Form For Channel Partner Evolution Name of the Business Organization: Address: Name of the promoters and their roles: Sr.No. Name of the Promoters Roles or Designations 1 —Please choose an option—OwnerManagerCEOOther 2 —Please choose an option—OwnerManagerCEOOther Existing Business Details: Sr.No. Name of the Company and Brand Name Products Roles Geogriphical Area (State or Town as Applicable) Period (In years indicating for how long the association has been) 1 —Please choose an option—DistributorDealerAgentOther —Please choose an option—StateTown 2 —Please choose an option—DistributorDealerAgentOther —Please choose an option—StateTown 3 —Please choose an option—DistributorDealerAgentOther —Please choose an option—StateTown Specific Market Influence Capabilities: Sr.No. Sectors Geographical Area 1 —Please choose an option—BuildersHospitalsSpecific IndustryOther —Please choose an option—StateTown 2 —Please choose an option—BuildersHospitalsSpecific IndustryOther —Please choose an option—StateTown 3 —Please choose an option—BuildersHospitalsSpecific IndustryOther —Please choose an option—StateTown Business Aspirations: Present Sales (Total) Target for Next 1 Year (Including Present and New Business) Target for Next 3 Years (Including Present and New Business) Name of the Firm Your Email Full Address City District State Zip Code Mobile Number Landline Number Year of Establishment GST Registration Number PAN Number The above information mentioned above is true and best of my or our knowledge. Place: Date:
