HACPL | Dealer Application Form
Dealership Application Form
(Please use a separate set for each individual in case of partners.) Dealership applied for (City): _______________________ 3S Personal Information
Name (In Full):____________________________________________________________________ _ Residential Address: ____________________________________________________________________
Home Tel: Cell No.: Fax:
Email: ______ _________No. of citizenship (Single, Dual etc):
Marital Status: NTN: ______ N.I.C: ___________________ ____
Educational Background
Please tick highest level of education achieved:
Below Metric Metric Intermediate Graduation Masters Above Masters
Business Experience
Company Name: _____________________________________________________________________ Position/Designation: ___________________________________________________________________ Type of Business (Please tick one): Sole Proprietorship Partnership Private Ltd. Co Public Ltd. Co Nature of Business: ___________________________________________________________ Address:_______________________________________________Tel:____________Fax:_____________ Described Services/Operations: ___________________________________________________________
No. of Employees:________________________________________________________________ 2 x 2 Pictures
HACPL | Dealer Application Form Position/Designation: ___________________________________________________________________ Type of Business (Please tick one): Sole Proprietorship Partnership Private Ltd. Co Public Ltd. Co Nature of Business: ___________________________________________________________ Address:_______________________________________________Tel:____________Fax:_____________ Described Services/Operations: ___________________________________________________________ No. of Employees:________________________________________________________________ (Please attach additional sheets if required).
Previous business experience (If any)
Company Name:____________________________________________Date Established:_____________ Position/Designation: ___________________________________________________________________ Type of Business (Please tick one): Sole Proprietorship Partnership Private Ltd. Co Public Ltd. Co Nature of Business: ___________________________________________________________ Address:_______________________________________________Tel:____________Fax:_____________ Described Services/Operations: ___________________________________________________________ No. of Employees:________________________________________________________________
Previous business experience (In case of multiple business experiences)
Company Name:_____________________________________________Date Established:____________ Position/Designation: ___________________________________________________________________ Type of Business (Please tick one): Sole Proprietorship Partnership Private Ltd. Co Public Ltd. Co Nature of Business: ___________________________________________________________ Address:_______________________________________________Tel:____________Fax:_____________ Described Services/Operations: ___________________________________________________________
No. of Employees:________________________________________________________________ (Please attach additional sheets if required).
HACPL | Dealer Application Form
Employment Experience
Current Occupation:____________________________________________________________________ Current Position/Designation: _________________________________Date Employed:______________ Company Name:_______________________________________________________________________ Nature of Business: ___________________________________________________________ Address:_______________________________________________Tel:____________Fax:_____________ Described Duties/Responsibilities: _______________________________________________________
No. of Employees Supervised:____________________________________________________________
Previous employment experience (If any, give exact names, addresses, and dates. List most recent first) Position/Designation held: __________________________________Date Employed:______________ Company Name:_______________________________________________________________________ Nature of Business: _______________________________Reason Left:__________________ Address:_______________________________________________Tel:____________Fax:_____________ Described Duties/Responsibilities: _______________________________________________________
No. of Employees Supervised:____________________________________________________________ (Please attach additional sheets if required).
HACPL | Dealer Application Form
Personal Financial Statement
For 12 month period ending ____/____/____
Salary/Wages:_________________________________________________________________________ Bonus/Commission:_____________________________________________________________________ Dividend/Interest:______________________________________________________________________ Real Estate Income:_____________________________________________________________________ Business Profits:________________________________________________________________________ Notes/Accounts Receivable:______________________________________________________________ Other Income (Specify source, e.g Trust,Spouse etc)___________________________________________ Total Income:__________________________________________________________________________
Assets Rs. Liabilities Rs.
Cash on hand and in Banks: Notes/Loan Payable to bank: Vested Profit Sharing: Notes/Loan payable to friends,
relatives etc
Securities: Accounts and Bills Payable: Bonds/Debentures: Real Estate Mortgages: Notes, Accounts and Mortgage
Receivable: Other Debts or Obligations: Real Estate (Current Market
Value):
Net value of business interest: Other- (automobile and other personal property):
Total Assets: Total Liabilities:
Net worth: Total Asset – Total Liabilities: Rs_______________________________ (Please attach separate set for each individual in case of partners)
HACPL | Dealer Application Form Give name of banks or finance companies where accounts are carried or where credit can be obtained or verified?
Name:_________________Address:________________Highest extended Credit:_______ Purpose____ _______________ ___________________ ______________________ ________________ _______________ __________________ _______________________ _______________ _______________ __________________ _______________________ _______________ _______________ __________________ _______________________ _______________ _______________ __________________ _______________________ _______________ Can you personally meet Honda’s financial requirements? From what sources? (Please specify details, use additional sheets if necessary)
_________________________________________________________________________ __ ____ _______________________________________________________________________ _______ _______________________________________________________________________ _______ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ ____________________________________________________________________________________
HACPL | Dealer Application Form What is your primary reason in applying for Honda Atlas Cars Dealership? Explain fully!
_____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________
HACPL | Dealer Application Form
Miscellaneous Information
Which geographical area you are interested in (Specific location within a City)?
_____________________________________________________________________________________ What is the ownership status of your proposed land site for dealership?
Self Ownership Joint Ownership Yet to be Purchased What is the legal status of land in case of ownership?
Commercialization approved Non- commercial Litigated______________ How far do you live from this area (in minutes and Kms)?
_____________________________________________________________________________________ How far is the nearest Honda Dealership from the prospected area (in minutes and Kms)?
_____________________________________________________________________________________ If awarded the dealership, will you devote your full time to this business including being physically present at least 70% of the normally daily operation hours at the dealership?
Yes No If not, how much time in your daily life that you will allocate?
_____________________________________________________________________________________ Are you related by blood or marriage to any employee on Honda Atlas Cars Pakistan/any Honda
Dealership/Automotive Company/Dealership?
Yes No If Yes, Then please mention:
Name:_______________________________________________Relationship:______________________ Are you or your employees providing products, goods or services to Honda Atlas Cars/any other
automotive company?
_____________________________________________________________________________________ Have you any kind of experience in Automotive Dealership? If yes then where and when?
HACPL | Dealer Application Form Did you ever apply for an Automotive Dealership? If Yes, then where and when?
_____________________________________________________________________________________ Do you have any pending dealership applications with other automotive companies? If so, indicate Name of the automotive company, date of application and status etc.
_____________________________________________________________________________________ Are you related by blood or marriage to any government official? If Yes, Please Indicate:
Name______________Relationship___________________Position____________________Office:_____ _____________________________________________________________________________________
Social Activities
List your sports and recreational activity:
_____________________________________________________________________________________ _____________________________________________________________________________________ Leadership/Academic awards, prizes, recognitions in sports, hobbies, etc:
_____________________________________________________________________________________ _____________________________________________________________________________________ List all civic, social, military, business organization or clubs where you are an active member:
_____________________________________________________________________________________ _____________________________________________________________________________________
Personal References (At least three persons who have known you for 5 years or more) Name (in full) Address Tel. No. Occupation Year Known ___________ ____________ ______________ __________________ ______________ ___________ ____________ ______________ __________________ ______________ ___________ ____________ ______________ __________________ ______________
HACPL | Dealer Application Form
Legal
Have you ever been convicted of anything other than traffic violation?
Yes No If yes; mention details:
_____________________________________________________________________________________ Has any judgment ever been entered against your company/s or your employer/s where you were one of the litigants?
Yes No If yes; mention details:
_____________________________________________________________________________________ Are you involved in any pending litigation?
Yes No If yes; mention details:
_____________________________________________________________________________________ Have you ever declared personal bankruptcy?
Yes No If yes; mention details:
HACPL | Dealer Application Form
Declaration
“I submit the foregoing information as my complete and true personal and financial conditions as of the date shown below. I expressly authorize any past or present employer, any law enforcement agency, national or local or any person who has personal knowledge of my character, work experience or criminal records to release this information to Honda Atlas Cars (Pakistan) Ltd (HACPL), if requested by HACPL. I agree to supply statements from any professional advisors (i.e. Banker, Broker, Accountant, Attorney) verifying the above assets, and I also agree to furnish copies of Income Tax Returns as filed for the last two years. I understand that HACPL is relying on all the above information as material factor in considering my application to become a Honda Dealer, and I therefore agree to promptly notify HACPL of any material change in any of the above information or any subsequent information provided to HACPL. In addition, I release all persons from liabilities as a result of true, accurate information”
Name and Signature Date
_________________ __________________ _________________ __________________ _________________ __________________
