Details of Local/ Regional Partner(Only applicable for foreign Companies/ Brands)

Partner Name Operating Region

Contact Person Cell Number
Office Address City /Town
Country

NTN / Sales Tax Reg. Phone Number

Email Address FAX Number
Website Other Locatios
* If more than one Agent, please attached another sheet.
Product Information
Number of years supplying commodity
What is your current product line (Top 5)
S.No Product Line
1
2
3

Major Customers/ Clientele

S.No Name of Customer Industry Counrty

1
2
3

Association with other Telenor institutions

Prior experience for working with other Telenor institutions? Yes No 
If Yes, please share the name of entity and refrences

E-Business Readiness/ Direct Ordering

Do you have E-Business / Direct Ordering facility? Yes No 
If Yes, please share the website address OR Process

Delivery Capabilities

Do you have experience in Just-In-Time (JIT) delivery? Yes No 

Do you have your products barcoded? Yes No 

Banking Information

Banking Detail

Account Number Bank Name

Branch Code/ Name City

Please Attach
1: Brand Affiliation Certificate/ Letters/Evidences if claimed above

2: Copies of NTN and Sales Tax Registration Certificates

UNDERTAKING
I HEREBY CONFIRM THAT THE INFORMATION PROVIDED ON THIS FORM REGARDING THE COMPANY &
BUSINESS DETAILS IS CCURATE AND COMPLETE Signature & Stamp

Name & Designation