FAN PROPOSAL CUM EVALUATION FORM - Commodity

Type: FAN – P / I FAN P

Existing FAN of IIFL Existing Yes/ No. NO Fan Code :
Name of the FAN MR. SHIV SHANKAR BHOOTRA
Status of the FAN (Individual / Sole
Proprietorship / Partnership / Corporate) INDIVIDUAL
Key contact person MR. SHIV SHANKAR BHOOTRA
Business location address MAHESHWARI KI GALI, INSIDE CHANDPOLE,
JODHPUR
City: JODHPUR Taluka:
Dist: JODHPUR State: RAJASTHAN PIN Code: 342001
Residence address MAHESHWARI KI GALI, INSIDE CHANDPOLE,
JODHPUR
City: JODHPUR Taluka:
Dist: JODHPUR State: RAJASTHAN PIN Code: 342001
Contact detail Office :
Resi :
Mobile 9828384183
:
E – Mail ID : hariinv@yahoo.co.in
Whether business & residence address
same Yes / No
PAN Card No. ACMPB6173B
FAN Terms
Deposit Cheque : KINDLY CONSIDER EQUITY DEPOSIT AS COMMODITY DEPOSIT
Shares ( ‘A’ Category ) : Rs.
Sharing Terms 65:35

INFRASTRUCTURE DETAILS
Office (Owned / Rented) OWNED
Office Area Sq. ft. : 319
Current Broking Tie Ups
Yes / No (If Yes)
Specify the details of company with
existing Proposal
No. of Clients 25
Brokerage Structure
Brokerage sharing pattern 65:35
Gross Brokerage avg. per month (for 6
months) 1,00,000/-
Is there any IndiaiInfoline Branch
nearest to your office? Yes / No
(If Yes) NO
Specify the distance in kilometers with
complete address of Branch
Is there any other IndiaInfoline
Franchisee nearest to your office?
Yes / No (If Yes) YES
Specify the distance in kilometers with 35 KM
complete address of Franchisee

Meeting with FAN by Senior IIL official
other than FAN introducer or the RM
who is managing the FAN
Date of Meeting 22/10/2015 Location :JODHPUR
Name of the official meet: MOHIT JAIN
Employee code: C131949 | Designation: AVP-FD
Comments on Background and Business potential:

Signature
Financial Status / Net Worth
Educational Qualification HSC
FAN Referred by Name: ASHISH AGARWAL Emp. Code: C133892
FAN Introduced by Name: ASHISH AGARWAL Emp. Code: C133892
FAN Managed by Name: ASHISH AGARWAL Emp. Code: C133892
Location / Code of branch who handles
this FAN Name: JAIPUR CITY MALL Branch Code: BM3963

Name Employee Cell Email id

Code Number
RM who are ASHISH C133892 98819351 Ashish.agarwal@indiainfolin
managing FAN AGARWAL 56 e.com
Immediate MOHI JAIN C131949 80800873 Mohit.jain@indiainfoline.
Authority of 00 com
above RM
For Office use:

FAN code

Approved By Name :
Signature :
Date
 SHIV SHANKAR BHOOTRA
MAHESHWARI KI GALI, INSIDE CHANDPOLE, JODHPUR, RAJASTHAN - 342001
MOBILE: 9828384183 | EMAIL: hariinv@yahoo.co.in

Date:

To,
India Infoline Commodities Ltd.
India Infoline Towers
143, MGR Road, Perungudi,
Chennai – 600096

Sub: Application for Business Association with your company

Dear Sir,

With reference to the above, I am interested in associating with you for all
your products including MCX Authorised person, NCDEX Authorised
person, NSEL Authorised Person & Alliance Partner.

I am aware that proposal and commercial terms is recommended to

management which is brokerage sharing ratio as 65:35 & deposit KINDLY
CONSIDER EQUITY DEPOSIT AS COMMODITY DEPOSIT acceptable to me/us & which is

subject to approval of management of IICL with same term or on modified

term.
Yon can note my email id & phone number for future communication as
below:
Email Id: hariinv@yahoo.co.in
Phone number: 9828384183

Looking forward to a mutually beneficial relationship with you.

Thanking you,

Yours faithfully

Signature of the applicant

Proprietor/Partner/Director
with Rubberstamp