Become a Securico Dealer Company Name Contact Person Designation Registered Address City State Pin Code Country Telephone Mobile Whatsapp No. Email Alternate Email Date of Birth Website Shipping / Billing Address City State Pin Code Country Year of Establishment No. of years in Electronic Security Business Preferred Method of Communication : Preferred Language of Communication : Preferred Method of Communication Email Telephone Courier Whatsapp Preferred Language of Communication English Hindi Ownership Type : Ownership Type Public Limited Private Limited Partnership ProprietaryDetails of Partners: Partner 1 Name Partner 1 Mobile Partner 2 Name Partner 2 Mobile Partner 3 Name Partner 3 Mobile Which customer verticals do you serve? Which customer verticals do you serve? Retail Government Warehouse/Godowns Institutional Realestate Banking & Financial Sector Residential Industrial Others Any Other: Company Profile GSTIN No. Please attach GSTIN registration Certificate Please enclose a copy of Article of Association in case of Company / Partnership Deed in case of Partnership / IT Return in case of Proprietorship / ID proof of the owner. Upload File Details of Sales Department Name of the concerned person : Email ID of the concerned person : Mobile No.: Tel. No.: SAME AS MAIN CONTACT Same as main contact Details of Accounts Department Name of the concerned person : Email ID of the concerned person : Mobile No.: Tel. No.: SAME AS MAIN CONTACT Same as main contact Details of Purchase Department Name of the concerned person : Email ID of the concerned person : Mobile No.: Tel. No.: SAME AS MAIN CONTACT Same as main contact Declaration I certify that all information given above is true and correct to the best of knowledge. Name Designation Date Submit