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DTH Channel Partner Application Form

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General Information

Are you an existing Reliance ADAG Channel Partner ?*

Yes No

Please enter Vendor Code :*

From which source you came to know about this portal ?

If, Other

Are you already dealing with other DTH companies such as Tata Sky, DISH TV, etc. ?*

Yes No

Please select atleast one

Are you related to any of Reliance BIG TV employees ?

Yes No

Please enter Name

Location of Employee

Login Details

Password:

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E-mail Id:

PREFERRED TERRITORY INFORMATION

Preferred Circle

Preferred Cluster

Preferred Town

Preferred Type Of Channel Partner

PERSONAL INFORMATION

I.

Name of Applicant: (Name of Firm)

Addresss

Telephone / Mobile:

Fax:

I.

TYPE OF FIRM

II.

Name(s) of Proprietor/Partner(s)/Managing Director(s) :

DETAILS OF THE OWNERS / PROMOTERS OF THE FIRM / COMPANY:

Sl. No	Name	Designation	Age	Qualification	% share	Involvement in the firm/Co.
1.
2.
3.

III.

BUSINESS HISTORY

Details of Present Business :

Sl. No.	Name of Firm	Name of Company dealt with	Geography	Since the year	Product Group	Annual Gross Turnover Rs.	No. of Retailers covered, if any
1.
2.
3.

Details of Past Business :

Sl. No.	Name of Firm	Name of Company dealt with	Geography	Since the year	Product Group	Annual Gross Turnover Rs.	No. of Retailers covered, if any
1.
2.
3.

IV.

OPERATIONAL DETAILS:

(A) Details of Present Managerial & Sales Staff (not relatives):

Sl. No	Name	Position	Qualification	Experience	Responsibility
1.
2.
3.
4.

(B) Details of Present Infrastructure:

1.	No. of Delivery Vans/Vehicles:
2.	No. of PCs :
3.	Availability of Internet Connection :
4.	Office Space (In sq. ft.):
5.	No. of Godowns & Storage Space (In Sq. ft.):
6.	No. of Telephone Lines :
7.	No. of Telecallers :
8.	No. of Two Wheeler:

I.

MANPOWER :

The number of sales personnel for successfully running the DTH business would depend upon the potential of the market, and hence, would change from time to time. Based on your initial discussion, please indicate the number of persons to be on-board at the time of start of operation.

TYPE	NUMBER
FOS
TELECALLERS

II.

INFRASTRUCTURE :

1.	Total Space (INCL. STORAGE)(In Sq. ft.):
2.	No. of Telephones :
3.	No. of PCs :
4.	INTERNET CONNECTION :
5.	DELIVERY VAN :

III.

FINANCIALS

1.

INITIAL INVESTMENT FOR DTH BUSINESS( INCL. DEPOSIT) is Rs. :

BANK NAME	BRANCH	ADDRESS	O/D FACILITY AVAILABLE

(Please enclose photocopies of suitable supporting letters from your bankers.)

I.

SALES & SERVICE TAX REGISTRATION NUMBERS:

State.R.S.T. No	Dated:	(DD/MM/YYYY)
C.S.T. No	Dated:	(DD/MM/YYYY)
Service Tax No	Dated:	(DD/MM/YYYY)
VAT No	Dated:	(DD/MM/YYYY)

(Please enclose photocopies of both the certificates)

I / we hereby certify that the information given in the application form is correct and complete.

I / we hereby certify that if selected as Reliance BIG TV Channel Partner, I / we will terminate our association with other DTH companies like DISH TV, TATA SKY, BHARTI DTH , SUN DIRECT, etc.

I / We agree to accept that the information given in the application form will be the basis of the dealership agreement, if entered into, between our respective organizations, and that if, at any time, I / we are found to have concealed any material information or given false details our dealership would be subject to termination without notice, and further that this would be without prejudice to our rights under the agreement. I / We agree to accept that the application shall be evaluated against various criteria and the company reserves the right to reject any application without assigning any reason.

Signature of Proprietor/Partner(s)/Authorised Person/Managing Director and Seal of the Firm

Name:
Date:
Place: