Bvm Puc Allotment Form - Bvm Business printable pdf download

BVM PUC ALLOTMENT FORM

1. PERSONAL INFORMATIONS OF THE APPLICANT:-

a. Name of the Applicant : _______________________________________________Distributor ID : ___________________________

b. Father’s/Husband’s Name__________________________________________________________________________________________

c. Occupation : __________________________________________ Qualification :_______________________________________________

d. Date Of Birth : _________/__________/_______________ E-mail Id :______________________________________________________

e. Bank A/c No. : ______________________________________ Ifs Code : ______________________________________________________

Name and address of the Bank______________________________________________________________________________________

g. PAN No. : ______________________________________________

h. Present Residential Address ________________________________________________________________________________________________________

State___________________City__________________ Distt.___________________ Tehsil_________________Post_____________ Pincode_____________

Phone No. (With STD Code) : ______________________________________________________Mobile Phone No.______________________________

i. Permanent Residential Address ______________________________________________________________________________________________________

State___________________City__________________ Distt.___________________ Tehsil_________________Post______________Pincode______________

Phone No. (With STD Code) : ________________________________________________________Mobile Phone No.______________________________

2. INFORMATIONS RELATED TO BVM PUC, SECURITY AND MINIMUM PURCHASE:-

a. Name of the BVM PUC : _________________________________________________________________________________________________________________

b. Complete Postal Address of the BVM PUC : ____________________________________________________________________________________________

State___________________City__________________Post_________________Tehsil__________________Distt.___________________ Pincode____________

Phone No. (With STD Code) : ________________________________________________________Mobile Phone No._______________________________

c. Name of the nearest Depot, from the proposed BVM PUC: - ___________________________________________________________________________

d. TIN No. of BVM PUC :- _______________________________________

e. Description about the security and first minimum purchase of the BVM PUC

Security of BVM PUC : ________________________________In Words : ________________________________________________________________________



First Purchase of BVM PUC : _________________________ In Words : ________________________________________________________________________



3. DECLARATION (BY APPLICANT)

a. I hereby declare that the statements made by me in this “BVM PUC Allotment Form” are true to the best of my knowledge and belief and complete

in all respects.

b. I understand that any information furnished in the application, if found incorrect or false will render me liable for any penal action or other

consequences as may be prescribed in law or otherwise warranted.

c. I agree that this “BVM PUC Allotment Form” and declarations shall be the basis of the contract between me and Adarsh Nirogdham Private Limited.

d. I also declare that any changes in the information given above after the submission of this would be conveyed to Adarsh Nirogdham Private

Limited immediately.

e. I have read and clearly understood the terms & conditions of this “BVM PUC Allotment Form”, printed overleaf and I undertake to be abide by and

follow them strictly.

Date: - ____________________________

_____________________________________________

Place: - ___________________________

(Signature of the Applicant)

4. DECLARATION (BY ROYALTY ACHIEVER)

a. I hereby declare that the statements furnished in this “ BVM PUC Allotment Form” are true to the best of my knowledge and belief and complete

in all respects.

b. I also declare that i know the applicant since________________and confirm that the applicant is able to enter into any agreement or contract

with the Company. He is honest, reliable and capable to operate/manage Company’s PUC, if allotted. I also undertake his complete

responsibility, both in present and future and without dispute or claim.

_______________________________________

___________________________________

_________________________________________

Name of Royalty Achiever:-

Distributor No.:-

(Signature of Royalty Achiever)

Signature of the Applicant_____________________________________

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Bvm Puc Allotment Form - Bvm Business

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