STRICTLY CONFIDENTIAL WHEN FILLED

To
ResMed India Private Limited
205, 2nd Floor, D2,
Southern Park, District Centre,
Saket, New Delhi - 110017

APPLICATION FORM FOR DEALERSHIP

Note: The information being asked for in this application form is critical for an important business
decision. It should either be typed or written in bold letters. Please give comprehensive and accurate
information and attach additional sheets if required.

A. ORGANIZATION DETAILS

A.1 Name of the applicant Organization:

A.2 Office Address :( if more than one office, please give other addresses also. Please attach separate
sheet if necessary)

Postal address:
Tel:
Fax:
Email:
Website:
Mobile No.:
Are you going to use the above premises for new dealership? [ ] Yes [ ] No

If no, please give details of alternative location from where you will carry out the new business:-

a)
Postal address:
Tel:
Fax:
Email:
Website:

b) Ownership: [ ] Own [ ] Rented [ ] Shared premises

c) Area of Office: ……………..Sq ft

d) Location: [ ] Prime Location in busy market

[ ] Commercial area away from prime location
[ ] Residential Area
[ ] None of the above. Give approx. idea …………………..

ResMed India Pvt. Ltd Private & Confidential Dealership Application Form 2011-12
A.3 (a) Corporate Status: [ ] Public Ltd. [ ] Private Ltd. [ ] Govt. Organization

[ ] Partnership [ ] Proprietorship [ ] Joint Sector

A.4 Do you have an import license and import export code? [ ] Yes [ ] No

A. 5. Do you have a tie up with an international freight forwarder? [ ] Yes [ ] No

A.6 Details of Directors/Partners/Owner(s) :-

Name
Age(Years)
Educational Qualification
Experience (yrs)
Responsibility in the co.
No of yrs of association
with the co.

A.7. Details of key management and technical personnel other than the above who will be directly
involved with dealership activities. (Please attach detailed bio-data/ resume for each individual)

Name Role & Responsibility Proposed Designation

1. ____________ ____________________ _________________

2. ____________ ____________________ __________________

3. ____________ ____________________ __________________

A. 8. Financial Information
Year Sales Net profit Loans
2009-10
2008-09
2007-08

ResMed India Pvt. Ltd Private & Confidential Dealership Application Form 2011-12
B. CURRENT BUSINESS

B.1. Details of business activities of applicant and/or associate organization(s):

Business Business Products Sales FY10 Number of Employees Yrs of Projected Sales
Entity Activity Mktg/Sales Service Admin operation FY11

B.2. Details of traded Products:

Product Principal(s) Sales Relation- Nature of Relationship Territory Projected

Description Name Country Direct/ FY10 ship (Pl. tick) covered Sales
Indirect since FY11
Sales Service C&F

B.3. Please describe three core competencies or key strengths of your organization along with specific
examples to substantiate your claim?

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B.4. What after sales support can you provide to your customers viz service, support, turnaround time,
management of faults-on-site etc?

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ResMed India Pvt. Ltd Private & Confidential Dealership Application Form 2011-12
 STATEMENT OF ATTACHMENTS

 Yes

X No

1. Copy of Company Regn Certificate/Partnership/Proprietary Certificate [ ]

2. Deed/ Articles of Association or agreements [ ]
3. Detailed resumes of Directors/Partners/owners and key management persons [ ]
4. Audited Financial statements for last two years [ ]
5. Net worth statement from Chartered Accountant [ ]
6. Income Tax Return Certificate for the last 2 years [ ]
7. Copy of PAN card [ ]
8. Bank Letter [ ]
9. Copy of Sales Tax Registration (TIN, VAT, CST) [ ]
10. No Objection Certificate from other Principal(s), if any [ ]
11. Write up on Marketing Plan [ ]
12. Bank Guarantee or Security Deposit cheque / draft of Rs. 1 Lac [ ]

ResMed India Pvt. Ltd Private & Confidential Dealership Application Form 2011-12