C-55/1,G.F.

,Okhla Industrial Area, Phase-II, New Delhi-110020

DISTRIBUTOR APPOINTMENT FORMAT
1. NAME OF THE PARTY……………………………………………………………………………………………………….
2. COMPLETE MAILING OFFICE ADDRESS…….…………………………………………………………………………...
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PHONE (Off.)……………………..(Resi.)………………….(Mobile)…………………..Email:………………………….…
3. RESIDENCE ADDRESS………………………………………………………………………………………………………
………..……………………………………………………….........................PHONE NO. …………………………………
4. LST NO………………………………………………………………………………………….....(Photocopy to be attached)
5. DRUG LICENSE NO……………………………………………………………………………...(Photocopy to be attached)
6. GSTIN REGISTRATION NO…………………………………………………………………….(Photocopy to be attached)
7. NAME OF BANKERS…………………………………………………………………………………………………………
8. CONSTITUTION: PVT. LTD./ PARTNERSHIP/PROPRIETARY FIRM (Tick whichever is applicable)
A) LIST OF DIRECTORS / PARTNERS (Please enclose)………………………………………………………………...…
B) NAME OF PROP/KEY PERSON………………………………………………………………………………………….
9. GSTIN NO. ………………………………………………………….DATED………………………………………………..
10. TRANSPORTER……………………………………………………………………………………………………………….
11. PHONE OF DIRECTOR/PROPRIETOR/PARTNERS……………...…………………………………………………….......
12. EXPERIENCE IN INDUSTRY………………..………………………………………………………………………………
13. ANNUAL TURNOVER………………………………………………………………………………………………………..
14. COMPANY DEALING WITH………………………………………………………………………………………………...
A) DIRECT COMPANIES……………………………………………………………………………………………………
B) INDIRECT COMPANIES…………………………………………………………………………………………………
15. AREA/TERRITORY COVERED……………………………………………………………………………………………...
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16. NO. OF RETAIL CHEMISTS COVERED…………………………………………………………………………………….
17. NO. OF SALESMEN………………………………………………SUPPLYMEN…………………………………………...
18. COMPUTERS AND INTERNET AVAILABLE OR NOT…………………………………………………………………...
19. WEEKLY CLOSING DAY…………………………………………………………………………………………………….
20. TYPE OF BUSINESS………………….……………………………………………………………………............…………
(Sitting wholesale)…………………………………………………………….(Distribution/Catering)……………………….
21. PREFFERED TRANSPORT: PRIORITY-
1:…………………………………………………………………………………………………………………...
PRIORITY-2:…………………………………………………………………………………………………………………...
PRIORITY-3:…………………………………………………………………………………………………………………...
 22. INSTUTIONAL OR GOVT. SUPPLIES DONE (If yes, Give details)
Name of the Instution Company Name Annual Sale

23. VERIFIED BY…………………………………………………………PLACE……………………DATE………………...

24. REMARKS…………………………………………………………………………………………………………………...
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TERMS & CONDITIONS FOR DISTRIBUTOR

1. Payment should be made in advance by A/c. Payee Demand Draft or through at par Cheque /or NEFT/RTGS only to SS.
2. Goods will be dispatched at destination point by SS via mode as may be suitable to SS and as per terms & conditions of
SS.
3. You will maintain stock equivalent to 2 months’ sales. A Minimum Monthly Sales Target will be fixed.
4. Field Staff are not entitled to take any Cash/Goods/ Bill for collection. The company will not be responsible for
any loss/damage caused by the field staff to the Distributor.
5. GST will be charged extra as applicable.
6. All disputes are subject to Delhi Jurisdiction only.

PARTY SIGNATURE & STAMP for SAS Pharmaceuticals (India)

 C-55/1,G.F.,Okhla Industrial Area, Phase-II, New Delhi-110020
DISTRIBUTOR APPOINTMENT UNDERTAKING FORMAT

UNDERTAKING

To, Date: _

M/s SAS Pharmaceuticals (India)

C-55/1, G.F., Okhla Industrial Area,
Phase-II,
New Delhi-110020

Dear Sir,

We undertake that we will make payments directly to the Super Distributor.

We undertake that we will not hand over any cash payment, goods or bills for
collection to any SO/ASM & RSM of the company.

If we do the same and the losses are incurred, it will totally be our responsibility and
M/s SAS Pharmaceutical (INDIA), shall not be held responsible for the same.

Further we shall be entitled to distribute the goods only in the areas mutually agreed,
decided and assigned by you. If in case we are found to distribute the goods in the areas
other than those entitled, our agreement and association with the organization shall stand
terminated and dissolved with immediate effect for the violation of the Company Norms
and policies.

Thanking you,

yours faithfully,

………………………..
Signature & Stamp Name of the Company & Address
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