channelpartnersapplicationform.docVIP

CHANNEL PARTNERS APPLICATION FORM (Photocopies of this Application Kit are also acceptable.) THIS KIT CONTAINS THE FOLLOWING FORMS : FORM 1 : PERSONAL PROFILE FORM 2 : INFRASTRUCTURE / FINANCE (NOTE : Filling of both forms is mandatory. The information furnished by the applicants shall be treated in strict confidence.) DETAILS OF INVESTMENT TO BE MADE BY CHANNEL PARTNERS IN STOCKS The investment to be made by Channel Partners is based on the population of the town / city where the Channel Partner is located. Details are as under :- (a) Population less than 5 lakhs : Rs 1,96,875 /- (b) Population between 6 - 10 lakhs : Rs 2,28,375 /- (c) Population between 10 - 20 lakhs : Rs 2,94,000 /- (d) Population between 20 - 50 lakhs : Rs 3,54,375 /- (e) Population greater than 50 lakhs : Rs 4.09,500 /- The completed Channel Partners Application Form should be couriered to: Lt Col Sunil Brijkrishan Channel Partners Cell LAMCON EDUCATION A division of LAMCON FINANCE MANAGEMENT SERVICES PVT LTD 3 Wing III Thackers House 2418 East Street Pune 411 001 Tel:6340316 Telefax:91-20-6348913 e-mail:info@ FORM 1 - PERSONAL PROFILE PERSONAL DETAILS NAME (IN FULL AND BLOCK LETTERS) : _____________________________________ FATHERS/HUSBANDS NAME : _____________________________________ COMPLETE POSTAL ADDRESS : _____________________________________ CITY/TOWN ____________________________ DISTRICT _____________________________ PIN __________________________________ STATE ________________________________ DATE OF BIRTH : _____________________________________ TELEPHONE NOs : Off. _____________ Resi. _____________ Mobile_________________ Fax: ____________ e-mail: __________________________________ QUALIFICATIONS DEGREE /DIPLOMA / CERTIFICATE UNIVERSITY / INSTITUTION SUBJECTS YEAR OF PASSING (Strike out unutilised rows) BUSINESS E