Company Address and Contact Information

Name Title
Company Name
Street Address
City Province
Zip Mobile
Phone Fax
Established Since E-mail
Number of Employees Website

Business Information

Annual Sales Rs For Last Year For Year Before
Projected Sales Rs
Company Strucutre (Please tick one) Private Ltd Sole Proprietorship Parntership Franchise Subsidiary
Sq. Ft. Total Admin Sq. Ft. Total Warehouse Sq. Ft. Total
Total Employees Sale Employees Admin Employees
Address of Warehouse

Government Registration and Certification

A) Has your company been registered by the Income Tax Department? If so please list and attach.
Cerfifcate Name Date Expires Number
B) Has your company been registered by the Sales Tax Department? If so please list and attach.
Cerfifcate Name Date Expires Number
C) Has your company been registered with the Drug Sales Department? If so please list and attach.
Cerfifcate Name Date Expires Number

Please List Bank Information

Please provide 3 Trade References

Customer Contact Phone
Customer Contact Phone
Customer Contact Phone

Bank and Trade Reference

Bank Name Bank Name Bank Name
Bank Address Bank Address Bank Address
Bank Contact Bank Contact Bank Contact
Any Other Info
 

Sales Organization and Geography

Number of Sale Representative  
  Name Designation Number of Years Qualification  
Details of Sale Representative  
 
 
 
 
 
 
 
 
 
 
 
Are these Representatives direct employees?  
Number of Sales Representatives that service the medical device field? Number of Sales Representatives that service the FMCG  field?
Are Accounitng Procedures Computerized? If yes the name of the package/software
Please list your current distributions and their monthly sale Company Stockist / Distributor / Dealer Area Covered Product(s) Monthly TurnOver
In which cities do you currently distribute in?
Number of Vehicles Available? Model and Registration # Make
Transporter Name and Number?

VAN ROUTE PLAN

DAY WEEKLY FORTNIGHTLY MONTHLY ROUTE NO OF OUTLETS COVERED
MONDAY
TUESDAY
WEDNESDAY
THURSDAY
FRIDAY
SATURDAY
SUNDAY
Number of Outlets Covered? Retailers Wholesalers
  Hospitals Others
 
Which current SHIFA or HAPPIES products do you wish to distribute?(check all that apply) IV SETS DISPOSABLE SYRINGES URINE BAGS DIAPERS OTHER PRODUCTS
Y PORT BLISTER DISPOSABLE SYRINGES PUSH AND PULL ADULT DIAPERS GLOVES
Y PORT POLY AD SYRINGES T PORT BABY DIAPERS CANNULAS
BASIC SAFETY SYRINGES BLISTER PACKED BURETTE SET
 
What do you expect your projected SYAH product sales (PKR) to be in: PRODUCT YEAR 1 YEAR 2 YEAR 3  
DISPOSABLE IV SET
DISPOSABLE SYRINGES
DISPOSABLE URINE BAGS
DISPOSABLE GLOVES
DISPOSABLE CANNULAS
ADULT DIAPERS
BABY DIAPERS
Please state how you plan to market and promote products of SYAH.  
Please state the terms proposed for business 100 % Advance Cash
 
SPO/ASM REMARKS:  
 
RSM REMARKS:  
 
Signature of SYAH Representative Signature of Owner