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Proposed Dealership Location (City) at:

Are you Resident in the city you have applied for?


If No, do you plan to shift to the City you applied for?
Personal Information
Name of Applicant Contact Details - Residence
Date of Birth
DD-MM-YYYY Residential: STD Code - Number
Educational Qualification Mobile: Countrycode - Number
Highest Degree of Education Fax: STD Code - Number
Educational Institution Email Address
Contact Details - Office
Nature of Business Company name
Residential: STD Code - Number
Mobile: Countrycode - Number
Fax: STD Code - Number
Email Address
Website Address
Information on Current Business and Activities
Business Information : Automotive
Brand Type of Firm
Gross
profit
Year of
Starting
Business Information : Non Automotive
Gross
profit
Year of
Starting
Are you a member of any Trade and Industry Association?
Do you hold any professional Leadership Positions?
Have you applied for a Renault Dealership earlier ?
Place
Date
DISCLOSURE
The applicant has made full disclosure of all information required in this Form and all the information given by him is true in all respects.
The applicant has made full disclosure of all information required in this Form and all the information given by him is true in all respects. The applicant further acknowledges that in case of
misrepresentation, intentional or unintentional, in the information submitted in connection with the application, RENAULT reserve the right to no longer consider the application or reverse any
decision taken on the basis of information provided in this application.
This Application Form entitles the applicant only to apply for a RENAULT Dealership.
The Application Form does not imply any commitment on the part of RENAULT to enter into any Dealer Agreement with the applicant.
The applicant certifies that he is not suffering from, or aware of any legal disability that would prevent him from being appointed as an authorized dealer of RENAULT.
The applicant acknowledges that any obligations undertaken or expense incurred by him in submitting this application shall be incurred entirely on the applicants own behalf.
The applicant authorizes RENAULT to make any inquiries it may consider necessary to verify this information and to share the information with an agency appointed by RENAULT for the purpose
of verifying the given information.
Others:
Type of Firm
Applicant's Signature
Renault India Pvt. Ltd.
ASV Ramana Towers, 4th Floor,
36-37, Venkatanarayana Road,
T.Nagar, Chennai - 600 017.
Please email your Dealership Enquiry Form to dealer.development@renault.com or send your Enquiry Form by Courier/ Registered Post/ Speed Post to Renault India Private
Ltd. Dealers Development Department to the following Address:
Dealer Development Department
Dealership Enquiry Form
Turnover in
Lacs
Name of Firm
(Automotive Industry)
Nature of Business
% of
ownership
Plot/Building No - Street
Area/Suburb
City - State - Pincode
Applicants have to fill in the complete form as mentioned below.
Plot/Building No - Street
Area/Suburb
City - State - Pincode
Name of Firm
(Non Automotive Industry)
Nature of Business
% of
ownership
Turnover in
Lacs
Finance
Real Estate
Manufacturing
IT
Trading
Hospitality
Automotive