BLINKO EDIBLE ORGANICS PVT ltd

Application for Distributorship

Asst. Area Manager Code:

Asst. Area Manager Name:

APPLICANT INFORMATION

*Full Name:

*Upload Photo:

*Father's/Spouse's Name:

*Date of Birth:

*Gender:

*Phone:

Email:

Residential Address:

IDENTIFICATION DETAILS

*Aadhar Card:

*PAN Card:

(Attach Photocopy of Adhaar)

(Attach Photocopy of PAN Card)

BUSINESS DETAILS

Business/Shop Name:

Business Address:

DECLARATION

I, the undersigned, hereby declare that the above information is true and correct to the best of my knowledge and belief. I understand that any false information may result in the cancellation of my distributorship. I agree to abide by all the terms and conditions laid down by the company.

*Date:

*Place: