Are you Resident in the city you have applied for?
If No, do you plan to shift to the City you applied for? Personal Information Name of Applicant Contact Details - Residence Date of Birth DD-MM-YYYY Residential: STD Code - Number Educational Qualification Mobile: Countrycode - Number Highest Degree of Education Fax: STD Code - Number Educational Institution Email Address Contact Details - Office Nature of Business Company name Residential: STD Code - Number Mobile: Countrycode - Number Fax: STD Code - Number Email Address Website Address Information on Current Business and Activities Business Information : Automotive Brand Type of Firm Gross profit Year of Starting Business Information : Non Automotive Gross profit Year of Starting Are you a member of any Trade and Industry Association? Do you hold any professional Leadership Positions? Have you applied for a Renault Dealership earlier ? Place Date DISCLOSURE The applicant has made full disclosure of all information required in this Form and all the information given by him is true in all respects. The applicant has made full disclosure of all information required in this Form and all the information given by him is true in all respects. The applicant further acknowledges that in case of misrepresentation, intentional or unintentional, in the information submitted in connection with the application, RENAULT reserve the right to no longer consider the application or reverse any decision taken on the basis of information provided in this application. This Application Form entitles the applicant only to apply for a RENAULT Dealership. The Application Form does not imply any commitment on the part of RENAULT to enter into any Dealer Agreement with the applicant. The applicant certifies that he is not suffering from, or aware of any legal disability that would prevent him from being appointed as an authorized dealer of RENAULT. The applicant acknowledges that any obligations undertaken or expense incurred by him in submitting this application shall be incurred entirely on the applicants own behalf. The applicant authorizes RENAULT to make any inquiries it may consider necessary to verify this information and to share the information with an agency appointed by RENAULT for the purpose of verifying the given information. Others: Type of Firm Applicant's Signature Renault India Pvt. Ltd. ASV Ramana Towers, 4th Floor, 36-37, Venkatanarayana Road, T.Nagar, Chennai - 600 017. Please email your Dealership Enquiry Form to dealer.development@renault.com or send your Enquiry Form by Courier/ Registered Post/ Speed Post to Renault India Private Ltd. Dealers Development Department to the following Address: Dealer Development Department Dealership Enquiry Form Turnover in Lacs Name of Firm (Automotive Industry) Nature of Business % of ownership Plot/Building No - Street Area/Suburb City - State - Pincode Applicants have to fill in the complete form as mentioned below. Plot/Building No - Street Area/Suburb City - State - Pincode Name of Firm (Non Automotive Industry) Nature of Business % of ownership Turnover in Lacs Finance Real Estate Manufacturing IT Trading Hospitality Automotive