BLUEEXPRESS™

L O G I S T I C S Services (I) Pvt Ltd.,

Domestic & International Courier & Cargo
12 Samaspur Jagir, Opp. Akshardham Temple
Delhi - 110091

APPLICATION FORM FOR GETTNG AGENCY

PASS
1. Name of Proprietor / Partner / Director PORT SIZE
PHOTO

2. Father’s / Husband’s Name

3. Permanent Address with Telephone / Mobile No.

4. Location for which applied

5. Name of Firm

6. Address of Firm where Logistics / transport go-down to be opened

 7. Expected Business

CURRENT NEXT THREE NEXT SIX MONTH NEXT 1 YEAR

MONTH

8. Are you already engaged in Logistics / Transport Business

YES No

9. If Yes with which Transport Company

………………………………………………………………………………………………………………………….

…………………………………………………………………………………………………………………………..

10. Are you interested to take delivery

YES No

11. If Yes with which area you want and minimum charges will be Rs. ------- per qtl.

12. References with Address & Phone No.

A. Govt. Employee:--------------------------------------------------------------------
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B. Businessperson:--------------------------------------------------------------------
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Declaration: I / We declare that what is stated in this application is true and correct. I /We have also read /
understood and agreed to abide by the term and conditions, norms procedures of the Company and prospectus.
NOTE: No security will be deposited, only our time brand & marketing fee which will be non-refundable/non-
transformable/non-adjustable will be taken by company. Payment is required to be paid exclusively through Pay
order / DD / RTGS / NEFT in favor of Blue Express Logistics services India Pvt ltd,
PNB account no.4442002100017298, IFSC no.PUNB0444200, Branch: DAV school, Shastri Nagar Meerut.

(Signature)

Name of Applicant’s:

Name of Agency:

Address: