नेशनल फर्टिलाईजर्स लिमिटे ड, आंचलिक कार्यालय (चंडीगढ़/लखनऊ/भोपाल)

National Fertilizers Limited, Zonal Office (CHD/LKW/BPL)

(A Govt. of India Undertaking)
डीलर कार्य निष्पादन मूल्यांकन फार्म/DEALER PERFORMANCE APPRAISAL FORM
वर्ष 2019-2020 (कार्य निष्पादन वर्ष के लिए) For The Period 2019-2020/ Performance Year
LOCATION ______________ DISTRICT _____________ STATE_______________

1. a) नाम/Name : M/s _________________________________________________________________

b) एफ.आर.सी. नं./ F.R.C. No. : ___________________Valid up to: _______________________
c) विक्रेता का पूरा पता / Full Address of the Party: ____________________________________
____________________________________________________________________________
d) Sale Point_____________________ Block __________________ Distt. __________________
e) पान नं./ PAN No.: __________________________________________________
f) मोबाईल नं./ Mobile No.: ______________________________________________
g) पार्टी कोड संख्या / Party Code No.: _____________________________________
h) नियुक्ति की तिथि / Date of Appointment: ________________________________
2. श्रेणी/ Category: General/ Reserved/ Special: __________________________________
3. सोल प्रोपराईटर/ Sole Proprietor: _______________________पार्टनरशिप/ Partnership: 1) _________
__________________ 2) ____________________ 3) __________________ 4) __________________
4. आउटलेट का स्थान /Location of Outlet: ________________________________________________
5. बिक्री केंद्र की स्थिति/Condition of the Sale Point: _______________________________
___ दिखावट/Appearance: __________________________________________________
___ साइन बोर्ड/Sign Board: _________________________________________________
___ पी.ओ.एस.पी./ POSP: __________________________________________________
___ उत्पाद की मात्रा/Stacking of Product: ______________________________________
6.
Product Target for the Achievement during Achievement in Targets for the
Assessment year the year 2019-20 %age year 2020-21
2019-20
Urea (MT) (Plain + Neem Coated)
Bio-fertilizers(MT)
Seeds (Qtls.)
DAP (MT)( Imp. +Indi.)
MOP (MT)
20:20:0:13 (MT)
10:26:26 (MT)
Agro-chemicals (in Lakhs)
Others (to be specified) CN (MT)
Total
Note: - 1. % age achievement will be restricted to 100% (maximum) & minimum %age for renewal of
FRC shall be 65% of Targets of all products.
2. The products which are not supplied against target will not be considered for calculation of %age
achievement.
3. In case any party becomes ineligible for FRC Renewal due to some unforeseen circumstances or company is
unable to supply material, in such cases the procedure in practice shall be applicable & such cases will be
forwarded by Area Office with proper justification for renewal of FRC.
4. In case any restriction imposed by state Govt. in particular district for not supplying during part icular month,
prorata reduction in targets will be carried out.
7. सी.एस.एस./ CSS ______________________ नान सी.एस.एस./Non CSS_______________________
8. गोदाम की क्षमता /Capacity of Godown : a) स्वयं का/Own: _________________मेट्रिक टन/MT
b) किराय का/Hired: ______________ मेट्रिक टन/MT
9. गोदाम की स्थिति/Condition of the Godown : अच्छी/ठीक/खराब/Good/ Fair/Poor
___छत/Roof: _______________________________________________________
___तल/Floor: _______________________________________________________
__ _कुरसी/Plinth: _______________________________________________________
10. प्रतिनिधि फ़र्म का नाम/ names of firms represented: _______________________________________________
_________________________________________________________________________________________
11. ग्राहक से सम्बन्ध/Customer relations: अच्छे /ठीक /खराब /Good /Fair /Poor
12. एन.एफ.एल. की प्रोत्साहन गतिविधियों में अभिरुचि/ : अच्छे /संतोषजनक /खराब
Interest in NFL’s Promotional Activities Good /Satisfactory/Poor

13. भुगतान रुचि/ Payment Behavior : अच्छे /संतोषजनक /खराब

Good /Satisfactory/Poor
14. ३१ डिसेम्बर २०......./ Outstanding as on 31st December………. : Rs. _______________________________
15. क्या अपेक्षित सुरक्षा राशि जमा कारवाई गई है ? विवरण दे ।
Whether the required security amount has been deposited? Give details
डी.डी.संख्या/ आर.टी.जी.एस./ DD No./ RTGS ___________________________ दिनांक/Date: ________________
राशि/ Amount _________________________
16. i) क्या संदर्भधीन समयावधि के दौरान नाम/ हाँ/नहीं (यदि हाँ तो शपथपत्र सल्ग्न करे )
कार्यशैली/ढांचे में बदलाव हुआ था?/ Yes/ No (Enclose Affidavit if Yes)
Change in Name/Style/Constitution during the period under ref.
ii) अगर हाँ तो क्या एन.एफ.एल. को इस बारे में हाँ/नहीं __________
सूचना दी गयी थी और सक्षम प्राधिकारी से
अनुमोदन लिया गया था/ If yes whether same has Yes/ No ___________
been intimated to NFL, & approved by Competent Authority
17. i) क्या डीलर को कभी ई.सी.ए./एफ.सी.ओ.
के अतिक्रमण का दोषी पाया गया है या
समीक्षाधीन अवधि के दौरान दिवालिया हुआ है ?
यदि हाँ, तो विस्तारपूर्वक बताएं। Whether Dealer has been Yes/ No ___________
Booked for violation of E.C.A./F.C.O. has become
insolvent during the period under review if yes, give details

जिला प्रभारी के हस्ताक्षर/

Signature of District in-charge
क्षेत्रीय प्रबन्धक की सिफ़ारिश/
Recommendation of Area Manager Name______________________ Desgn. _____________ Place ___________
________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
(i) डीलरशिप चालू रखी जाए/बन्द की जाए/Continue/ Discontinue the dealership:
________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
(ii) डीलर के कार्य निष्पादन को सुधारने का सुझाव/ Suggestion for improving the performance of the dealer
________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________

क्षेत्रीय प्रबन्धक के हस्ताक्षर

(Signature of Area Manager)
Name ________________________ Desgn. _________________ Place ________________________
राज्य प्रबन्धक की टिप्पणी/ सिफ़ारिश/ Remarks/ Recommendation of State Manager
______________________________________________________________________________________________________
__________________________________________________________________________________________

राज्य प्रबन्धक के हस्ताक्षर

(Signature of State Manager)
Name ________________________ Desgn. _________________ Place ________________________
Remarks of selection Committee

Signature Signature Signature Signature

Name & Desgn. Name & Desgn. Name & Desgn. Name & Desgn.