Reliance Communications
Channel Partner Registration Form
Note: Columns Marked With ( * ) Are Mandatory.
General Information
1.  Are you an existing Reliance Communications Channel Partner ?* Yes    No
2.  From which source you came to know about this portal ?*
3.  Are you already dealing with other Telcom & IT companies or FMCG ? Yes    No
Business Information
1.  Scale of Business *
2.  Type of Business:*
3.  Business Turnover per Month(Rs.)*
4.  Investment Capital (Rs.)*
5.  Market Presence (No.of years in Area applied for)*
6.  Office Space Available (in Sqft)*
Personal Information
1.  Name *
2.  Age (in Years)* 3.  Qualification (Select Highest Degree)*
4.  Educational Qualification 5.  Email Address*
6.  Contact No(s). LandLine * 7.  Mobile*
8.  Address 1* 9.  Address 2
10.  State* 11.  District*
12.  Taluka* 13.  Town/Village*
14.  PIN* 15.  Firm/Co.Website if any
16.  Any remarks/comments
Territory Information (Preferred)
1.  Circle of Operation*
2.  Cluster of Operation*
3.  Town of Operation*
4.  Business of Interest*
Do you have Sales Staff?(excluding Relatives)*       Yes    No
1.  Name of the Company / Firm*
2.  Type of the Firm*
3.  Details of OTHER Owners/Promoters of the Firm/Company
Sl. No Name Designation Age Qualification % Share Role in Firm/Co.
Add New Record  Remove Record
4.  Details of Present Business
S.No Name of Firm Name of Company dealt with Location Since the year Product Group Annual Gross Turnover(Rs. in lacs) No.of Retailers Covered,if any
Add New Record  Remove Record
5.  Details of the Past Business(es)
S.No Name of Firm Name of Company dealt with Location Upto the year Product Group Annual Gross Turnover (Rs. in lacs) No.of Retailers Covered,if any
Add New Record  Remove Record
Details of Present Infrastructure
1.  No.of PCs* 2.  No.of Godowns*
3.  Storage Space(in Sqft)* 4.  Availability of Internet Connection*
5.  No.of Delivery Vans* 6.  Office Space(in Sqft)*
7.  No.of Two Wheelers* 8.  No.of Telephone Lines*
9.  No.of Telephone Callers*      
Other Information
1.  CST Number. * 2.  CST DATE.
3.  LST Number.* 4.  LST DATE.
5.  PAN Number(eg. ABCDE1234X)* 6.  VAT Number.*
Please Upload Scanned Copies of Respective Documents.(in .doc / .docx / .pdf / .txt / .jpeg / .xls / .xlsx formats only.)
1.  Company Registration Certificate
2.  PAN Card
3.  Latest Balance Sheet/Current Account Statement
4.  Service Tax Certificate
5.  For Partnership Firm
Copy of Partnership Deed
6.  For Private/Public Companies
a) Copy of Memorandum of Association
  b) Copy of Articles Of Association
7.  Office Address Proof
(Rent Agreement or, Ownership Document)
8.  In case of sole proprietorship / partnership photograph and details of proprietors / partners
9.  Shops and Establishment Certificate
10.  Copy of PF Registration
11.  Copy of ESI Registration
12.  Tax Return for last 3 years
13.  Letter from bank for solvency and credit enjoyed
14.  In case of new firms
a) Solvency letter of partners
  b) Working Capital Arrangement
15.  Power of attorney duly signed by all partners and notarized. In case of company supported by board resolution.
16.  Affidavit from Channel Partners that all statuary compliance will be completed .
17.  Other Documents(if any)
(Note: If there are more than one document, please zip into a single file and then upload.)
Infrastructure Proposed for RCOM Business
1. Total Space(incl. Storage)
(in Sqft) *
2. No. of Telephones*
3. No. of PCs * 4.  Dedicated Internet Connection Yes    No
5.  No of Sales Staff*
S.No Bank Name Branch Address Bank A/C No. OverDraft Faciltity
1. Yes   No
2. Yes   No
3. Yes   No
  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 organisations. And that if, at any time, I/we are found to have concealed any material information or given false details about our business, our agreement 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 my/Our application without assigning any reason.
  Date 30 Aug 2015