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PARTNERSHIP APPLICATION FORM

This form is designed to help us understand your company better and your assessment of the market

Please fill-in details here:

Business Structure:

Company Information:

Products & Services:

Competing Products in domestic market:

Which LOB would be of interest to you:

Please indicate your preferred agreement criteria ticking the boxes.

Preferred Partnership Type:

Please indicate your preferred agreement criteria ticking the boxes.

Please mention following: Name, Designation, Email Id & Mo. No:

Azentio Point of Contact:

Company/Partner Profile:

Mandatory documents to be provided along with the Partner Application Form (jpg,png,pdf)

Additional Information:

Disclaimer

By providing the information in this questionnaire, you are informed that any data that you provide and/or we may collect will be processed by Azentio in order to ensure compliance with legal and regulatory obligations, as well as to ensure the respect of our internal governance and good business practices, with regards to onboarding. For the performance of any contract or service that we may enter into with your organization, we may process the data which will be processed in compliance with applicable data protection laws and use it for the following purposes only:

  • • assessing existing and prospective business partners being engaged by Azentio;
  • • ensuring compliance with legal, regulatory and corporate governance obligations and good practice;
  • • generally engaging with and managing business partners.
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