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Company Name:
Name of Applicant:
Designation:
Business Registration No.:
Country of Incorporation:
Date of Incorporation:
Correspondence Address:
Telephone No.:
Fascimile No.:
Email:
Website:
Interest of Business:	Distribution OEM ODM
Nature of Business:	Sole Proprietor Partnership Private Limited Co. Public Limited Co.
Core Business:	Distributor Dealer Consultant Electrical Contractor System Integrator Installer Misc:
Industry:
Market Covered:	Residential Commercial Industrial Public Security Government Transportation Military Medical Education Others:
Total number of employees:
Technical:
Managerial / Executives:
Others:
Authorized Capital:
Paid Up Capital:
Turnover (last year):
Name of Suppliers Brands/ Products Acquaintance Since Year
Do you intend to carry stock?	Yes No
Do you intend to have a display/ showroom area?	Yes No
Do you intend to advertise?	Yes No
** All information provided in this application will be treated as confidential and will not be used for further distribution.