DBCL

A) In Case of Proprietorship
S .NO Particular
Name of Agent / Agency /
1 M/s
Client

2 (a) Name of Proprietor Mr./Mrs/Ms.

2 (b) Name of Husband's Mr./Mrs/Ms.

3 Business Address & Contact Details - HO

Branch office if any , please furnish Address &

4
Contact Details

Add the sheet if number of branches are more.

5 Current Residential Address & Contact Details

 5 Current Residential Address & Contact Details

Permanent Residential Address & Contact

6
Details

7 Date of Formation of Firm

8 PAN Card No

9 Age of propritor's(As on -------------)

10 Bank A/ct details

11 Registration No

12 Sales Tax / Vat Registration No / GST No

13 Whether any relative of Proprietor is working or is in business relation with any company of Dainik
If Yes, Pleass furnish the details of Name, Address, Contact details and PAN of Relatives as below :

13a Name of Relative Mr./Mrs/Ms.

13b Designation

13c Place where posted

13c Department where Working

13d Relation with agency

Note : Please refer "Appendix" for list of DB Group companies & relation who fall under ca

Supporting attached:
1
2
3
4
5
 Vendor's SAP Code:

Surname Middle Name

Surname Middle Name

Flat / House No Building / Society Name

Street No 2 Locality / Land Mark

State Country

Phone No 1 Phone No 2

Fax No Email ID

Branch's Name:
Flat / House No Building / Society Name

Street No 2 Locality / Land Mark

State Country

Phone No 1 Phone No 2

Fax No Email ID

Flat / House No Building / Society Name

/

Street No 2 Locality / Land Mark

/
State Country

Phone No Mobile No.

 Flat / House No Building / Society Name

Street No 2 Locality / Land Mark

/
State Country

Phone No Mobile No.

Accounts Holder's Name

Bank Account No

Bank's Name & branch

Address
IFSC Code No
MICR No

working or is in business relation with any company of Dainik Bhaskar Group:

me, Address, Contact details and PAN of Relatives as below :

Surname Middle Name

of DB Group companies & relation who fall under category of Relatives.
FORMAT - 1

--------------
Passport size
photograph
First Name

First Name

Street No 1

City

Pincode

Mobile No.

Street No 1

City

Pincode

Mobile No.

Web Site Address

Street No 1

City

Pincode

Email ID
Street No 1

City

Pincode

Email ID

First Name
Signature of Applicant

Date :

Place: