Name of Applicant *
Name of the Company/Firm *
Level at which you can become a distributor* *
Select State *
--select district--Andhra PradeshArunachal PradeshAssamBiharChandigarhChhattisgarhDadra and Nagar HaveliDaman and DiuDelhiGoaGujaratHaryanaHimachal PradeshJammu and KashmirJharkhandKarnatakaKeralaLakshadweepMadhya PradeshMaharashtraManipurMeghalayaMizoramNagalandOdishaPuducherryPunjabRajasthanSikkimTamil NaduTelanganaTripuraUttar PradeshUttarakhandWest BengalNepal
Select District *
--select district--BaksaBarpetaBishwanathBongaigaonCacharCharaideoChirangDarrangDhemajiDhubriDibrugarhDima HasaoGoalparaGolaghatHailakandiHojaiJorhatKamrupKamrup MetropolitanKarbi AnglongKarimganjKokrajharLakhimpurMajuliMorigaonNagaonNalbariSivasagarSouth Salmara-MankacharSonitpurTinsukiaUdalguriWest Karbi Anglong
Do you have any experience of FMCG distribution / Wholesale distribution / Other distribution?
If Yes, Brief History of the products of the distribution business you have done so far.
Name of the company for whom you have already done the distribution
If No, then give detail of your present business.
Last One Year Turnover?(In Rs Lakhs)*
Investment Capacity (In Rs Lakhs)*
Lessthan 2021-5051-100Above 100
Area of Warehouse (in sq.ft.)*
Less than 50005001-1000010001-25000Above 25000
No. of Sale Person*
No. of Transport Vehicles (Don`t include Two wheelers)*
A. If you accept the above terms and conditions and is ready to give us all the information’s mentioned above then please attach your last year ITR (Income Tax Return) and balance sheets with this application form and send to Email ID. firstname.lastname@example.org.
C. The Person who deals with the trade of Intoxication Business are not eligible to fill the form because our organisation is a Social and Spiritual Organisation