Partners Registration Form -Jolly Healthcare

LE JOLLY HEALTHCARE PRIVATE LIMITED

(CIN: U24299RJ2021PTC074789)

H-163, Malviya Nagar Industrial Area, Jaipur, Raj., India - 302017

Mobile: +91 8003633988 | Phone: 91 141 4023838

E: info@jollyhealthcare.org | W: JollyHealthcare.org

Email *

PRIMARY DETAILS:

Business Owner Name: *

First Last

PLEASE USE CAPITAL LETTERS ONLY

Your Company Name *

Type of Entity (Select from the list) *

Registered Office Address *

Street Address

Address Line 2

City State/Region/Province

Postal / Zip Code Country

Head Office/Contact Address: *

Street Address

Address Line 2

City State/Region/Province

Postal / Zip Code Country

Local Office/Contact Address: *

Street Address

Address Line 2

City State/Region/Province

Postal / Zip Code Country

Telephone: *

Code Number

Fax:

Website URL:

Office Email ID: *

SECONDARY DETAILS:

Contact Person Name: *

First Last

Designation *

Telephone:

Code Number

Mobile Number: *

Code Number

Email/Fax

Accountant Name: *

First Last

Accountant Phone: *

Code Number

Accounts Email: *

Details of Top Management: *

Payment Terms Acceptance: *

NOTE: FIRST TRANSACTION MUST BE AGAINST ADVANCE PAYMENT

Details in case selected "Others" in Payment Terms:

Customer Profile (Name and Contact of Customers): *

Briefly describe your main customers i.e. hospitals

Pending Legal Disputes (If Any):

REGISTRATION DETAILS:

Permanent Account Number (PAN) *

Stockiest Classification (Please select the one applicable for your organisation *

Provisional GSTIN ( In case the application is under process)

Date of GST Registration:

dd-MMMM-yyyy

Location:

(Please specify all the locations and separate GSTIN for each state)

Address:

GST Number:

Turn Over (Last Financial Year) *

Warehouse Area: *

Cold Chain Product Safety: *

HSN (Harmonized System Nomenclature) Code (List to be attached)

Services being supplied

SAC (Services Accounting Code) (List to be attached)

ESI Registration No:

Labor Contract Registration No

Provident Fund (PF) Registration No

Drug License (20B) Number *

Drug License (21B) Number *

Drug License (Other) Number

Any Other (Please specify):

SUPPORTING DOCUMENTS TO BE ATTACHED:

PAN Card (Attachment) *

Please attach copy of PAN card

GST Registration Certificate (Attachment) *

Please attach copy of GST Certificate (Contact us if unregistered)

Drug License Retention Letter (Attachment) *

Please attach DL 20 & 21 Copy

Terms and Conditions *

Return, Exchange & Order Policy :

It is the responsibility of our customers to promptly notify Le Jolly Healthcare Private Limited (referred as ‘Company’) about any stock expiring in the next six months and such short expiry stock should reach the Company’s CFA/CSA 6 months before the Expiry. Failing which the Stockiest is liable for any loss due to expiry. Company would Exchange near expiry with the same product only.

STOCKIEST MUST INFORM (IN WRITING OR BY ELECTRONIC MAIL) THE COMPANY REGARDING THE NON-MOVING/NON-SALEABLE PRODUCTS WITHIN 60 DAYS OF RECEIPT OF GOODS IN CASE OF POSSIBLE RETURNS. IT IS STRICTLY RECOMMENDED THAT ALL CUSTOMERS WITHIN THE DISTRIBUTION NETWORKS OF THE STOCKIEST ARE ALSO MADE AWARE OF THIS POLICY .THE RESPONSIBILITY IN THAT CASE WOULD BE SOLELY IN THE HAND OF THE STOCKIEST ONLY. THE COMPANY WILL NOT BE HELD RESPONSIBLE FOR ANY LOSS DURING TRANSIT FROM IMPROPER HANDLING OR STORAGE OF ALL SUCH STOCK.

The Stockiest shall send to the Company’s CFA, H.O. Email or Field Staff, a consolidated monthly order on their letterhead or on the Company’s order pad with stamp and signature every month by end of First Week along with the Stock and Sales Statement

The credit period is #7 days for stockiest only after first successful advance paid transaction only and the stockiest shall arrange payment by way of Post Dated Cheque / DD / NEFT / IMPS in such a way that the payment is credited into the

Company’s account within this credit period. Stockiest is liable to pay Interest @ 24% per annum on any delayed payments.

A blank undated Security Cheque submission is mandatory for billing & settlement of expiry / return claims. In case we don’t have security cheque from our stockiest, we would not entertain any expiry/exchange or return claim.

Cold chain products once sold can’t be returned/exchanged unless approved by the company as its sole discretion

I accept the Terms and Conditions.