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APPLICATION FOR DISTRIBUTORSHIP CUM KYC
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FULL NAMENAME OF APPLICANT
Business NameIf any
Postal Address
Office / Shop Address
Telephone Number
Residential Address
Next of kin
AddressNot P.O. Box
Guarantor
Contact AddressNot P.O. Box
Occupation
Bankers Name & Branch
Account Name
How long have you been operating the Account?
Have you any objection to our contacting your banker for any information?pick one!
If yes please state why
I / We undertake to abide by the rules and terms of the company under which the facility will be approved
I AgreeI Disagree
Dateof agreement
Sales Rep CommentsRecommendations
0 /
NameSales Rep Name
RSM's CommentsRecommendations
0 /
NameRSM's Name
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