Ather Energy Private Limited

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APPLICATION FOR ISSUE / RENEWAL OF LICENCE FOR ATHER
ENERGY DEALERSHIP OF ATHER ENERGY PRIVATE LIMITED

 Name of the Person/Firm (in block letters)

2. Address of registered office

Building Number.
Building Name

Street

City PIN

State

Tel.

Mobil

eFax

E-mail

3. Status
(Please tick Proprietorship Private Limited Company
where
appropriate)
Partnership
Co-operative
Society
Others specify

Ather Energy Private Limited

Corporate Office: - 3rd Floor Tower D, IBC Knowledge Park, Bannerghatta Main Road,
Bengaluru, Karnataka 560029.
(CIN) U40100KA2013PTC093769
Web: www.atherelectricdealer.com Email: info@atherelectricdealer.com
 Ather Energy Private Limited
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4. Type of licence applied for Dealership (Please tick whereappropriate)

5 Years (Rs. 6, 50,000.00) 10 Years (Rs. 10, 50,000.00)

5. Full name and permanent address of the Proprietor/partners/directors (Attach additional sheets wherever
required)
Name

Building Number

Building name
City PIN

State

Tel.

Mobile

E-mail

6. Permanent Account
Number (PAN)

(a) Sales tax registration

(Attach self-attested copy) General Sales Tax

Date of issue

Place of issue

Central Sales Tax

Date of issue

Place of issue

(b) Indicate whether the application is for renewal ofthe

existing licence or for a new licence (Please tick where Renewal New
appropriate)

Ather Energy Private Limited

Corporate Office: - 3rd Floor Tower D, IBC Knowledge Park, Bannerghatta Main Road,
Bengaluru, Karnataka 560029.
(CIN) U40100KA2013PTC093769
Web: www.atherelectricdealer.com Email: info@atherelectricdealer.com
 Ather Energy Private Limited
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(c) If for renewal, indicate

licence number.

Date of issue

(d) Quantity and value of Ather Energy Private Limited purchased and sold during the last three years

Year Quantity Value (in Lakhs)

(e) Details of fee remitted

Amount

(f) Mode of payment NEFT RTGS

(g) Source of purchase of Ather Energy Private Limited (Please tickwhere appropriate)

Dealer Company

(h) Storage facilities Yes No

Address of Service Center

PIN

(i) Capacity of Service

Center (YEARLY)

Ather Energy Private Limited

Corporate Office: - 3rd Floor Tower D, IBC Knowledge Park, Bannerghatta Main Road,
Bengaluru, Karnataka 560029.
(CIN) U40100KA2013PTC093769
Web: www.atherelectricdealer.com Email: info@atherelectricdealer.com
 Ather Energy Private Limited
****************************************************************************************************

DECLARATION

I/We……………………………………………………………………………………………………………declare that the information

given above are true to the best of my/our knowledge and belief and that I/We shall abide by the Ather
Energy Private Limited (Licensing and Marketing) Rules, and any instructions given by the Board from
time to time regarding the conduct of business.

Place: ………………………….. Signature: ………………………...

Date: ………………………….. Name: …………………………….

Designation: …………………..…

Ather Energy Private Limited

Corporate Office: - 3rd Floor Tower D, IBC Knowledge Park, Bannerghatta Main Road,
Bengaluru, Karnataka 560029.
(CIN) U40100KA2013PTC093769
Web: www.atherelectricdealer.com Email: info@atherelectricdealer.com