CENTURY PLYBOARDS (INDIA) LIMITED.

H.O.: P 15/1, Taratala Road, KOLKATA 700 088.

BRANCH -

Customer Information Form (Dealer / Distributor / Direct)

1 Name of the Firm (Pl attach existing visiting card,if any)

2 Complete Postal Address (Pl attach valid address proof)

3 Pin Code (mandatory)

4 Telephone/Fax No.
Email ID,if any
Mobile No.

5 Type of Ownership (Proprietory/Partnership/Pvt Ltd/Public Ltd/Others (pl specify)

(Any change in ownership MUST be informed to the Co. in writing beforehand)

6 Name & Address of All the Owner(s)/Directors

7 Contact/Dealing Person Name & Designation with mobile no.

8 ID Proof of Executive Director/Partner/Proprietor

9 VAT No. (pl attach copy of RC)

CST No. (pl attach copy of RC)
(If applied for then copy of application MUST be attached)

10 PAN No. of the firm (pl attach copy of PAN card)

11 Area of Showroom (in sq. ft.) /Description

12 Area of Warehouse (in sq. ft.) /Description

13 Complete Address/Tel no of Warehouse (pl attach copy of Trade Licence)

14 Products/Brands Dealt in

15 Present Annual Turnover

(Pl attach last 1 years' Audited Balance Sheet / IT Return / VAT Return)

16 Expected Annual Business Potential

(for Century Ply products,pl specify products)
(for Century DV/Senzura)
(for Century Laminates - 0.8mm/1mm/1.5mm)
(for Sharon Ply products,pl specify products)

17 TOD Target (Value in Rs.)

17A Other Business details,if any

18 Bankers Name & Address with Tel No.

19 Nature of Bank A/c & No.(pl attach copy of Bank statement for last 6 months)
(Bank A/c must not be closed without prior notice to the Co. in writing)
(Give details of associated Co/firm/personal Bank a/c in case the firm in which
dealing will be done with CPIL is new)
20 References (mandatory)

N.B.:Dealer/Distributor is required to clear all the payment on bill to bill basis.

In any case the Company is not responsible for any payments for supplies made by Dealer/Distributor to any party.
All the documents (which needs to be submitted) must be signed & stamped by the concerned customer.

21 DECLARATION

I/We,the undersigned,have gone through the above details/documents for my/our appointment as the Dealer/Distributor of the
Company. I/We state that all informations as mentioned in this application form is true & correct to the best of my/our knowledge and
information and I/We shall abide by and maintain the declarations made herein.

Dealer/Distributor Name :
Signature (with Full Name) & seal :
Date :

22 CREDIT CONTROL Recommended Sanctioned

A. Credit Rating (A/B/C)
B. Credit Limit (Rs.)
C. Credit Days
D. Nature of the Party (CD or NON CD party)
E. Security Cheque Details - 2 nos.Blank & Undated alongwith covering letter (attach copy)
F. PDC details (attach copy)
G. Terms of Payment
H. Discount Structure (Bill to Bill)
I. Scheme Slabs,if any.
J. Scheme Discount(Monthly/Quarterly/Half Yearly/Yearly),if any
(Pl mention Annual Value Target for scheme,if any)
K. In case of restarting of Customer,pl mention/submit the following:
(i) Reason for closing of business
(ii) Period during which business was done (pl also mention last transaction date)
(iii) Whether any amount was WRITTEN OFF as BAD DEBTS (if yes, pl mention the
amount)
(iv) NOC from the Customer that he don't have any claim or dispute with the CPIL

23 Remarks

24 Selected By
(Name & Designation)

25 Details of personal visit (mandatory)

(Date & Time / Concerned Person met with)

26 Recommended By
(Name & Designation)

For Office Use Only (To be filled by Sanctioning Authority Only)

Appointed/Refused
Reasons
Date of Appointment
Approved by