CONFIDENTIAL

APPLICATION FOR FORD INDIA LIMITED , DEALER SALES AND SERVICE AGREEMENT
APPLICANT
(Hereinafter called the D.S.S.A.)
Date .
Name ___________________________________
First Middle Last
Birthdate _______________ Single Married
Address ________________________________ Tel. Residence______________ Tel.Business_______________
Street City Post

EDUCATION
High School ______________________________________________________________Years______________
______________________________________________________________
University ______________________________________________________________ Degree Awarded________
______________________________________________________________ ________
Others ____________________________________________________________________________________
FAMILY DETAILS
Spouse's Name___________________________________________________________
Name & Age of Dependents ______________________________________________________________________
_____________________________________________________________________________________________
Highest Level of Education________________________________________________________________________
_____________________________________________________________________________________________
REFERENCES





CIVIC, BUSINESS OR PERSONAL REFERENCE (other than Relatives or Employers )





CUSTOMER SATISFACTION INDEX

YOUR CUSTOMER SATISFACTION INDEX______________________________GROUP AVERAGE_______________

(Current Business )

BANK REFERENCES
NAME CONTACT STREET, CITY, POSTAL CODE
AREA

CODE


PHONE

NUMBER
NAME CONTACT STREET, CITY, POSTAL CODE
AREA

CODE


PHONE

NUMBER
Please jll n the alcaton jorm and send t to:
Manayer - Market Reresentaton, Ford lnda Pvt. Ltd, RMZ
Mllenna Park, 143, MCR Road, Perunyud, Chenna - 600 096

REASON FOR LEAVING
REASON FOR LEAVING
REASON FOR LEAVING
REASON FOR LEAVING
REASON FOR LEAVING
Application (Cont'd)
PREVIOUS BUSINESS OR WORK EXPERIENCE DURING THE PAST 10 YEARS
List chronological order starting with the most recent first. (if necessary, use supplemental sheet )
NAME COMPANY OF
ADDRESS
TYPE OF BUSINESS
POSITION HELD
EMPLOYED ( MONTH ANY YEAR) EARNINGS
Rs. PER MO. FROM TO
NAME COMPANY OF
ADDRESS
TYPE OF BUSINESS
POSITION HELD
EMPLOYED ( MONTH ANY YEAR) EARNINGS
Rs. PER MO. FROM TO
NAME COMPANY OF
ADDRESS
TYPE OF BUSINESS
POSITION HELD
EMPLOYED ( MONTH ANY YEAR) EARNINGS
Rs. PER MO. FROM TO
NAME COMPANY OF
ADDRESS
TYPE OF BUSINESS
POSITION HELD
EMPLOYED ( MONTH ANY YEAR) EARNINGS
Rs. PER MO. FROM TO
NAME COMPANY OF
ADDRESS
TYPE OF BUSINESS
POSITION HELD
EMPLOYED ( MONTH ANY YEAR) EARNINGS
Rs. PER MO. FROM TO
PLEASE EVALUATE YOUR LEVEL
OF EXPERIENCE AND ABILITY
GENERAL
MANAGEMENT
NEW CAR SALES
MANAGEMENT
USED CAR SALES
MANAGEMENT
SERVICE
MANAGEMENT
PARTS
MANAGEMENT
BUSINESS
MANAGEMENT
EXPERIENCE APPRAISAL OF ABILITY
Extensive Adequate Limited Excellent Good Fair Limited
RESPONSIBILITY
RESPONSIBILITY
RESPONSIBILITY
RESPONSIBILITY
RESPONSIBILITY
DO YOU HAVE, OR HAVE YOR HAD, A FINANCIAL
INTEREST IN A COMPANY, INCLUDING THOSE
ABOVE ?YES___________NO_________PLEASE DESCRIBE.
1.
2.
3.
APPLICANT'S STATEMENT
Application ( Cont'd )
Personal Financial Statement as of
ASSETS
Cash
Receivables
Rs.

Life Insurance - Cash Value
Marketable Securities (list)
Other Investments (list)
Total Current Assets
Real Estate (list)
Vehicles (list)
other(list)
Total assets.
Rs.
Rs.
Rs.
Rs.
Rs.
Rs.
Rs.
Rs.
Rs.
Rs.
Rs.
Rs.
Accounts payable
Notes payable (list)
Line of Credit
(approved limit______________)
Other (list)

Total Current Liabilities
Mortgages (list)
Other (list)

Total Current Liabilities
Tangible Net Worth
Total Liabilities & Net Worth
LIABILITIES
Rs.
Rs.
Rs.
Rs.
Rs.
Rs.
Rs.
Rs.
Rs.
Rs.
Rs.
Rs.
Rs.
Rs.
SOURCE OF FUNDS FOR PROPOSED DEALERSHIP INVESTMENT
Amount Source Comments ( Encumbrances )
1. Personal capital
2. Borrowed capital
3. Additional funds
Total
Strike this section if it is not applicable.
1. Have you ever been convicted of a criminal offense or an offence under a federal or provincial statute, other than for minor traffic violations ?_____________________
if so, explain (giving dates, courts and places )_________________________________________________________________________________________________
______________________________________________________________________________________________________________________________________
2. Have you personally. or a business which you managed or of which you were the majority owner ever made an assignment or been petitioned into bankruptcy, or
has a receiver / manager been appointed to operate any such business ? ___________________Have you or any such business any remaining liabilities therefrom ?
___________________if so, explain_________________________________________________________________________________________________________
______________________________________________________________________________________________________________________________________
Rs.
Rs.
Rs.
Rs.
Application ( Cont'd )
Do you intend to personally manage the dealership on a day to day basis ? Yes/No
If no, who will be the manager?
Is this person a Family member-relationship?
Has this person completed and lodged a similar application to this ? Yes/No
Please give detail career of person nominated as manager
Will you be active in the management and for daily operation of the dealership ? Yes/No
If Yes, in what areas
Are you a member of any clubs (Rotary, Lions ) or other Social Organisation? Yes/No
If yes, Provide details
Please feel free to provide additional attachments.
Set out below any additional information or comments that you believe are relevant to you Application and which
you would like to be considered. In particular we are seeking details of the location and type of building you
purpose to provide for the service outlet and showroom. A copy of a city map showing locations would assist.
Application ( Cont'd )
UNDERSTANDINGS AND ACKNOWLEDGEMENTS
LIMITATION OF FORD INDIA LTD'S OBLICATION - It is understood that any Buy and Sell Agreement, Buy out
Agreement, Management Services Agreement , Partnership Agreement, Option, Lease, Articles of Incorporation,
Corporate By-Laws, Corporate Resolutions, Corporate Minutes or any other agreement or document of any kind
whatsoever to which Ford India Ltd. is not partly , but which, nevertheless includes a provision making such agreement
or document subject tyo approval of Ford India Ltd. Shall not create any obligations on the part of Ford India Ltd. and it
shall be in no way liable with respect to the same.
It is further understood that this application does not obligate Ford India Ltd. in any way to enter into a D.S.S.A.with me.
Any options on real estate or investments of any kind made by me or any other action taken by me in contemplation of the
acceptance of this application are done solely on my own responsibility and do not obligate Ford India Ltd. or any of its
representatives in any way.
It is also understood that the execution between Ford India Ltd. and me of the D.S.S.A. applied for is the only manner by
which Ford India Ltd. may accept this application and bind me to the terms of this application and such D.S.S.A.
I hereby represent and warrant that no representations or statements have been made to me on behalf of Ford India Ltd.
which would in any way tend to change or to modify any of the terms of this application and that in submitting this
application, and, if this application is approved and I execute and submit such as D.S.S.A., to Ford India Ltd. for
execution and delivery I will have done so and determined to become an authorized dealer in such products and to make
the investments necessary therefore, solely in reliance on my own investigation and judgement of present and future
conditions and expectations in my area and the industry and not in reliance on any statements made or documents
exhibited to me by any representatives of Ford India Ltd. and such other statements or documents as may be specified
in writing to Ford India Ltd. prior to my execution and submition of such D.S.S.A. I made the forgoing representation and
warranty to induce Ford India Ltd. to approve this application and to execute and deliver to me the D.S.S.A. applied for,
and I acknowledge and intend that Ford India Ltd. will rely thereon in so doing and that if no exceptions are shown or
specified as above provided, it shall be conclusively presumed that there are none.
It is understood that any misrepresentation of any kind by me in this application shall give Ford India Ltd. the right
to terminate the D.S.S.A.
For the purpose of this application, I hereby acknowledge receipt of notice that a consumer credit or personal
report will be obtained by Ford India Ltd. which might include a personal or credit or personal report will be obtained by
Ford India Ltd. which might include a personal or credit information about me or a business that I have managed or in
which I have been the majority owner, and I consent to such a report (s) being prepared for Ford India Ltd. I understand
that any such report(s) will be shown to me by Ford India Ltd. and I will be given a reasonable oppurnity to respond to
and/or clarify any statements which are contained therein. It is further understood by me that Ford India Ltd. accepts no
responsibility for the accuracy of the statements contained in any such reports, but I agree that it can rely on the contents
of such reports in deciding whether or not to offer a D.S.S.A. to me.
BY-APPLICANT DATE BY-WITNESS DATE