APPLICATION FOR REGISTRATION OF CONVERGE RETAIL STORE

SUNRISE CONVERGE MARKETING PVT. LTD.

WZ/14-A MANDAP BANQUET HALL
BODELLA MKT. VIKAS PURI, DELHI-110018
LANDLINE: - 011-45638503 DATE________________
Please provide the entire information request below. Kindly go through the terms and conditions.

I hereby apply for the authorized Converge Retail Store for all FMCG Products. Kindly register me for the same
task. I will take full responsibility to service each and every matter with my best effort.

FIRST NAME LAST NAME

NAME:- _________________________________________ ________________________________

DATE OF JOINING ____________________________ID ____________________________

NAME OF UPLINE_____________________________ID _____________________________

ADDERESS OF CONVERGE RETAIL STORE__________________________________________

CLOONY________________________VILLAGE/CITY__________________TEH.___________

DISTRICT___________________ STATE______________________ PIN__________________

BANK NAME_______________________________ BRANCH CODE_____________________

BANK A/C NO.