Registration Form

* ÞAk1NLk'S kLGIS1kA1ICN IkCM
Company name & Address:
Þln code:
CS1 no. vA1/ 1ln no.: ÞAn no.
SLaLus : Cwnershlp 8enLed Leased
1el. no. (WlLh S1u Code): lax no. :
Moblle : Company L-mall:
*kLG Iorm No:
kLG Date:
(* f|||ed by Larth)
?ear of LsLabllshmenL : uuraLlon (Pow Cld) of Company: ?rs. MonLh
Company 1ype : ÞroprleLor ÞarLner ÞvL. LLd. LLd. 1rusL lndlvldual CovL.org.
Ma[or AcLlvlLles (lnvolve ln) : P/W S/W P/W & S/W CLhers
Pow do you raLe your self: ulsLrlbuLor Sub ulsLrlbuLor Servlce CLM (ÞC mfrs.)
: 8e-sellers SysLem lnLegraLor Lnd CusLomer CLM (mfrs.)
: 8epalrs value Added 8eseller
LasL ?r.-Annual 1urnover (ln Lakhs):______________________________________________
* 8ANkLkS

8ank name & 8ranch : Þhone:
AccounL no.: ConLacL Þerson:
Any CredlL faclllLles avalled from bank: Slnce ?ear:
lf yoo bove occooots oo ooy otbet book pleose speclfy bet oqolo. -
8ank name & 8ranch : Þhone:
AccounL no.: ConLacL Þerson:
Any CredlL faclllLles avalled from bank: Slnce ?ear:
lnLel Membershlp no# (Clu no)

Larth Syscom Þvt.Ltd.
12,1rllok 8aw Pouse,Cpp.Chankya 1ower,
vasLrapur, Ahmedabad-380034
1el.:079-26837024/23
M. 98234 16118 / 98234 74733 / 98240 23266
L-Mall: sales[earLhsyscom.com
WebSlLe: www.earLhsyscom.com
Please Fix your
PassPort
Size
Photograph
here
* BUSINESS REFERENCES (MINIMUM 3 NOS.)
WITH WHOM YOU HAVE DEAL WITH IN THE LAST 3 MONTHS
Sr. name of Company ConLacL Þerson ueslgnaLlon L-Mall Moblle#
1.
2.
3.
4.
» name & LocaLlon of Croup Companles/ 8ranches/Show 8oom lf any
1)
2)
3)
» lf you deal wlLh any of our slsLer concerns wlLh us , please mark: name:
ADDI1ICNAL INICkMA1ICN
ÞLkSCNAL INICkMA1ICN CI DIkLC1CkS ] ÞAk1NLkS ] ÞkCÞkIL1Ck
name:
uaLe of 8lrLh:Marrlage Annlversary:
8esldenL Add:
Þln code:
Þhone: Moblle: L-mall ld:
.......................................................................................................................................................................................
name:
uaLe of 8lrLh:Marrlage Annlversary:
8esldenL Add:
Þln code:
Þhone: Moblle: L-mall ld:
.......................................................................................................................................................................................
name:
uaLe of 8lrLh:Marrlage Annlversary:
8esldenL Add:
Þln code:
Þhone: Moblle: L-mall ld:
.......................................................................................................................................................................................
Group Compan|es 8ranches Show koom
1.MarkeLlng Þerson :
Moblle no.: Lmall:
2.AccounL Þerson:
Moblle no.: Lmall:
3.Servlce Þerson:
Moblle no.: Lmall:
4.LoglsLlc Þerson:
Moblle no.: Lmall:

key Þersons' Informat|on
* Dec|arat|on :We have Understood the Þayment Þo||cy
Company's SLamp
S|gnature w|th Name & Des|gnat|on
Date:______________
Check L|st:
uocumenLs: needed ALLached 8ecelved 8y
1.vlslLlng Card of your company
2.xerox copy of your Company's 1ln no.
3.xerox copy of lasL Lhree MonLh 8ank SLaLemenLs.
4.xerox copy of your company's ÞAn no
3.xerox copy of ÞAn no. of every ÞarLner/ulrecLor's/ÞroprleLor.
6.3 ÞassporL slze color phoLo every ÞarLner/ulrecLor's/ÞroprleLor.
7.3 SecurlLy AccounL Þayee 8lank daLed Cheque (ln favor of LarLh SyscomÞvL LLd..)
8.LasL 1wo year audlLed 8alance SheeL wlLh ÞroflL & Loss A/c..
1hanks & kegards Þrepared by:
Ior Larth SyscomÞvt. Ltd.
(Note: Þ|ease I||| up the Iorm& Send us w|th the Du|y S|gned & Stamped w|th Necessary Documents As Soon As Þoss|b|e.)