Section A



(A) Personal Information

First name

Middle name

Last name

The term “main applicant” refers to the applicant who has the largest proposed shareholding, or is the majority partner / managing director in the proposed company.

First name

Middle name

Last name

First name

Middle name

Last name

First name

Middle name

Last name

First name

Middle name

Last name

(3) Highest degree of education

Highest degree of education Education and professional qualifications of applicant(s) & other proposed partner / directors

Name Relationship with
main applicant 		Age
(Yrs)		 Highest degree
of eduction 		Institution Year passed
Main applicant
co-applicant 1
co-applicant 2
co-applicant 3
co-applicant 4
Primary
Alternate
Land-line
*
Address line 1 *
Address line 2
City *
Pin Code *
Email address *
Website
Address for the correspondence

Are you resident of the city applied for



(B) Company information


(1) Do you have a registered company


(2) Company background

Information of company held by applicant

Name of the company City Nature of business
(Agriculture, automotive, real
estate, if other please mention)		 Current CEO
(self, professional, relative)
Main applicant
co-applicant 1
co-applicant 2
co-applicant 3
co-applicant 4
co-applicant 5


(c) Business information



(1) Existing business finanacial details

(All figures to be mentiYesd in lakhs)

(3) Real estate details

Sr. No Description Owned by Current market value
(Rs lacs) 		Mortgaged (Yes/No)
1
2
3
4
5
Total 0.00

(4) Product profile & business experience details

(a) Are you already a manufacturing


(b) If the above (a) is Yes, please select the sector/product


(c) Do you have experience in Retailing


(d) Do you have own or leased storage / warehouse facilities








(D) Other information

(1) Have you ever been convicted of a criminal offence


(2) If the above (1) is Yes, please provide details


(3) Have you ever been convicted of a sales / income tax / GST violation


(4) If the above (3) is Yes, please provide details










Section B


Proposed Business

(1) Name of the proposed company

(2) Nature of the proposed company

(3) Date of incorporation



(4) Shareholding pattern

Shareholders's name Relationship with main
applicant		 Proposed shareholding (%) Responsibilities in proposed
business

(5) Details of person (s) who will be managing the business on day to day basis

Name Relationship
with main
applicant		 Designation Experience details Current
business/occupation 		Proposed role in
business


(6) Break up of investment
Head Own funds Loans Total Source of own funds
Head Cash Fd's Shares / Bonds LIC / ULIP Property liquidation Others Total
Land
Fixed investment
(Infrastructure/equipments etc.)
Working capital
TOTAL


(7) If the proposed investment will require liquidation of assests, please provide the details below:

Asset details Current selling price
(Rs in Lacs) 		No of days required for liquidation Mode of liquidation (How will be the
asset liquidated)
TOTAL 0.00
(8) Site details

(please select from appropriate dropdown menu)

Address Detail Site 1 Site 2 Site 3 Site 4 Site 5
Proposed for storage
Type built-up/green field
Ownership status
(owned/leased)
Acquisition status:
acquired/to be acquired
Land usage
(agricultural, commercial,
residential, industrial )
Plot area (sqft)


Attachments

Checklist for attachments

(1) Identity
(a) Passport Size Photo


(b) ID Proof


(c) PAN Card

(2) Financials
(a) Balance sheet - last 3 years


(b) Profit & loss account statement - last 3 years


(c) Bankers letter in the desired format (see section B, point 11)


(d) Income tax & wealth tax returns

(3) Others
(a) Authorised person by board resolution (Attach resolution copy)



(b) Photographs of site


(c) Family tree of applicants


(d) Current organization structure


(e) Occupation and experience details of directors

Declaration




Name

City

Date





Instructions

  1. All sections should be completely filled. Only fully completed applications will be accepted
  2. Washwell Bio reserves the right to reject the application if the mandatory questions are not filled
  3. All figures should be mentioned in Indian rupees (lakhs)
  4. The selection of application is purely at the discretion of Washwell Bio management
  5. Washwell Bio shall not give any reasons or explanation for selection or rejection of particular applicant
  6. Shortlisted applicants will be invited for further discussions
  7. Washwell Bio shall take reasonable steps to keep the information submitted by the applicant confidential
  8. A candidate can apply for multiple districts.


Checklist for attachments

  1. Balance sheet - last 3 years
  2. Profit & loss account statement - last 3 years
  3. Bankers letter in the desired format (see section B, point 11)
  4. Income tax & wealth tax returns
  1. Photographs of site
  2. Family tree of applicants
  3. Current organization structure
  4. Occupation and experience details of directors


FAQs:

  1. For any help in the form, please call our call centre (+91) 9001899811.
  2. For any clarifications regarding the product, please write to sales@washwellbio.in Washwell Bio will get back to you within 5 working days.