Distributor Application

DHAN BIO NATURALS
10/5,Sivanandham Colony, Korattur, Chennai . 600080.
Tamilnadu, India
Web: www. dhanbionaturals.com - email: [email protected]
I N D E P E N D E N T D I S T R I B U TO R A P P L I C AT I O N F O R M
NAME
Status
Individual
Entity
Gender
Male
Female
Affix Photo
Tg
S/o / D/o / W/o
Income Tax
Permanent
Account No.
Date of Birth
D
D
M
M
Y
Y
Y
Y
ADDRESS
Line 1
Line 2
Line 3
City
Pincode
Country
State
Phone
E-mail
Mobile
Nominee
Age
Relationship
Placement
Placed under Independent Distributor Code
Sponsor code
Name
Name
Placed under Team
Winno
Activa
Name of account holder
as per bank records
IFS code
Account No.
Bank & Branch
Declaration by the applicant:
I / we _______________________________have read and understood the Definintions, General Policies, Procedures, Terms and
conditions of independent Distributorship printed overleaf of the application form and I declare that I am fully aware and
conversant with the same. I hereby apply to join in your company as an Independent Distributor. I have applied to become an
Idependent Distributor out of my free will and choice and hereby agree to abide by the terms and condtions of the company in
force. Also I understand and agree that I will be bound by any amendments, notifications published / circulated time to time.
Further I declare that I have signed Independent Distributor application personally and all the particulars given above are true
to the best of my knowledge and the signature affixed here in this applicationis my authentic signature and I undertake to intimate the company any modifications to that. I am aware that any false information would result in termination of my Distributorship without any benefit whatsoever.
Signed at
on
D
D
M
M
Y
For office use only
Code allotted
Remarks
Y
Y
Y
Applicant’s Signature