Trufedu Budgetary Education Private Limited

DSA EMPANELMENT – REQUEST LETTER

To,
Trufedu Budgetary Education Private Limited
Block L, Embassy Tech Village Devarabisanahalli,
Outer Ring Road,
Bellandur Bengaluru,
KA 560103

Sub: Request for Empanelment as a Direct Selling Agent

Dear Sir,

I/We would like to apply for an empanelment with your organization as a DSA to
promote your services. I/We have enclosed herewith my/our profile sheet along
with necessary supporting documents. I/We also agree to execute the agreement
with your company after receiving the confirmation for the same.

Yours Faithfully,

Signature of the Applicant: _________________

Name of the Applicant: _______________________

Declaration: I/We hereby confirm that all information/documents submitted

by us along with the request letter are true and fair as on date of
application.

Encl:
1. Profile
2. PAN Card
3. Service Tax Registration Certificate / Exemption Certificate
4. Incorporation Documents (Applicable)
5. Address Proof
6. Identify Proof
7. Recent Photograph (In case of an Individual) to be pasted on the request form and signed across
8. Board Resolution (Applicable only in case of a Company)
 Trufedu Budgetary Education Private Limited

DSA EMPANELMENT – FORM

Please provide all the information requested below. If additional space is required you may attach supplemental
sheets as per your need.

1. APPLICANT DETAILS / INFORMATION (IN BLOCK LETTERS)

A. CONTACT DETAILS

Name of the DSA

Mr. Ms. Mrs. M/s

Address

City Pin Code Area of Operation

Mobile Number Telephone Number / Fax Number

PAN Details Service Tax Number

E-Mail Id

B. TYPE OF BUSINESS (Tick One)

Individual Proprietorship Partnership Public Ltd. Private Ltd.

C. DATE & PLACE

Date of Birth/Incorporation Place of Birth/Incorporation

D. Number of Years in Current Business

Years

E. Name of Proprietors/Partner(s)/Director(s)&Key Contacts of the Applicant

Full Name Position / Title Since Mobile Number

F. Branches / Employees
Location Area Number of Branches Number of Employees

G. Industry Standing G. & Customer Base

Client / Company Name Since (Date) Products Managed Services Offered
 Trufedu Budgetary Education Private Limited

H. Group Company Details, if any

Client / Company Name Since (Date) Products Managed Activities Undertaken

I. Indicate the Nature of any Relationships with TRUFEDU Affiliated with the DSA
Client / Company Name Since (Date) Products Managed Activities Undertaken

J. Banker Details
Bank Name
Full Address with Telephone Nos.
A/c Holder Name as appearing in Bank Statement
Bank A/c Number
MICR No.

2. OTHER DETAILS

A. Please specify the number of Permanent employees employed by the DSA

B. Does the DSA provide its employee's with ID Cards prominently displaying the name of
the employee, designation & name of the DSA on it?
Yes No

C. Does the DSA perform a background check on all employees before hiring?
Yes No

D. Does the DSA hire employees having industry experience?

Yes No

E. Does the DSA issue appointment letters to all new employees?

Yes No

F. Are the appointment letters signed & acknowledge by the employee?

Yes No

G. Does the DSA take resignation letters from employees leaving the organization, with reasons for
resignation?
Yes No

H. Do you subcontract any of your services?

Yes No

If Yes please list services below:

____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________

3. IS THE APPLICANT INVOLVED IN ANY LEGAL DISPUTE

Yes No

If Yes please provide the details below:

____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
 Trufedu Budgetary Education Private Limited

4. DETAILS OF THE PERSON WHO WILL BE COORDINATING WITH TRUFEDU

Name of the Coordinator Designation Mobile Number Email Id

5. PHOTOGRAPH

I/We confirm that the details submitted by me/us are true and correct as on application date.

Signature and Stamp _______________________________________________________

Printed or typed name of Signatory ___________________________________________

Date _______________________Place _________________________________________

DOCUMENT CHECKLIST FOR DSA EMPANELMENT

SR.NO. CATEGORY VENDORS DOCUMENTS SOLE PARTNERSHIP PUBLIC /
PROPRIETORSHIP PRIVATE
LTD. CO.
1. Incorporation
Documents
Partnership Deed 
Memorandum & 
Article of Association
Certificate of 
Incorporation
Board Resolution 
2. Photo Id Passport
Proof Driving License
Voter’s Id Card Any one or two of these
Photo Credit Card
3. Photograph   
4. Address
Proof of
Copy of Latest Telephone
Bill
  
Vendor
Office
Copy of Latest Electricity
Bill
  
Premises Copy of Lease Deed   
Shops and Establishment
Certificate
  
Any Other Government
Issued Certificate
  
Pan Card   
Service Tax Certificate /
Exemption Certificate
  
 Trufedu Budgetary Education Private Limited

FINANCIAL COUNSELLOR Recommendation Note:

____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
Name of FINANCIAL COUNSELLOR: _____________________

Signature of FINANCIAL COUNSELLOR: ___________________________________________