* Ak1NLk'S kLGIS1kA1ICN IkCM

Company name & Address:

ln code:
CS1 no. vA1/ 1ln no.: An no.
SLaLus : Cwnershlp 8enLed Leased
1el. no. (WlLh S1u Code): lax no. :
Moblle : Company L-mall:
*kLG Iorm No:
kLG Date:
(* f|||ed by Larth)
?ear of LsLabllshmenL : uuraLlon (Pow Cld) of Company: ?rs. MonLh
Company 1ype : roprleLor arLner vL. LLd. LLd. 1rusL lndlvldual CovL.org.
Ma[or AcLlvlLles (lnvolve ln) : P/W S/W P/W & S/W CLhers
Pow do you raLe your self: ulsLrlbuLor Sub ulsLrlbuLor Servlce CLM (C mfrs.)
: 8e-sellers SysLem lnLegraLor Lnd CusLomer CLM (mfrs.)
: 8epalrs value Added 8eseller
LasL ?r.-Annual 1urnover (ln Lakhs):______________________________________________
* 8ANkLkS

8ank name & 8ranch : hone:
AccounL no.: ConLacL erson:
Any CredlL faclllLles avalled from bank: Slnce ?ear:
lf yoo bove occooots oo ooy otbet book pleose speclfy bet oqolo. -
8ank name & 8ranch : hone:
AccounL no.: ConLacL erson:
Any CredlL faclllLles avalled from bank: Slnce ?ear:
lnLel Membershlp no# (Clu no)

Larth Syscom vt.Ltd.
12,1rllok 8aw Pouse,Cpp.Chankya 1ower,
vasLrapur, Ahmedabad-380034
1el.:079-26837024/23
M. 98234 16118 / 98234 74733 / 98240 23266
L-Mall: sales[earLhsyscom.com
WebSlLe: www.earLhsyscom.com
Please Fix your
PassPort
Size
Photograph
here
* BUSINESS REFERENCES (MINIMUM 3 NOS.)
WITH WHOM YOU HAVE DEAL WITH IN THE LAST 3 MONTHS
Sr. name of Company ConLacL erson ueslgnaLlon L-Mall Moblle#
1.
2.
3.
4.
name & LocaLlon of Croup Companles/ 8ranches/Show 8oom lf any
1)
2)
3)
lf you deal wlLh any of our slsLer concerns wlLh us , please mark: name:
ADDI1ICNAL INICkMA1ICN
LkSCNAL INICkMA1ICN CI DIkLC1CkS ] Ak1NLkS ] kCkIL1Ck
name:
uaLe of 8lrLh:Marrlage Annlversary:
8esldenL Add:
ln code:
hone: Moblle: L-mall ld:
.......................................................................................................................................................................................
name:
uaLe of 8lrLh:Marrlage Annlversary:
8esldenL Add:
ln code:
hone: Moblle: L-mall ld:
.......................................................................................................................................................................................
name:
uaLe of 8lrLh:Marrlage Annlversary:
8esldenL Add:
ln code:
hone: Moblle: L-mall ld:
.......................................................................................................................................................................................
Group Compan|es 8ranches Show koom
1.MarkeLlng erson :
Moblle no.: Lmall:
2.AccounL erson:
Moblle no.: Lmall:
3.Servlce erson:
Moblle no.: Lmall:
4.LoglsLlc erson:
Moblle no.: Lmall:

key ersons' Informat|on
* Dec|arat|on :We have Understood the ayment o||cy
Company's SLamp
S|gnature w|th Name & Des|gnat|on
Date:______________
Check L|st:
uocumenLs: needed ALLached 8ecelved 8y
1.vlslLlng Card of your company
2.xerox copy of your Company's 1ln no.
3.xerox copy of lasL Lhree MonLh 8ank SLaLemenLs.
4.xerox copy of your company's An no
3.xerox copy of An no. of every arLner/ulrecLor's/roprleLor.
6.3 assporL slze color phoLo every arLner/ulrecLor's/roprleLor.
7.3 SecurlLy AccounL ayee 8lank daLed Cheque (ln favor of LarLh SyscomvL LLd..)
8.LasL 1wo year audlLed 8alance SheeL wlLh roflL & Loss A/c..
1hanks & kegards repared by:
Ior Larth Syscomvt. Ltd.
(Note: |ease I||| up the Iorm& Send us w|th the Du|y S|gned & Stamped w|th Necessary Documents As Soon As oss|b|e.)