NEW AGENCY AGREEMENT APPLICATION FORM

Date: _ _ /_ _ /_ _ _ _ SALES EXECUTIVE NAME (AZIZI):

Name of Company/Individual:Benz Properties LLC

Trade License/Passport No.:1233378 TAX REGISTRATION NO (TRN):

RERA Reg.No: 37633

COMPLETE ADDRESS (for communication by courier (MUST BE COMPLETE; OFFICE NUMBER, BLDG NAME / NO,
STREET NAME/NO. CITY, COUNTRY, PO BOX/ZIP CODE ) Office F-031, Sabha Building, Jebel Ali, Dubai

Post Box No.:181231 City:Dubai Zip/Postal Code: Country: _

Phone: Mobile: Fax: _

Official Company Email:

Name of Authorized Signatory (with Power of Attorney Certificate):

Mr. /Mrs. M i s s I f r a h S i d d i q u i e
(As per passport) First Name Middle Name
Last Name

Designation: C o m p a n y O w n e r Nationality: P a k i s t a n i

Mode of Payment: Bank Transfer

Bank Account Details of Agent/COMPANY BANK DETAILS FOR AGENCY: (if its bank transfer)

Account Number: Name of Bank:

Swift/Sort Code:

Beneficiary Name:

IBAN:

I do hereby declare that I do not have any relatives or members of my family within the third
degree either of consanguinity or of affinity who is/are connected/employed with Azizi
Developments as either employee/job order contractor.
Ifrah Siddiquie

Signatory & Company Stamp

*For Individual, please ignore not applicable information