MALABAR CEMENTS LIMITED (A Govt. of Kerala Undertaking) Walayar, Palakkad, Kerala -678 624 Tel. (0491) 2863600, 2862228 / 2862117 / 2862118. Fax (0491) 2862230 F mail: sales@malabarcements.com Website : www.malabarcements.com ‘Cement Grinding Unit, Pallipuram, Cherthala, Pin : 600541 Phone : (0478) 2552186, 2553688 (Fax) APPLICATION FORM FOR DEALERSHIP OF MALABAR CEMENT 4. Name and address of the applicant a) ») INDIVIDUAL : Full postal address with Pin code Father's Name ‘Age of the Applicant iv) Phone No FIRM () IF PROPRIETORY : a) Name of the Firm b) Name of Proprietor c) Full postal address with Pin code and Telephone Nos. (t) IF PARTNERSHIP a) Name and full address of Firm with Pin code and Telephone Nos. b) Name of Managing Partner (a photo copy of partnership deed should he attached)(iil) 1F COMPANY : a) b) Name and full address ot the Company with Pin cade and Telephone Nos. Name of Managing Director (a copy of Memorandum & Articles of Association and current list of Directors should be enclosed) Name and address of your Bankers (also specify type of account) GST No & Date (Copy should be enclosed) a) Central b) State Details of existing lines of business : a) Are you dealing in building materials viz., Hardware, Paints, Timber, Tiles, Steals etc b) Are you dealing in Cement, If yes, give details of brande dealt with ©) Approximate Volume of Business (Rs. ln lakhs) Place / Town where Stockistship is required a) Taiuk & District in which place is situated b) Nearest Railway Station6. Details of Godown a) Adgress b) Size of Godown ©) No. of Godown 7. Whatis the area of your Place/Town (Copy of the license should be enclosed) 8. What would be the approximate consumption of Cement per month in your area: 9. Whatis the quantity you will quarantee: to lift per month 410. Any other information that you may like to give in support of your request DECLARATION BY THE APPLICANT 1/ We have gone through your terms and conditions governing the appointment as dealer. 'We hereby convey me / our full consent to abide by these guidelines issued by Malabar Cements Limited and also any other directive that may be issued in respect of price of Cement, sales policies, rules and regulations and such other matters pertaining to the sale of ‘Malabar Cement’ from time to time. | case of any dispute, I/We will abide by the decision of the Managing Director of Malabar Cements Limited. We hereby certify that the information furnished above is true and correct to the best of my / our knowledge and belief. Place : Date Signature of applicantFOR OFFICE USE ONLY Application Form ; Issued ons... ” Receipt No. DD No. Date Amount Bank..... Security Deposit Receipt No... DD No.ieererne Date: Bank: AMOUNE sossseser ese : Code Allotted Agreement date