4S店经销商申请表

NetworkDevelopment,MBCL/BBAC0DealerApplicationFormDeclaration声明1)Theapplicantdeclaresthattheinformationprovidedaccordingtotherequirementsistrue.“申请单位”声明它按本申请表要求所提供的全部资料都是真实的。Ifanyoftheinformationsubmittedisnottrue,itwillbethebasisfortheMercedes-BenzNetworkDevelopmentdealershipevaluationteamtomakethefollowingdecision:若呈交的有关申请资料存在不真实，将是梅赛德斯—奔驰经销商评估小组做出以下决定的根据：a)Decidenottoconsidertheapplication,or决定不再考虑它的申请，或b)TerminatethedealershipagreementbetweenMercedes-Benz(China)Limitedandtheapplicantfortheinvestment/setupofthedealership.终止由梅赛德斯—奔驰(中国)汽车销售有限公司与其或其投资建立的梅赛德斯—奔驰品牌经销商所执行的经销协议。2)TheapplicantdeclaresheretoagreetheMercedes-BenzNetworkDevelopmentdealershipevaluationteamtoinvestigateanynecessaryinformation,withoutviolatingtheprivacycause.“申请单位”在此声明，同意梅赛德斯—奔驰经销商发展小组对认为有必要核实的资料进行调查，并不构成对其隐私的侵犯。3)Theapplicantdeclarestokeepthisapplicationformandcontentconfidential.TheinformationprovidedintheapplicationformwillbekeptconfidentialbytheMercedes-BenzNetworkDevelopmentdealershipevaluationteam,butwillnotbereturnedtotheapplicant.“申请单位”声明对此申请表的格式及内容保密负责，所提供资料将由梅赛德斯—奔驰经销商发展小组存档并负责保密，但不再归还。Applicant(Stamp)Signaturebythelegalrepresentative申请单位(盖章)：法人代表签名：Date日期：Theapplicantmuststamp&signthedealerapplicationform申请者必须在经销商申请表上签字盖章DealerApplicationFormwithoutStampandSignaturecannotbeprecededfortheselectionprocess!经销商选择程序将不接受未签字和盖章的经销商申请表！DealerApplicationForm经销商申请表ApplicantName:申请人名称：ProjectName：项目名称：FormatSize:规格：*PleasefillinapplicationeitherinEnglishorChinese*请用一种语言（英文或中文）填写本申请书Mercedes-Benz(China)Ltd.BeijingBenzAutomotiveCo.,Ltd.NetworkDevelopment梅赛德斯-奔驰（中国）汽车销售有限公司北京奔驰汽车有限公司经销网络发展部Mercedes-BenzDealerApplicationForm梅赛德斯-奔驰经销商申请表NetworkDevelopment,MBCL/BBAC1DealerApplicationForm1.ApplicantInformation申请单位现状2.ProposedMercedes-BenzDealershipDetail梅赛德梅赛德斯-奔驰拟建店经销商详情3.DeclarationandListofAttachedDocuments申请声明及随附文件清单CONTENT目录Mercedes-BenzDealerApplicationForm梅赛德斯-奔驰经销商申请表NetworkDevelopment,MBCL/BBAC3DealerApplicationFormBasicInformation基本信息FinancialStatus财务状况BusinessPerformance经营历史及业绩表现CurrentManagementTeam现有管理团队ComplianceDeclaration合规申明PARTIApplicantInformation第一部分申请单位现状NetworkDevelopment,MBCL/BBAC4DealerApplicationFormBackgroundInformation背景信息1.BasicInformation基本信息ContactInformation联络信息CompanyNameofApp.申请单位公司全称(English)（中文）DateofOpening成立日期LegalRepresentative法人代表(English)（中文）ContactPerson联络人名称：(English)（中文）CompaniesRegisteredADD.公司注册地址(English)（中文）PostalCode邮编PostageAddress邮寄地址(English)（中文）PostalCode邮编215300Telephone电话Mobile手机Fax传真E-mail电子邮箱Website网址LegalStatus法律状况CompanyRegistrationCode公司注册码LegalEntityTypeSOEGroupPrivateJointVentureForeignInvestmentOthers(PleaseSpecify)法人形式国营集体私营合资外资其他(请注明)TypeofCompany公司性质(English)（中文）NetworkDevelopment,MBCL/BBAC5DealerApplicationFormBackgroundInformation背景信息2.ShareholdersInformation股东及股份信息RegisteredCapital注册资本RegisteredCapital注册资本万（人民币）Shareholders’Structure股权结构Shareholders股东Capital（thousand）出资额（千元）Share(%）份额（%）Position职务Shareholders’Background股东背景Name(English)姓名（中文）Age年龄Sex性别EducationBackground教育背景School学校Time就读年份Degree学位Major专业WorkingExperience工作经验Period起止年月Company公司名称Position/Job职务/岗位13.LegalRepresentative’sBackground企业法人背景LegalRepresentative’sBackground企业法人背景EducationBackground教育背景School学校Time就读年份Degree学位Major专业WorkingExperience工作经验NetworkDevelopment,MBCL/BBAC6DealerApplicationFormBackgroundInformation背景信息Period起止年月Company公司名称Position/Job职务/岗位NetworkDevelopment,MBCL/BBAC7DealerApplicationFormFinancialStatus财务状况4.APPLICANTfinancialstatus“申请单位”财务状况：Pleasedescribeformerorexistingbankruptcy,ifany如以前或现在有破产情况，请阐述English:中文：无Pleasedescribecontingentliabilityarisingfromlegallitigation,ifany如有因法律诉讼责任引起的负债，请阐述English:中文：无Pleasedescribebaddebtrecord,ifany如有过往坏账记录，请阐述English:中文：无FinancialBackground财务背景NetworkDevelopment,MBCL/BBAC8DealerApplicationFormBusinessHistory&Performance经营历史与业绩表现IftheAPPLICANTisnowoperatinganautomotivebusinessinChina,pleasecompletesectionA,andiftherearealsootherbusinessespleasecompletesectionBinaddition.如“申请单位”在中国现正经营汽车业务，请完成以下A部分表格，如有经营其他业务，请同时完成B部分表格。APPLICANTbusinesshistory&performanceforautomotivebusiness“申请单位”汽车业务经营历史与业绩表现：1.APPLICANTBusinessExperience申请单位行业经验APPLICANTLegalScopeofBusinessandOperation申请单位合法经营范围Automobileretailingpremiumbrand(3Soutlet)高档品牌轿车经营（3S经销商）3Sautomobileoperation3S轿车经营Othernon-automotivepremiumbrandretailing其他高档品牌零售Passengercarbusiness小轿车经营Usedcartrade旧机动车交易Autorepair汽车维修Autoparts汽车配件Autorental汽车租赁Otherautobusiness(pleasespecify)其它汽车经营（请注明）：OperatingPeriod经营年期Autosalesexperience汽车销售经验Yearsofexperience有多久经验？年Autoserviceexperience汽车服务经验Yearsofexperience有多久经验？年SectionAA部分NetworkDevelopment,MBCL/BBAC9DealerApplicationFormBusinessHistory&Performance经营历史与业绩表现OverviewofAutomotiveBrandOperation汽车品牌经营概况Brand品牌Shares%股权比例BusinessScope经营范围Location地点(城市)AuthorizedBrand授权品牌DateofAuthorization获得授权时间OpeningDate开业时间4SStore4S店Saleonly仅销售Service&accessory仅售后服务及配件4SStore4S店Saleonly仅销售Service&accessory仅售后服务及配件NetworkDevelopment,MBCL/BBAC10DealerApplicationFormBusinessHistory&Performance经营历史与业绩表现AutomotiveRetailBusinessSalesandServiceFigures(LatestThreeYears)汽车经营销售及维修数量