STOCKIST-SELF TEST (PROPOSAL FORM)
Check List
Proposal Form
Review Filled Form
Following documents are to be attached along with Proposal Form "duly stamped and signed by the proposed person"
*
:
Drug License - 20B and 21B or MD-42
Copy of GST Certificate (Along with Annexure A and B)
PAN Card
AADHAR Card (In case of Partnership/Private Limited/Sole Proprietor/HUF – Require AADHAR card of each individual)
Purchase Order
All pages of proposal form along with supporting documents shall be signed and stamped by the Stockist
Stockist- Self test has agreed to do the marketing promotions such as installing and pasting of Posters/Danglers & other items not specifically mentioned in the list at all retail counters. The delivery boy of the Stockist should be trained to do all marketing promotional activities.
I herby acknowledge that I have read and understood the check list as above and I agree to all of the terms.
Proceed
PROPOSAL FORM FOR STOCKIST-SELF TEST
Check List
Proposal Form
Review Filled Form
ProPerty Size (sq. ft.)
*
:
0-1000
1001 - 1500
1501 - 2000
2001 - 2500
2501 - 3000
3000+
Bedrooms
*
:
1
2
3
4
5
5+
Bathrooms
*
:
1
2
3
4
5
5+
Bath Tubs
*
:
Null
1
2
3
4
5
Sitting/Conference Room
*
:
Yes
No
Dining Room
*
:
Yes
No
Kitchen
*
:
Null
1
2
Oven
*
:
Null
1
2
3
4
Kitchen Items
*
:
Not Required
Refrigerator
Washing Machine
Microwave
Tumble Dryer
Back
Next
Step 3 of 5
Check List
Proposal Form
Confirm
Frequency of Cleaning
*
:
Daily
Weekly
Monthly
One Time
Preferred Day(s)
*
:
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Preferred Time
*
:
Morning
Afternoon
Evening
Back
Next
PROPOSAL FORM FOR STOCKIST-SELF TEST
Check List
Proposal Form
Review Filled Form
Note
Please Fill in the information requested for as accurately as possible.
Do not leave any column blank if the question is not applicable. Please write
"NOT APPLICABLE"
but do not leave blank"
Please note that no employee of the company or any of his relatives should be a partner/member of this dealership. Person who are relatives of the Employee is automatically debarred from dealership of the Company. Incase such Relationship is not disclosed and comes to light, subsequently. It will be taken as a fraud on the company by that concerned person.
Provide Your Identity:
Application Company Name (* Required)
Type of Entity (* Required)
--- Select ---
Sole Proprietor
Partner
Private Limited
HUF
Address (* Required)
Telephone/ Fax No. (S) (* Required)
Mobile No. (* Required)
Names of Proprietor/Partners/Directors (* Required)
Sr. No.
Name
Address
Action
1
Add
Name of Responsible/ Contact Person/ Partner/ Director (* Required)
Sr. No.
Name
Telephone (Office)
Telephone (Res)
Mobile Number
Email Id
Action
1
Add
GST Registration Number (* Required)
Upload GST Reg. (max. 10MB) (* Required)
Browse…
Select Drug License Type
I have 20B, 21B & MD-42
I have 20B & 21B
I have MD-42
Drug License No.(20B) (* Required)
Upload Drug License 20B (max. 10MB) (* Required)
Browse…
Drug License No.(21B) (* Required)
Upload Drug License 21B (max. 10MB) (* Required)
Browse…
Drug License No.(MD-42) (* Required)
Upload Drug License MD-42 (max. 10MB) (* Required)
Browse…
PAN No.(* Required)
Upload PAN (max. 10MB) (* Required)
Browse…
Upload Aadhar Card(max. 10MB) (* Required)
Sr. No.
Name
Upload Aadhar Card
Action
1
Add
Details of Storage Space / Facility Available. (Please Provide the storage area of Measurement Preferably in Square Feet / Cubic Feet) (* Required)
Office Area
Square Feet
Godown
Square Feet
Stacking Facility Available
Yes/No
Yes
No
Enter Open Space / Gallery Details
Square Feet
Territory of operation (* Required)
Main / Current Line of Business (* Required)
--- Select ---
Dignostic Kits
Medicines
Medical Equipments
Others
Enter Number Of Retail Counters
MAJOR PRODUCTS YOU DEAL WITH (* Required)
Value in Rupees of Business you Expect to generate on your Own (* Required)
Any Other Information You Wish To Add (* Required)
Back
Review Filled Form
Review & Submit
Check List
Proposal Form
Review Filled Form
Your Inputed Data Summary:
Application Company Name
Type of Entity
Address
Telephone/ Fax No. (S)
Mobile No.
Names of Proprietor/Partners/Directors
Sr. No.
Name
Address
Name of Responsible/ Contact Person/ Partner/ Director
Sr. No.
Name
Telephone (Office)
Telephone (Res)
Mobile Number
Email Id
GST Registration Number
Upload GST Reg.
Drug License No.(20B)
Drug License 20B file
Drug License No.(21B)
Drug License 21B File
Drug License No.(MD-42))
Drug License MD-42 File
PAN No.(* Required)
PAN Image
Uploaded Aadhar Card
Sr. No.
Name
Upload Aadhar Card
Details of Storage Space / Facility Available. (Please Provide the storage area of Measurement Preferably in Square Feet / Cubic Feet)
Office Area
Square Feet
Godown
Square Feet
Stacking Facility Available
Yes/No
Open Space / Gallery
Square Feet
Territory of operation (* Required)
Main / Current Line of Business (* Required)
NUMBER OF RETAIL COUNTERS (PHARMACIES) (* Required)
MAJOR PRODUCTS YOU DEAL WITH (* Required)
Value in Rupees of Business you Expect to generate on your Own (* Required)
Any Other Information You Wish To Add (* Required)
I herby acknowledge that the information provided is accurate and authentic.
Back
Final Submit & Download
