesi O Yes ' 1 Cooperative 1 Private Sector (Centres LI No (lfY¥es, please attach a list of addresses of the branches) Total Assets (In INR): Total Sales Turnover Number of Managers: Total Number of Emp! WORK EXPERIENCI (In INR): joyees: E 1 others (Please specity Please give a brief idea of the assignments and responsibilities handled, including change of position within one company: Organization Designation ‘Number of years of Experionce Job Responsibility (indicate NA where Not Applicable)BANK ACCOUNT DETAILS BY WHICH YOU WILL DO TRANSACTION WITH US IN FUTURE nefiance S No. AIC Holder Name Name of Bank Last Four Digit of A/C No LIST OF ENCLOSURES WITH THIS APPLICATION FORM 1. Copy of Memorandum/Articles of Association (For Private Limited), If applicable. Dattachea 2. Partnership Deed, If Applicable. DAttached 3, Certificate of Registration of Firm CAttached 4, GST Certificate (For Existing Firm) DAttached 5, Property Ownership Documents/ Rental Agreement. Dattachea 6. Letter of Deployment of Working Capital from Candidate. J Attached 7. Copy of income Tax Returns filed for the last 3 years. [J Attached 8, Voters Card of Applicants/ Residential Proof of Applicants. J Attached 9, Photocopy of Pan Card /Aadhar Card. attached 10. Candidate Profile PPT with Location Map. DAttached DECLARATION Not Available CNot Available Not Available Not Available CNet available CNet available Not Available Cnet available Not Available Cnet available (1170 be Applied (To be Applied CTo be Applied (To be Applied (170 be Applied (To be Applied (To be Applied (170 be Applied (170 be Applied (To be Applied | We declare that the details and information provided by me / us herein above are true to the best of my knowledge and belie. Date: Name Name: (ropes 1) (poptean-2) Place: Signature: Signature: (optcant- 1) (hootcar-2) (FOR OFFICE USE ONLY) Application Status: [] Complete [2 Incomplete Financial Profle Strength 1 2.3 4 5 6 7 8 8 10] Romarks: