Mediyant Technologies Pvt Ltd

1. Basic Company Information

Company / Firm Name*

Year of Establishment*

Type of Entity (Proprietorship / Partnership / Pvt Ltd / LLP)*

Registered Office Address

GST Number*

Website (if any)

2. Contact & Leadership Details

Primary Contact Person Name

Designation

Email ID*

Mobile Number*

Alternate Contact*

3. Territory & Exclusivity Scope

Proposed Territory for Exclusivity (State / Region / Multiple districts)*

Expected annual sales potential in your proposed territory (₹)*

Do you currently hold exclusivity for any medical device brands?*

Yes

No

If yes, please specify brand(s) & product category*

4. Industry Experience & Product Portfolio

Years of experience in medical device / capital equipment sales*

Current product categories handled

Key brands currently represented*

Top 5 hospital accounts handled*

5. Sales & Service Capability*

Number of sales professionals in your team

Service coverage area*

Average response time for service calls*

Do you have in-house service engineers?*

Yes

No

6. Infrastructure & Compliance Readiness

Office location(s)*

Warehouse / storage facility

Yes

No

Basic compliance readiness

ISO

Not yet

7. Strategic Alignment

Why do you want to partner with Mediyant Technologies?

What value can you add beyond sales?

I confirm that the above information is accurate

Dealer Information