General Instructions

1 All information must be provided within the application Form itself. Additional information wherever specifically
asked for in the Application Form may be provided in the form of enclosures.

2 All information provided in the application form will be kept strictly confidential. You give us permission to share
the information with an agent appointed by us for the purpose of verifying the given information. By submitting
references, you are also explicitly giving us permission to contact your references and ask them about your
person, business and matters concerning this application.

3 This application form entitles you only to apply for a Skoda DEALERSHIP and it does not imply any
committment on the part of Skoda to grant you such a dealership.

4
Once you are finished filling the application and collecting all the necessary additional documentation:
Save one copy of the application form on a CD-ROM and submit it together with a printed copy of the entire
document, plus all the necessary attachments by courrier along with E-mail us to the following address :

5 Incomplete application will not be accepted.Decision by SAIPL will be final

Network Development Phone +91 22 3313 7162 / 7151

Skoda Auto India Private limited
Silver Utopia, 4th Floor- A Wing, E mail Id dealerdevelopment@skoda-auto.co.in
Cardinal Gracious Road, Chakala,
Andheri (East), Mumbai 400099

Dealer Development SF/DND/2412 7/11/201710:26 AM

 Dealership Application Form

5 City Applied for

6 Applicant Details

6.1 Name 6.8 Office Tel. No.:

6.2 Address 6.9 Other Tel. (Home):

6.3 City 6.10 Mobile Phone No.:

6.4 State 6.11 Fax No.:
6.5 Phone No 6.12 e-Mail:
6.6 Mobile No 6.13 Website:
6.7 E mail Id

Have you or anyone involved with this application ever applied for a dealership / workshop of the Skoda
7
Group (Audi, Skoda, Skoda, Seat, Lamborghini, Bentley or Bugatti)?
If yes, then please give details: City for which applied :

Month & year :

For Office use only

8 Date received: Received by:

9 Complete or Incomplete or Incomplete

10 No. of Enclosures:

11 Comments:

Skoda India
Network Development Team

SF/DND/2412
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 Applicant Profile
Individual
You must fill in this section completely. Corporate

First Name (given name): Picture:

Last Name (family name): (Key Applicant - if applicable)
Date of Birth (dd.mm.yyyy):
Place, Country of Birth:
Present Citizenship
Martial Status
Spouse's Name:
Number of Children:

Contact Address of Main Applicant PERSON

c/o: Street and Number:

Street and Number:
Postal ZIP Code:
Postal ZIP Code: City:
City: Country:
Country: Home Tel. No.:
Office Tel. No.: Home Fax No.:
Fax No.: Are you a resident of the city for which you are applying?
Mobile No.:
e-Mail:
Website:
Institution:
Highest degree of Education: Year:
Specialization:
Languages Spoken:

Professional Information

Current Profession:
Are you member of Automotive organizations, association, agencies, etc?
Do you hold any professional leadership positions?
Are you a member of social clubs (Rotary, Lions, Social Clubs, Sports, etc)?
Have you been convicted or involved in any Tax violation/Bankruptcy?
Specify if you or your relative have any political Association
Please list your experience for at least the last 15 years. In addition, we ask you to please attach your CV, describing your responsibilities and achievements at
each of the listed jobs.
Responsibility / From To Yearly Earnings
Company Type of Business
Ownership % (mm.yyyy) (mm.yyyy) (Rs.)
1

5
Please attach audited balance sheet , profit and loss statement for last 3 years ,if you are into running any business enterprise

SF/DND/2412
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Please judge your experience and ability in the following disciplines: (make an X where relevant to mark your choice)

Experience Appraisal of Ability

Discipline
Extensive Adequate Limited Good Fair Limited
General Management
New Car Sales Management
Used Car Sales Management
Service Management
Parts Management
Business Management

Are you planning on managing the dealership yourself?

Please specify Yes/No

Personal / Professional References

Please submit at least 1 personal and 1 professional reference (not relatives or employers)

Personal Reference 1 Professional Reference 1

Name (first, last): Name (first, last):
Phone Number: Phone Number:
eMail: eMail:
Relationship: Relationship:

Personal Reference 2 Professional Reference 2

Name (first, last): Name (first, last):
Phone Number: Phone Number:
eMail: eMail:
Relationship: Relationship:

Financial Information

Bank Reference
contact
Bank Name Contact Name Street, City, Postal Code Area Code Phone Number
since

Please attach a certificate from your main Banker in support of your financial strength and investment capability
This document should certify the following
1] The turnover of your account
2] Your crerdit limits
3] Your interest rates
4] Your credit ratings

SF/DND/2412
Issue No. 2
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 Financial statement of assets and liabilities
(you are requested to support this information together with the pertinent detailed documentation, including a copy of your tax return for the last three years)

ASSETS ( IN LAKHS) LIABILITIES

Cash Account Current Accounts Payable:
BANK CASH
0

Other Current Assets: (e.g. Securities, Desposits, Life Insurance etc.)

ASSET CASH VALUE Mortgages, Long Term Loans:

Installment Accounts:
TOTAL CURRENT ASSETS : -

Other Assets: (e.g. Real Estate, Cars, Furniture etc.)

ASSET CASH VALUE Income Tax Liability:

Specified Reserves:

Business Investments:
ASSET INVESTMENT
ANY OTHER OBLIGATIONS: (e.g. Guarantees,
0 warranties ) Describe

TOTAL ASSETS - 0

Total Assets & Liabalities -

Please enclose latest CIBIL Report
Do you have, or have you had, a controlling financial interest in a company?
Please describe

Company Information

Company / Group Name:

Street:

Postal ZIP Code: Nature of the Business:

City:
Country:
Tel. No.: Company Type:
Fax No.: Shareholding:
Website: Major Shareholders: (if applicable, Name, Relationship and % Shares)
Main Brands: Shareholder 1:
Founding Year: Shareholder 2:
Shareholder 3:
Shareholder 4:
There are additional shareholders

2016-17 2015-16 2014-15 2013-14 2012-13

Number of Employees:
Sales/Revenues:
Net Profit After Tax:
Net Worth (Book Value):

SF/DND/2412
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 Site Location Proposal

(Please fill 1 form for each location proposed)

1 City:
2 State:
3 City District or Neigborhood:
4 Location Name:

5 Do you propose more than one location in this city? Yes/No

6 Are you applying for more than one dealership location in this city? Yes/No
7 Are you applying for other cities? Yes/No

8 Which other cities are you applying for? Wrte the names

9 How much investment can you make for proposed Skoda Dealership?
Expected Project cost

In Lac
10
Own Fund Term Loan Total

Land
Fixed Investment
Working capital Investment
Total

11 Location Type / Description:

Please describe the neighbourhood, status and
availability of the property, exposure of the
dealership and showroom

Please attach a map indicating the proposed location for the Skoda dealership and sales and service territories, highlighting the high
income districts (residential and business) and existing competitors.
Please include pictures of the location showing the streefront, the buildings from outside and the buildings from inside.
Please attach valuation certificate by certified valuers of the property shown

SHOWROOM WORKSHOP

12
What is the complete address of the land/building (please use
'Alt+ENTER' to do a line break)

13 If the Showroom and the Workshop are not at the same location, at
what distance is the Workshop from the Showroom? (Kms.)

14 If owned, is the property available to you? Yes/No

- If property is available, Copies of title deeds of the property along with the Site plan
and city map in relation to the area where Dealership is to be entered into, showing major
access roads, photos, legal ownership and other documentation.
- If property is not available, please discribe where do you plan to acquire space in question Nr. 3.XX

15 If leased, until what year is the lease valid? (YYYY)

Showroom Workshop
16 How large is the land plot? (square feet)
How long is the property's frontage
17 (street front)? (in Feet)
What is the built surface of the building?
18 (square feet)
What size is the Showroom / Workshop? (Length x
19
Width x Height) (in feet)
20 Status of Plot (Own / Lease). If leased, pls mention the expected lease amount.
21 If there is Buildings on the Land / Site, pls specify build up area
22 Is the site Proposed for Showroom or Workshop or Both combined?
23 Is there any other dealership located within the same area? (Name & Distance)?

NOTE: 1. Please attach photographs of land / building

2. Details of Market Situation, Trend and Potential in the area
3. Please show the location of the SITE(s) on the geographical map of your city and highlight
a) Automobile Dealerships around the site(s)
b) Competitor Dealerships around the site(s) and distance from the proposed site.
c) Major Roads / Highways, Business CentersSF/DND/2412
in the vicinity. d) Any other information
Issue No. 2
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 Family tree

Name
Relation
Age in Yrs.
Business Involved
resident of

Name Name Name Name

Relation Relation Relation Relation
Age in Yrs. Age in Yrs. Age in Yrs. Age in Yrs.

Business Involved Business Involved Business Involved Business Involved

Name Name Name Name

Relation Relation Relation Relation
Age in Yrs. Age in Yrs. Age in Yrs. Age in Yrs.

Business Involved Business Involved Business Involved Business Involved

SF/DND/2412
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 Motivation

According to you, what does Skoda stand for?

In what respects do you feel qualified to own and manage Skoda

dealership, considering your background, track record, infrastructure
and financial strength?

How much money are you willing to invest in the dealerships and
how do you finance this (debt/Equity)

Why should Skoda take you as a dealer?

What is your expectation from Skoda?

SF/DND/2412
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 DECLARATION

The Applicant, certifies that

(1)

He has made full disclosure of all the information required in this application and all the information given by him is true in
all respects. He further acknowledges that any misrepresentation, whether intentional or unintentional, in the information
submitted in connection with the application shall be grounds upon which Skoda Auto India Private Limited may either: (a)
decide to no longer consider his application, or (b) immediately terminate any dealership agreement executed by Skoda
Auto India Private Limited with him or the dealer company designated by him.

(2)
The applicant acknowledges that this is only an application for dealership and by submitting this application, he will not
place any obligations on Skoda Auto India Private Limited to appoint the applicant as an authorised dealer of Skoda Auto
India Private Limited

(3) The applicant certifies that he is not suffering from, or aware of any legal disability that would prevent him from being
appointed as an authorised dealer of Skoda Auto India Private Limited

(4) The applicant acknowledges that any obligations undertaken or expense incurred by him in submitting this application shall
be incurred entirely on the applicant's own behalf.

(5)
The applicant hereby authorizes Skoda Auto India Private Limited to make any inquiries it may consider necessary to verify
this information and will not consider such inquiry to constitute an invasion of his privacy.

The applicant acknowledges that copies of all documents, photographs etc. furnished by him to Skoda Auto India Private
(6) Limited in the process of applying for dealership will henceforth become a property of Skoda Auto India Private Limited and
will be retained by them for their records.

(7)
The applicant hereby authorises the receipt, provision, verification and exchange of relevant credit related information from
/ with any source including banks, credit rating agencies, credit bureaus in respect of his personal account as well as
business for the purpose of considering his request.

Date:

Applicant's Signature: Witness's Signature:

Applicant's Name: Witness's Name:

SF/DND/2412
Issue No. 2
Dealer Development Issue Date: 22.11.2010 7/11/201710:26 AM