Distributor Form

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DISTRIBUTOR ENQUIRY FORM

This Report is intended to provide Principal (Genes2Me) with data relative to capabilities of the Distributor. Please
complete this Questionnaire in Sufficient detail to permit us to evaluate you Company’s Capabilities and controls
H and D Medical Store and Equipment Trading LLC
Company Name _________________________________________________________________________

Address_______________________________________________________________________________
Office no. 09, Building # M07, AL Warsan , Dubai

Email _________________________________
Infor@hndmedical.com +97145545799
Tel. ________________________URL www.hndmedical.com
_______________________
2018
Years of Incorporation /Operation _________________________ 06
Total Employee Strength__________________
01 01
No. of Application Team Members __________________ Service Engineers ___________________________

Company’s Turnover in the Year 2020 ______________________________


5-6 MILLION USD (Specify Currency)

Dealing in Brands related to:


A. COVID-19 (Please specify) B. Non COVID-19 (Please specify) C. Others (Please specify)
_______________________
BIOCORE _________________________
LABQUALITY _______________________
VACUTEST KIMA

_______________________
AMSBIO _________________________
STEMCELL TECHNOLOGIES ALLTEST
_______________________
BIOTECHNE HUMASIS
_______________________
YOCON BIOTECHNOLOGY _________________________ ________________________

Business Operation/Interest in Countries (Please Specify in Sequential Order)


1. ___________
UAE
2. ___________
QATAR
3. ___________

Business Contribution during COVID Era (Please Tick)


A. 0%-5% B. 05%-10% C. 10%-15% D. 15%-20% E. 20%-25%
F. If More (Kindly Specify)

Are You Interested In:


 Rapi-Q Point of Care Rapid PCR Solution: YES
(Yes/No) _______
 COVID-19 RT-PCR Solutions: (Yes/No) _______
 Non COVID RT-PCR Solutions: (Yes/No) _______
 Nucleic Acid Extraction Kits: (Yes/No) _______
 COVID-19 Antigen Kits: (Yes/No) _______
 Non COVID Rapid Antigen/Antibody Test Kits: (Yes/No) _______
 Molecular Biology Reagents: (Yes/No) _______
 NGS Solutions: (Yes/No) _______

Completed By (Full Name & Sign) Title Date

Arun P. T. Operations Manager 02-Feb-2022

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