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Stockist Application

  • Name of the Firm*full name
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  • Full address of the Firm*
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  • Landline*
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  • Cell Phone*
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  • Fax*
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  • Email*a valid email address
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  • Name of Competent Person & Designation*
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  • Constitution of the Firm*to order
    Proprietary
    Partnership
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  • Drug Licenses No.*
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  • GST No*
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  • PAN Details*
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  • Area/District Covered*
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  • Experience Of Stockistship in Years*
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  • Name and address of the Bank*
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  • Name of the Companies Presently Dealing with and Turnover Per Annum
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  • 1*
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  • 2*
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  • 3*
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  • 4*
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  • Preferred Transporter*
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  • Number Of Field Staffs*
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  • I/We declare that the above given information are true and correct. I/We also agree to abide by your terms and conditions.
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   We are looking for DSAs all over India (except Kerala,Gujarat and Chatisgrah) .Interested parties may contact 9846505044.