APPLICATION FORM FOR GREEN LP GAS DISTRIBUTORSHIP
A. Applicant's Information
Emergency Contact ___
B. Business Information
Yes No
B.1. Propose Area/Territory ___
B.2. If you are currently in LPG Distributorship Business, Describe your Portfolio below ___
Company Name Investment Source of Investment (Own/Loan/Others) Monthly Turnover Duration of Business Remarks
B.3. Can you currently facilitate a warehouse?       Yes No
B.4. Do you have own transportation facilities?       Yes No
B.5. Personnel Details of your Organization
Description No of People Monthly Salary Remarks
Manager
Sales Man
Delivery Man
Others
C. Financial Aspects
C.1. Investment Proposition for each of the Brand that you are selling
Company Name Business Type (Distributorship) Cylinder Quantity Monthly Sell (Refill) Profit(Per Refill) Nature/Mode of Payment (TT/DD/Payorder/Online) No. of years doing business in LPG industry
C.2. Funding status in order to receiving the ‘GTLPGL’ Distributorship
C.3. Details of Bank(s) you maintain your regular transaction with
Name of Bank Branch Monthly Transaction (BDT)
C.4. Current credit arrangement with any Bank?       Yes No
TT
DD
PAY ORDER
ONLINE
D. The following papers/documents are required to be enclosed herewith the application form
Description
01. An application on company letter head pad
02. Passport Sized Photograph (Attested)
03. Trade license (Attested Photocopy)
04. TIN certificate (Attested Photocopy)
05. VAT registration (Attested Photocopy)
06. NID Photocopy
07. Explosive license (Attested Photocopy)
08. Warehouse/Showroom (If any) location map, layout and photograph of site
09. Bank Statement of last 6 months
Add Bank Statement of last 6 months

"I hereby certify that the above statements are correct in all respect. Any false statement if arises will cause cancellation of my distributorship."