Reliance Communications Ltd.
Channel Partner Registration Application Form
Fields mark (*) are mandatory
General Information
  Are you an existing Channel Partner of any Reliance Group Company ?* Yes    No
  From which source you came to know about this portal ?
  Are you already dealing with other Telcom & IT companies?* Yes    No
  For which business, do you want to signup as a channel partner?
  Your Target Segment (you can select the multiple values using ctrl button)*
Criteria Information
  Nature of Existing Business*
  Customer Base*
  No. of Years in Business*
  Business Turn-over per Annum*
  Qualification *
Personal Information
  First Name*
  Last Name*
  Educational Qualification*
  Email Address*
  Contact No (Telephone/Mobile)*
  Address 1*
  Address 2
  PIN*
  State*
  City*
  Your Website if any
  Any remarks/comments
Territory Information
  Preferred State of operation*
  Preferred Town of operation*
Business Information
  Name of the Company / Firm*
  Type of the Firm*
  Details of the Owners & Promoters of the Firm/Company*
 
Sl. No Name Designation Age Qualification % share Role in the firm/co.
1.
2.
3.
  Details of the Present Business*
 
Sl. No Name of Firm Name of principal Comapny dealing with Location Since the year Product Group Annual Gross Turnover Rs. (in lakhs) No. of Retailers covered, if any
1.
2.
3.
  Do you have Sales staff? (not relatives)* Yes    No
Details of present Infrastructure
  No. of PCs*
  Availability of Internet Connection* Yes    No
  Office Space (In sq. ft.)*
  No. of Telephone Lines*
Supporting Documnets     (Attach documents as .pdf/.doc/.docx/.xls/.xlsx/.ppt/.pptx/.jpeg/.jpg/.gif/.bmp file)
  PAN Card Details
  Company Registration Certificate
  Balance Sheet/Current account statement (last financial year)
  Service Tax / Sales Tax Certificate
  Other Documents
Terms & Conditions
  I / we hereby certify that the information given in the application form is correct and complete.

I / We agree to accept that the information given in the application form will be the basis of the dealership agreement, if entered into, between our respective organizations, and that if, at any time, I / we are found to have concealed any material information or given false details our business would be subject to termination without notice, and further that this would be without prejudice to our rights under the agreement. I / We agree to accept that the application shall be evaluated against various criteria and the company reserves the right to reject any application without assigning any reason.
  Name*
  Date
  Place*