HOME   APOLLO HISTORY   HAIR CENTER   PRODUCTS   APOLLO WOMEN   APOLLO CENTER   MEDICAL TIPS   OUR CLIENTS   MEDIA AND EVENTS   BEFORE AND AFTER   WHAT'S NEW   BECOME A DEALER   INTL. LOCATION   BECOME A DEALER STANDARD COUNTRY QUESTIONNAIRE Qualification Report. THE PURPOSE OF THIS INITIAL QUALIFICATION REPORT IS FOR OBTAINING GENERAL INFORMATION THAT HELPS EVALUATE YOUR QUALIFICATIONS TO BE AWARDED AN APOLLO DEALERSHIP. THIS IS NOT AN APPLICATION, AND DOES NOT REPRESENT ANY KIND OF COMMITMENT FROM THE PART OF APOLLO USA, NOR FROM THE PART OF THE MASTER DEALER FOR YOUR REGION. SHOULD YOU QUALIFY A MUTUAL INTEREST DEVELOPS, WE WILL REQUEST ADDITIONAL INFORMATION. IN CASE YOU DON'T HEAR FROM US WITHIN TEN WORKING DAYS AFTER THE SUBMITTAL OF THIS FORM, KINDLY CONSIDER YOUR APPLICATION AS NOT MEETING OUR REQUIREMENTS. AS LONG AS IT WILL REMAIN WITH US, BE SURE THAT ALL INFORMATION MENTIONED WILL REMIAN CONFIDENTIAL. (To be completed by each proposed partner of the Dealership Group) PERSONAL DATA Name  ID No   Adresse  Nationality   City  Country   Business Phone  Home Phone  Best Time to Call  P.O. Box  Fax   Date Of birth  Martial Status  Spouse Name  Number of Dependents  Ages   How did you become aware of the Dealership opportunity? BUSINESS EXPERIENCE: (Please list company name, type of business, position held, dates position held, and your most significant accomplishments.) PRESENT/MOST RECENT POSITION   Dates   PREVIOUS POSITION   HAVE YOU EVER OWNED A BUSINESS ?   please select YES NO IF YES WHAT IS THE TYPE?   · OTHER BUSINESS AFFILIATIONS (OFFICER, DIRECTOR, PARTNER, ETC.) · BUSINESS AND MANAGEMENT GOALS: Do you plan to devote full time to this business venture   please select YES NO Will your spouse be active in the Dealership   please select YES NO Do you plan to have equity partners   please select YES NO IF YES, PLEASE IDENTIFY ALL PARTNERS NAME ADDRESS TELEPHONE ACTIVE DEALERSHIP Planned date to open first Center   Other Locations of Preference 1st Choice   2nd Choice   3rd Choice   PRELIMINARY FINANCIAL DISCLOSURE: (Please specify details on a separate sheet i.e. break down of Assets, Liabilities etc.) Assets      Liabilities      Net Worth   Unencumbered Liquid Assets Available   Personal Residence $       Other Real estate $   How do you plan to finance this new business venture?  Own Cash  Credit.  Other: Specify   PLEASE ATTACH RESUME AND PERSONAL PASSPORT PHOTO

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