DBCL FORMAT - 1

A) In Case of Proprietorship
S .NO Particular
Name of Agent / Agency /
1 M/s Vendor's SAP Code: --------------
Client

Surname Middle Name First Name

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

Surname Middle Name First Name

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

Flat / House No Building / Society Name Street No 1

Street No 2 Locality / Land Mark City

3 Business Address & Contact Details - HO State Country Pincode

Phone No 1 Phone No 2 Mobile No.

Fax No Email ID

Branch's Name:
Flat / House No Building / Society Name Street No 1

Street No 2 Locality / Land Mark City

Branch office if any , please furnish Address &
4
Contact Details State Country Pincode

Phone No 1 Phone No 2 Mobile No.

Fax No Email ID Web Site Address

Add the sheet if number of branches are more.

Flat / House No Building / Society Name Street No 1

/

Street No 2 Locality / Land Mark City

5 Current Residential Address & Contact Details /
State Country Pincode

Phone No Mobile No. Email ID

Flat / House No Building / Society Name Street No 1

Street No 2 Locality / Land Mark City

Permanent Residential Address & Contact
6 /
Details
State Country Pincode

Phone No Mobile No. Email ID

7 Date of Formation of Firm

8 PAN Card No

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

10 Bank A/ct details Accounts Holder's Name

Bank Account No

Bank's Name & branch

 Address
IFSC Code No
MICR No

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 Bhaskar Group:
If Yes, Pleass furnish the details of Name, Address, Contact details and PAN of Relatives as below :

Surname Middle Name First Name

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 category of Relatives.

Supporting attached:
1
2
3
4 Signature of Applicant
5

Date :

Place:
Passport size
photograph