Supplier Evaluation Form: Company Name

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SUPPLIER EVALUATION FORM

Company Name:

Date

Address

Name of the women entrepreneur (as applicable): No. of employees: No. of women employees: Website : CEO Contact KAM Contact : Supply Chain: Are you vertically integrated? *If yes, please provide latest annual report
Type of Industry over one industry) (X FMCG FOOD PRODUCE HARDLINE SOFTLINE OTHER

City/ State/ Country:

E-mail E-mail E-mail Warehouse and shipping locations

Ph. No. Ph. No. Ph. No.

Year Business Established Are you a Public Company?


Type of Business:

*please list on separate page

Sales:
Total Sales-INR

2009

2010

2011 (approx.)

% Growth (avg)

Domestic % Export %
Expansion Investments-INR ( Crs)

Top Customers

Products Sold

Annual Sales-INR % to TTL Crs.

Countries:

Sales % TTL

to

Distribution Yes or No?

Countries:

Sales % to TTL

Distribution Yes or No?

Bharti Wal-Mart'share in vendors annual sales:

Year %age

2009 2010

2011 (Proposed volume)

Factory Location/Indian State

Major Products:

Production/Year (Qty)

% to TTL

Annual Volume-INR Crs

% to Total INR Volume

Lead Time in Weeks

Do you own a Brand? Do you hold a License?

If Yes which Brand(s)? If Yes which License(s)?

Factory Information Factory Name Factory Ownership: Company Owned Factory Size (Square Feet)
Production Capacity per Month (pcs)

# Employees

Joint venture
WM Factory Certification Rating Last Certification Date Production Capacity per Year (Units/Packs)

Sourced Factory By Whom


% Capacity Used

Products produced in factory Production Curve Jan Feb Mar % by Month Authorised Signatory Name: Comments:

Apr

May

Jun

Jul

Aug

Sep

Oct

What Industry certifications do you hold? Nov Dec Total Signature

Buyer's Signature Date Assessed:


Effective from -22/07/11

DMM Signature:

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