Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.Full Name of Applicant / Firm: *Type of Firm (✔): *ProprietorshipPartnershipLLPPvt. Ltd. Co.LimitedOtherOwner / Directors / Partner / Proprietor Name: *Date of Establishment:PAN No.:GST No.:Aadhar No. (If applicable):NextOffice Address: *Address Line 1Address Line 2CityState / Province / RegionPostal Code--- Select country ---AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBolivia (Plurinational State of)Bonaire, Saint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCongo (Democratic Republic of the)Cook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Kingdom of)EthiopiaFalkland Islands (Malvinas)Faroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHondurasHong KongHungaryIcelandIndiaIndonesiaIran (Islamic Republic of)IraqIreland (Republic of)Isle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea (Democratic People's Republic of)Korea (Republic of)KosovoKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesia (Federated States of)Moldova (Republic of)MonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth Macedonia (Republic of)Northern Mariana IslandsNorwayOmanPakistanPalauPalestine (State of)PanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint Martin (French part)Saint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint Maarten (Dutch part)SlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyrian Arab RepublicTaiwan, Republic of ChinaTajikistanTanzania (United Republic of)ThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUgandaUkraineUnited Arab EmiratesUnited Kingdom of Great Britain and Northern IrelandUnited States Minor Outlying IslandsUnited States of AmericaUruguayUzbekistanVanuatuVatican City StateVenezuela (Bolivarian Republic of)VietnamVirgin Islands (British)Virgin Islands (U.S.)Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland IslandsCountryMobile Number *Alternate Number:NextCurrent Business Activity (✔): *WholesaleRetailOnlineOthersDo you currently deal in cosmetics/ayurvedic products? *YesNoIf yes, list brands:Number of years in this business:NextPreferred Area / District: *Taluka / Region Covered: *NextGodown / Storage Available?YesNoIf yes, size: _ sq.ft.Office Space Available?YesNoNo. of Employees:Delivery / Logistics Facility:Own VehicleThird PartyNot AvailableNextAnnual Turnover (Approx.): * No.: – sq.ft. Investment Capacity: *Below ₹50,000₹50,000–₹1,00,000₹1,00,000–₹3,00,000₹3,00,000–₹5,00,000Above ₹5,00,000NextReference 1 – Name / Contact:Reference 1 – Name / Contact:Next1. Territorial Restriction You are strictly instructed not to operate or interfere in any business area allotted to other distributors. Any such act of infiltration or territory violation will lead to immediate suspension of your supplies without prior notice. 2. Minimum Purchase Requirement If you fail to generate at least one purchase invoice (as per the minimum billing limit set by the Company) for three consecutive months, your distributorship will be automatically cancelled without any formal intimation. 3. Amendments to Rules The Company reserves the right to amend, update, or revise the distributorship rules at any time. All updated rules will be applicable immediately upon release, and compliance will be mandatory. 4. Mandatory Advance Payment All orders placed by the distributor must be accompanied by 100% advance payment. No goods will be dispatched until full payment is received in advance. Check To Continue *I hereby declare that the information provided above is true and correct to the best of my knowledge. I agree to abide by the terms and conditions of Vedankur Healthcare for distributorship.Signature of Applicant:Date: *Submit