Distributorship Application Form

Company Information Company Name:

Registered Office Address:

Delivery Address, if different to registered address:

Primary Contact Person Name:

Mobile:

Email ID:

Office Telephone No.:

Fax:

Website (if any):

Company Details Company/Firm/Proprietorship:

Year of Incorporation:

Years of Experience:

List names of companies you are associated with:

List names of companies you are associated with on exclusive basis and non-exclusive basis. Also mention territory covered:

Turnover of Last 3 Financial Years in INR:

Number of Sales Personnel:

Total Staff:

Name of your top 5 prime customers:

Warehouse facilities – Yes or No:

Are you well equipped for storage of products at 2 to 8 degrees Celsius and other varied minus degrees Celsius? Give a brief on your storage capacity:

Distributorship Details You are applying for Distributorship for which Foreign Brands of KHC Healthcare:

You are applying for Distributorship for which Cities or Regions:

Registration Information Drug License Number (attach copy):

GST Registration Number (attach copy):

CIN Number, if company (attach copy):

PAN Number (attach copy):

partner to success

Expand Your Reach In India With KHC. You Will Enjoy Your Growth
Journey in the Fascinating Indian Market

write to us

it can drive innovation at top-notch speed.Being frugal is not at all bad.

Wahi Anuj

Vice-Chairman & Managing Director

Being frugal is not at all bad, it can drive innovation at top-notch speed.

Anuj Wahi

Vice-Chairman & Managing Director

Diagnostics

Instruments and Software

Diagnostics

Reagents and Kits

Pharmaceuticals & Research

Instruments and Software

Pharmaceuticals & Research

Reagents and Kits

Distributor Form

Distributorship Application Form

partner to success

Expand Your Reach In India With KHC. You Will Enjoy Your Growth
Journey in the Fascinating Indian Market

it can drive innovation at top-notch speed.Being frugal is not at all bad.

Wahi Anuj

Being frugal is not at all bad, it can drive innovation at top-notch speed.

Anuj Wahi

Write To Us Form

Diagnostics

Instruments and Software

Diagnostics

Reagents and Kits

Pharmaceuticals & Research

Instruments and Software

Pharmaceuticals & Research

Reagents and Kits

Distributor Form

Distributorship Application Form

partner to success

Expand Your Reach In India With KHC. You Will Enjoy Your Growth Journey in the Fascinating Indian Market

it can drive innovation at top-notch speed.Being frugal is not at all bad.

Wahi Anuj

Being frugal is not at all bad, it can drive innovation at top-notch speed.

Anuj Wahi

Write To Us Form

Expand Your Reach In India With KHC. You Will Enjoy Your Growth
Journey in the Fascinating Indian Market