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Company Name :
Broker Evaluation Form
*Mandatory Fields
*Name of Owner/Prop :
First Name                            Middle Name                            Last Name
*Resi. Address :
*No. of Years at Current Address :
Years
Owned       Rented       Other
Permanent Address :
Company Type :
Prop.       Partnership       Pvt. Ltd.       Public Ltd.
*Office Address :
*No. of Year at Current Business :
© 2010-11. Poddar Developers Ltd.
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Years
*Contact No. :
Residence                          Office                                 Mobile
*Email ID :
PAN No. :
Shop Act No. :
VAT/CST No. :
Bank Name :
Branch Name :
A/c No. :
Area Of Operations :
From :
To :
Documents Required :
Pan Card
Resi. Proof
Office Address
2 Colour Photo
Customer Catagory :
HIG
MIG
LIG
Remarks :