Team Medias 24 Hours Recharge Distributers Application Form

To be filled in BLOCK letters. Please use a ballpoint pen while filling the form.
Team Medias regd. Office: Plot no.100, Osmanpura, Eknath nagar, old peer bazaar, Railway Station, Aurangabad. 431005.
Maharashtra, India. Visit wwW.mediarecharge.webly.com
AFFIX RECENT
Status of Subscriber:
Individual
Bulk
Corporate
PAS S PO RT SI ZE
PHO TO GRAPH
Corporate Name:
Please S ign across,
sign should
Mobile No for Activation:
over lap on photo
& APEF

Costumers Name:
First
Middle
Last

E-mail ID:
Date Of Birth:

D
D
D

D
D
D

M
M
M

M
M
M

YYY

YYY

YYY

YYY

PAN/GIR No.

Complete Present/Local Address:

House Or
Office No
Street Add

Landmark

City/Dist

Locality/Tehsil

State/UT

Nationality
Pin

Complete Permanent/Local Address:

House Or
Office No
Street Add

Landmark

City/Dist

Locality/Tehsil

State/UT

Nationality
Pin

Doc Type:

Doc No:

Declaration by customer
I/we have read & understood the terms and conditions mentioned over leaf and unconditionally accept them as binding on me/us.
I/we have understood the Deposit AMT table plan and related conditions on which services will be provided inside and outside
Maharashtra, as applicable on this date and as amended from time to time the details on APEF have been filled in by me/ us and
are true and correct in all respects.

Name: _________________
Signature:
Stamp:
Date:

Name:_________________
Signature:
Stamp:
Date:

24 Hours Recharge Distributers Plan Table

Regular Plan New Years 2013
Table No.

Deposit
AMT
31000/-

TM-001

Refund AMT
If Not
Activated
Total Ref
AMT

10,500+Opening Bal Ref

Opening
Balance
10,000

Commission

20,500/-

Total Bal

10,300/-

3%

Make User
Limit
Unlimited

TM-002

25000/-

INA
Total Ref
AMT

5500+Opening Bal Ref

10500/-

5000
Total Bal

3%
5150/-

Limited-50

TM-003

16300/-

Null
Null

3000
Total Bal

3%
3090/-

Limited-30

New Launches Plan

4999/-

INA
Total Ref
AMT
Null

Null

Null

2.75%

Unlimited

MINI-DISTRIBUTER

TM-004

INA
Total Ref
AMT

Limited-___
Unlimited

Total Bal

Do you wish to use this table Activate for Telemarketing Please Tick

For Yes

For No

Table No
TM-001

TM-002

TM-003

TM-004

Information Of Payment Mod

Cheque

DD

Cash

If payment mod of DD or Cheque Please Give Bank Details.

DD or Cheque No
Date of Issue

Bank Name
D
D
D

D
D
D

M
M
M

M
M
M

YYY

YYY

YYY

Branch Code or Name

YYY

Name:______________
Signature:
Stamp:
Date:

Name:_________________
Signature:
Stamp:
Date:

KYC APPLICATION
Dated:
1)

Location:

What is your Existing Business?

Ans.
2)

Do you Have Knowledge about Telecom Industries or marketing?

Ans.
3) Do you have any Branches?
Ans.
4) Where all is your network and how many people joined your network or company?
Ans.
5) According to you how many Retailers are there in your City?
Ans.
6) How will you make Retailers in your city?
Ans.
7) How many Retailers you can Appoint in Your city?
Ans.
8) How much turn over you can maintain?
Ans.
9) What is your current turn over for your company?
Ans.

:_____________

:_________________
Signature:
Stamp:
Date:

Signature:
Stamp:
Date: