Dynamic Beneficial Accord Marketing Pvt. Ltd.

CIN U51909PB2011PTC035491
Regd. Office: Plot No. 585, Sector-82, JLPL Industrial Area, S.A.S Nagar, Mohali, 160082,India
Phone: (+91) (124) 6906900; Email: ach@asort.com

ASORT CO-COMMERCE HUB (ACH) APPLICATION FORM

Eligibility Criteria: Important Guidelines:

a. Tenure in business should a. Please enter all relevant details. Do not keep any details vacant/unfilled.
be greater than 1 Year. b. In case of questions with multiple options, please tick the appropriate answer.
b. Rank should be ACE and c. In case you wish to provide any additional information, please attach a separate
Above. sheet.
c. Should have signed ACE d. Please attach all the supporting documents with the form.
Agreement
e. Please ensure that all the documents attached are correct and valid.
f. All information will be kept confidential in our files.

PRIMARY INFORMATION – Tell us about your Entity

Partnership Firm LLP One Person Private Limited Public Limited Company

Legal Name of your Entity_________________________________________________________________

CIN / LLP / OPC Registration No.___________________________________________________________

PAN of the Company__________________________GST No. if any_______________________________

Registered Office Address (Complete Postal Address with PIN Code)______________________________

______________________________________________________________________________________

Landmark_________________________ City / Town_________________________

State____________________________ _ PIN Code__________________________

Landline Phone ____________________ Email ____________________________

Mobile____________________________ Alternate Email_______________________

Alternate Mobile_____________________

Correspondence Address (Other than Registered office address, if any)____________________________

_____________________________________________________________________________________

Landmark__________________________ City / Town__________________________

State______________________________ PIN Code___________________________

Landline Phone_______________________ Email ____________________________

Mobile _____________________________ Alternate Email______________________

Alternate Mobile_______________________
PRIMARY INFORMATION – Tell us about yourself

Full Name of Director / Partner / Full Name of Director / Partner / Full Name of Director / Partner /
Designated Partner Designated Partner Designated Partner

Designation Designation Designation

Gender Gender Gender

ASID and Rank(as on the date of ASID and Rank(as on the date of ASID and Rank(as on the date of
application application application

Distributor Since Distributor Since Distributor Since

Permanent Account Number(PAN) Permanent Account Number(PAN) Permanent Account Number(PAN)

Voter ID / AADHAR* No. Voter ID / AADHAR* No. Voter ID / AADHAR* No.

Complete Address with PIN Code Complete Address with PIN Code Complete Address with PIN Code

City/State City/State City/State

Cont.No.(Mobile/Landline/Alternate) Cont.No.(Mobile/Landline/Alternate Cont.No.(Mobile/Landline/Alternate

Email ID# Email ID# Email ID#

Applicant (Primary / Secondary) Applicant (Primary / Secondary) Applicant (Primary / Secondary)

Apart from Asort, what Apart from Asort, what Apart from Asort, what
is your other source of Income? is your other source of Income? is your other source of Income?

Are you directly or indirectly Are you directly or indirectly Are you directly or indirectly
engaged with other direct selling engaged with other direct selling engaged with other direct selling

Have been convicted or charged of Have been convicted or charged of Have been convicted or charged of
any civil or criminal offense? any civil or criminal offense? any civil or criminal offense?
* I / we hereby submit these details voluntarily at my own discretion including the Aadhaar card
number/physical e-Aadhaar / masked Aadhaar / offline electronic Aadhaar xml as issued by UIDAI
(Aadhaar).
The consent and purpose of collecting Aadhaar has been explained to me / us in local language.

# I/we authorise Asort and its authorized rep. to contact me on my contact details (like landline number,
mobile number or email id) registered with Asort and I /we will be a subscriber to such marketing list. This
consent will override my registry on DND/DNDC, as the case may be.

Signature(1st) Signature(2nd) Signature(3rd)

DETAILS OF THE SITE / PROPOSED ACH / REGSITERED OFFICE ADDRESS

Ownership: Owned by Company Owned by one of the Applicants

Rented/Leased Property Type Shopping Complex

Malls or other commercial space Residential

Approved by Municipal Corporation Authorities Yes No

Lease Duration: From To

Carpet Area Seating Capacity

Local Police Station

Address_______________________________________________________________________________

Period of Occupancy
of the Premises_________________________________________________________________________

Name of all the activitiescarried out at

the Premises Present and Past)____________________________________________________________

Is Property being used for any other purpose than

one mentioned under current business______________________________________________________

Number and Details of other Training Centre

Run by all Applicants____________________________________________________________________

Total number of people presently working at the Site___________________________________________

DETAILS OF SITE INCHARGE – Tell us about the Point of Contact for the Proposed ACH

Name of the Contact Person______________________________________________________________

Address______________________________________________________________________________

Landmark__________________________________________City / Town__________________________

Landline Phone________________Mobile_________________Alt. Number_________________________

Email_____________________________________Alternate Email________________________________

NEARBY OPERATIONAL ACH WITH ADDRESS AND DISTANCE FROM PRESENT SITE

1__________________________________________________________________Distance____________

2__________________________________________________________________Distance____________

3._________________________________________________________________Distance____________

BANK DETAILS OF THE ENTITY

Account Holder_________________________________________________________________________

Name of the Bank_______________________________________________________________________

Account No._______________________________________ IFSC_____________________________

Branch Address________________________________________________________________________

Account holder’s name must be the name of the legal entity mentioned above in the form. Please provide a
cancelled cheque which should have account holder’s name, bank account number and IFSC code of the
bank.

ENROLMENT OPTIONS – Kindly select as per your choice

Purchase of Merchandise worth Rs.25,000/- (Non-Refundable) – Validity 6 Months Purchase of

Merchandise worth Rs.50,000/- (Non-Refundable) – Validity 11 Months

DECLARATION

I / we do hereby represent that all the above details and information filled in this form are true and complete
to the best of my / our knowledge. I / we have signed the ACE agreement with the Company. I am aware
that my / our application will treated strictly on first come first serve basis. I recognize that Asort is not in any
way obligated to approve my center. I acknowledge that any false statement on the application shall be
considered sufficient cause to deny any further consideration or cause revocation of any signed agreement
with Asort. I also understand and agree that to the fact that the initial merchandise purchased (i.e. Welcome
Kit) by way of this application is non-refundable. The merchandise (i.e. Welcome Kit) cannot be returned or
refunded at any stage. I understand that my application will go through a systematic process involving
different stages such as Interview, Verification and Final Approval Process and I also understand that an
enquiry regarding my character, general reputation, personal characteristics, financial background and
general fitness to run a center may be made as a result of this application.
I am hereby attaching the following documents alongwith this duly signed form which I/we certify as correct
and valid:

List of Directors: Yes No NA Certificate of Incorporation: Yes No NA

List of Shareholders: Yes No NA PAN of the Entity: Yes No NA

List of Partners: Yes No NA Signed copy of

ACE Agreement(all) Yes No NA

Rent Agreement
of the site Yes No NA PAN of all Applicants Yes No NA

Photograph and Floor

plan of site Yes No NA V. ID/AADHAR of all Applicant Yes No NA

Utility Bill of the site Yes No NA Passport size photograph

of all applicants Yes No NA

Cancelled Cheque Yes No NA Shops & Establishment License Yes No NA

Signature Signature Signature

Date Date Date

Place Place Place