Reliance Communications
Channel Partner Registration Application Form
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Fields mark (*) are mandatory
General Information
Are you an existing Reliance Communications Channel Partner ?
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Yes
No
If yes, Please enter Vendor Code
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From which source you came to know about this portal ?
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Friends
Newspaper
Reliance Representative
Internet
Others
Are you already dealing with other Telcom & IT companies?
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Yes
No
Please select atleast one
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Bharti
Tata
Tulip
Others
For which business, do you want to signup as a channel partner?
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Enterprise Services
Your Target Segment (you can select the multiple values using ctrl button)
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BFSI
IT/ITES
Retail
Logistics
Textile & Export Houses
FMCG
Automobile & Auto Ancillieries
Telecom
Government
Power & Energy
Media& Entertainment
Services
Others
Criteria Information
Current Business
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I am a System Integrator
I am a PBX Vendor
I am a Office Automation
I am a Telecom / Software Business
None of the Above
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20
20
20
15
5
Existing Infrastructures
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One Man ownership Company
More than 2 manpower + One office
Very Good Set Up + More than one office
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10
15
20
My Coverage(Physical Presence)
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My Presence Is Limited to the City
My Presence Is till the state level
My Presence Is Across India / 4 metros
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7
9
10
I am in business since
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Start up Buisness, New, Less than 1 year
1 To 2 Years
2 To 5 Years
More Than 5 Years
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5
6
8
10
My Turn-over of the business
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Less Than 5 Lacs
Rs 5 to 50 Lacs
Rs 50 to 50 Lacs
> Rs 50 Lacs
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5
12
16
20
My Qualification is
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Engineering Graduate or Diploma or MBA
Other Graduate / Post Graduate
Non Graduate
Select
10
8
5
References
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Excellent
Good
Average
Select
10
8
5
Personal Information
First Name
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Last Name
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Educational Qualification
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Email Address
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Contact No (Telephone/Mobile)
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Address 1
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Address 2
PIN
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City
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State
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Your Website if any
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Any remarks/comments
Territory Information
Preferred State of operation
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Preferred Town of operation
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Business Information
Name of the Company / Firm
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Type of the Firm
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Company
Proprietorship
Partnership
Details of the Owners & Promoters of the Firm/Company
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Sl. No
Name
Designation
Age
Qualification
% share
Role in the firm/co.
1.
2.
3.
Details of the Present Business
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Sl. No
Name of Firm
Name of Company dealt with
Location
Since the year
Product Group
Annual Gross Turnover Rs. (in lakhs)
No. of Retailers covered, if any
1.
2.
3.
Details of the Past Business
Sl. No
Name of Firm
Name of Company dealt 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)
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Yes
No
Sl. No
Name
Position
Qualification
Experience
Responsibility
1
1
1
Details of present Infrastructure
No. of PCs
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Availability of Internet Connection
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Yes
No
Office Space (In sq. ft.)
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No. of Telephone Lines
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Other Information (only .doc/.docx or .pdf file)
PAN Card Details
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Company Registration Certificate
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Balance Sheet/Current account statement (last financial year)
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Service Tax number
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Other Documents
Proposed Plan for RCOM business
Infrastructure
Total Space (INCL. STORAGE)(In Sq. ft.)
No. of Telephones
No. of PCs
Dedicated Internet Connection
Yes
No
No of Sales Staff
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
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Date
Place
*