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1、经销商基本信息表Dealer Contact Form姓名/ Name电邮地址/ Email电话/ Telephone传真/ Fax移动电话/ Cell Phone公司名称/ Company NameCNEN投资人信息（简历可作附件）/ Investors（Resume preferred as Attachment）123公司地址/ AddressCNEN电话/ Telephone企业网站/ Website公司简介(可用附件呈交)/ Company Brief Introduction (Attachment preferred)CN公司简介(可用附件呈交)/ Company Brief I
2、ntroduction (Attachment preferred)EN过去及现在的汽车行业经历 /Past and Current Activities in Automotive IndustryCNEN计划申请国家 / Planned Country of Dealership计划申请省份 (如适用)/ Planned Province of Dealership (if applicable) CNEN计划建店城市/ Planned City of DealershipCNEN意向区域或城市的市场情况与机遇分析 (可用附件呈交) /Automotive Environment Anal
3、ysis and Opportunities in the Area (Attachment preferred)CNEN加盟观致汽车经销商网络的原因/ Motivation for Joining the Qoros Dealer NetworkCNEN中国申请公司，请同时使用中文及英文填写表格及相关附件。For an applying company based in China, please complete the form and attach relevant documents in both English and Chinese.矚慫润厲钐瘗睞枥庑赖賃軔。矚慫润厲钐瘗睞枥庑
4、赖賃。非中国申请公司，请使用英文填写表格及相关附件。For an applying company based out of China, please complete the form and attach relevant documents in English.聞創沟燴鐺險爱氇谴净祸測。聞創沟燴鐺險爱氇谴净祸。Dealer Application Form 经销商申请书Applicant Name:申请人名称： Time of Application:申请时间:Applicants Chop:申请单位(盖章)：残骛楼諍锩瀨濟溆塹籟婭骒。残骛楼諍锩瀨濟溆塹籟婭。Qoros Automo
5、tive Co., Ltd.观致汽车有限公司Preface 前言Thanks for your interest in joining Qoros sales and service network! We hereby provide you instructions about the application form 非常感谢您对加盟观致汽车营销网络的兴趣！现对本申请书相关事宜做如下说明：酽锕极額閉镇桧猪訣锥顧荭。酽锕极額閉镇桧猪訣锥顧。Applicants submission of the application form represents applicants agreemen
6、t in building the sale and service sites for Qoros Automotive Co., Ltd. according to Qoro Facility Standard 申请单位呈递本计划书，即代表申报单位同意按照观致汽车有限公司的建店标准建设观致汽车销售服务店。彈贸摄尔霁毙攬砖卤庑诒尔。彈贸摄尔霁毙攬砖卤庑诒。Applicant agrees that the documents submitted will be kept on file by Qoros Automotive Co., Ltd. and will not be returne
7、d 申报单位同意在申报过程中，由其提供给观致汽车有限公司的所有文件及其复印件、照片等资料由观致汽车有限公司作为记录保存，将不予以退还，敬请理解。謀荞抟箧飆鐸怼类蒋薔點鉍。謀荞抟箧飆鐸怼类蒋薔點。Qoros Automotive Co., Ltd. will keep confidential of the documents that applicant submitted 观致汽车有限公司应对申报单位所提供的任何资料恪守保密原则。厦礴恳蹒骈時盡继價骚卺癩。厦礴恳蹒骈時盡继價骚卺。Please bind the application documents and mail to 书面申请材料请
8、装订成册后邮寄至：茕桢广鳓鯡选块网羈泪镀齐。茕桢广鳓鯡选块网羈泪镀。上海市浦东新区国展路388号3楼观致汽车经销商网络发展与管理部。邮编：Applicant introduction申请公司简介Business of the applicant申请公司所经营业务Financial Status of the applicant鹅娅尽損鹌惨歷茏鴛賴縈诘。鹅娅尽損鹌惨歷茏鴛賴縈。申请公司财务状况Business plan of the proposed Qoros dealership观致拟建店业务计划Declaration and list of required attachments申请声明
9、及附件清单Please fill all questions in either Chinese or English籟丛妈羥为贍偾蛏练淨槠挞。籟丛妈羥为贍偾蛏练淨槠。请选择使用中文或英文填写Applicant introduction申请公司介绍Basic information 基本信息Company Name of Applicant申请单位全称Date of Opening 成立日期Automotive Sales Experience 汽车销售经验Automotive Service Experience 汽车售后服务经验Registered Capital 注册资本Companie
10、s Registered Address公司注册地址Legal Entity Type法人形式 SOE 国有 Collective 集体 Private 私营 Joint Venture 合资 Foreign Investment 外资 Others (Please Specify) 其他 (请注明)Legal Representative法人代表Contact Person联络人名称Telephone 电话Cell phone 手机Fax 传真Email Address 电子邮件Postage Address and Postal Code 邮寄地址与邮编Website 网址Applican
11、ts management 申请单位管理层Position 职位Name姓名Age年龄Education教育程度Automotive experience汽车行业经验LegalRepresentatives Background 企业法人代表背景Name 姓名 Position 职务Age 年龄Gender 性别Education Background 教育背景School学校Time就读年份Degree学位Major专业Working Experience 工作经验Time起止年月Company单位名称Position/Job职务/岗位Shareholdersstructure股权结构Sha
12、reholders股东Capital （000 RMB）出资额（千元）Share (%)份额 (%)Position职务Business of the applicant申请公司所经营业务If the applicant company is now operating automotive business (shareholding is more than 50%), please include information of 5 most representative dealership 如申请公司现正经营汽车业务（股权比例超过50%），请说明最具代表性的5个授权的汽车经销品牌的经营
13、情况預頌圣鉉儐歲龈讶骅籴買闥。預頌圣鉉儐歲龈讶骅籴買。Manufacturer生产厂家Brand品牌Time of Authorization 授权时间Opening date开业时间Territory业务区域CSI & SSI ranking of latest year 最近1年的CSI & SSI 排名Sales units of last year上一年度年销量Sales units of strongest local competing dealer上一年度本区域内上牌量最大的同品牌店的年销量Note 备注: Total No. of brands authorized 授权经营的
14、汽车品牌数量: （）个Total No. of 4S dealership in operation 所运营的4S店数量:（）个渗釤呛俨匀谔鱉调硯錦鋇絨。渗釤呛俨匀谔鱉调硯錦鋇。Automotive retail business sales and service figures (past three years) 汽车经营销售及维修数量（过去三年）铙誅卧泻噦圣骋贶頂廡缝勵。铙誅卧泻噦圣骋贶頂廡缝。Brand 品牌Total sales unit销售数量（台）Total service throughput维修数量（台）201420152016201420152016Total 总计备注：
15、Historical business performance of automotive retail business (past 3 years) 汽车经销行业相关公司历史经营业绩（过去三年）擁締凤袜备訊顎轮烂蔷報赢。擁締凤袜备訊顎轮烂蔷報。Currency: (000 RMB)币种：(千元人民币)Y2013Y2014Y2015Y2016Turnover 营业额Total 总额Which 其中Passenger car sales小轿车销售Spare parts sales配件销售Service sales维修服务Used car trade二手车交易Others (Please spe
16、cify) 其它（含装饰、保险、二手车）Expense 费用Total 总额Which 其中Operating expense经营费用Wages员工工资Depreciation and Amortization折旧与摊销Rental租金Others (Please specify)其它 (请注明)（财务费用Profit margin利润率New car sales margin 新车销售毛利率(%)Labor hour margin工时费收入毛利率(%)Parts sales margin配件销售毛利率(%)Used car sales margin二手车销售毛利率(%)Other margi
17、n (please specify)其他毛利(%)(请注明)（含装饰、保险、二手车）Financial status of the applicant申请公司财务状况Latest balance sheet 最近的资产负债表Currency: (000 RMB)币种：(千元人民币)Assets 资产Total assets 总资产Non-current assets 非流动资产Fixed assets固定资产Construction in progress 在建工程Land use right 土地使用权Others 其他Current asset 总流动资产Cash and cash equ
18、ivalents 现金与现金等价物Inventory 存货Accounts receivable应收帐款Prepaid accounts预付帐款Others其他Liabilities 负债Total liabilities 总负债Short-term Liabilities 短期负债Loans and borrowings 贷款及借款Trade and other payables 应付帐款Others 其他Long-term Liabilities 长期负债Loans and borrowings 贷款及借款Others 其他Owners equity 所有者权益Does applicant
19、 provide guarantee to outsider 申请公司目前对外是否有担保？ Yes是 No否贓熱俣阃歲匱阊邺镓騷鯛汉。贓熱俣阃歲匱阊邺镓騷鯛。if yes, the guaranteed parties are若是，主要被担保方为：，total guarantee amount对外担保总额：(000 RMB)千元Does applicant have mortgage loans申请公司目前是否有抵押借款? Yes是 No否坛摶乡囂忏蒌鍥铃氈淚跻馱。坛摶乡囂忏蒌鍥铃氈淚跻。If yes, please provide information of assets for mort
20、gage and value 若是，请提供抵押资产以及价值相关信息蜡變黲癟報伥铉锚鈰赘籜葦。蜡變黲癟報伥铉锚鈰赘籜。Creditor债权人Assets for mortgage抵押物Value (000 RMB)价值(千元)Top 3 creditors 前三大债权人序号Creditor债权人Amount 金额Top 3 debtors 前三大债务人序号Debtor 债务人Amount 金额Bank credit reference银行资信情况Has applicant obtained Bank Credit Rating 公司是否取得银行资信等级?買鲷鴯譖昙膚遙闫撷凄届嬌。買鲷鴯譖昙膚遙闫
21、撷凄届。 Yes是 No 否If yes, bank name is若是，信用等级评定银行为，credit rating is资信等级为，綾镝鯛駕櫬鹕踪韦辚糴飙钪。綾镝鯛駕櫬鹕踪韦辚糴飙。Has the company obtained secured credit facility公司是否取得银行授信额度?驅踬髏彦浃绥譎饴憂锦諑琼。驅踬髏彦浃绥譎饴憂锦諑。 Yes是 No 否If yes, bank name is若是，授信银行为，credit facility size is 信贷额度为，available credit可用信贷额度为，duration is from 授信期间自to至，猫
22、虿驢绘燈鮒诛髅貺庑献鵬。猫虿驢绘燈鮒诛髅貺庑献。Business plan of the proposed Qoros dealership观致拟建店业务计划Target city of the proposed Qoros dealership计划建店城市所在省份_城市_锹籁饗迳琐筆襖鸥娅薔嗚訝。锹籁饗迳琐筆襖鸥娅薔嗚。Format of the proposed Qoros dealership申请观致授权经销商形式Format 形式Number 数量o新建4So改建4So展厅o迷你展厅Proposed land for Qoros dealership 此次申请拟建店土地基本信息Gene
23、ral information of proposed land土地基本信息Establishment Format 建店形式Newly build 4S 新建4S 项目Rectangular land矩形场地Other shape其他形状场地Retrofit4S改建4S项目retrofit showroom需改建展厅retrofit workshop需改建车间City Showroom城市展厅项目with quick service含快修without quick service不含快修MiniShowroom迷你展厅项目with quick service含快修without quick
24、service不含快修Ownership 拥有状态 Own 自有 Rent 租赁 Land to be acquired or rented 意向购买或意向租赁土地 Others 其他Address stated in the redline map 土地规划红线图地址Nature of land 土地性质 Industrial 工业用 Commercial 商业用 Multi-purpose 综合用 Others (please specify) 其他（请注明）Total Land area 总面积 (m2)Total Buildable footprint总可建投影面积(m2)Depth
25、of land 场地进深 (m)Frontage land width可用临街面宽 (m)Building Height Limitation 建筑物限高 (m)Retrofit4S detail information改建4S项目附加信息Display car capacity原展车数量Mechanical and electrical work bay capacity 原车间机修工位数Sheet metal & paint work bay capacity原车间钣喷工位数Parts warehouse capacity配件库面积Retrofit Building Frontage 改建
26、项目建筑物正面宽度(m)Retrofit Buildingfaade height改建项目建筑物正面高度(m)Description of land transportation convenience and surrounding environment请对该场地的交通便利性与周边环境进行简要的描述At least 11pictures of proposed land and surroundings (requirement: please provide 11 photos from the viewpoints as shown below)至少11张所建议土地及其周边环境照片（拍
27、摄要求：如图所示拍摄11个角度照片。）構氽頑黉碩饨荠龈话骛門戲。構氽頑黉碩饨荠龈话骛門。室外照片：1.正立面远景（10米外拍摄）2.正立面近景3.对面左侧45度（10米外拍摄）4.对面右侧45度（10米外拍摄）5.室外左前45度6.室外右前45度7.正立面对面室内照片：8.室内左前45度9.室内右前45度10.室内左后45度11.室内右后45度12.室内正面Please provide proposed site layout plan, with the red line area and surrounding situation 计划中的新经销点土地平面布置图，显示土地规划红线图及周边情
28、况輒峄陽檉簖疖網儂號泶蛴镧。輒峄陽檉簖疖網儂號泶蛴。If rebuild, please provide pictures of proposed showroom and service area如为改建店，请同时提供展厅及车间照片等尧侧閆繭絳闕绚勵蜆贅瀝纰。尧侧閆繭絳闕绚勵蜆贅瀝。If rebuild, please provide site layout map and dimensions of showroom area and service area如果是改建店, 请附改建场地平面布置图,并标注展厅尺寸与售后服务区域尺寸识饒鎂錕缢灩筧嚌俨淒侬减。识饒鎂錕缢灩筧嚌俨淒侬。City
29、map with indication of proposed land, neighboring 4S dealership, major commercial/residential area and auto clusters, and map scale 请在城市地图上标明计划经销点位置，临近其他品牌4S店，主要商业/住宅区域以及汽车经销商聚集地，地图比例凍鈹鋨劳臘锴痫婦胫籴铍賄。凍鈹鋨劳臘锴痫婦胫籴铍。Note: if more than one landsubmitted, please add accordingly 恥諤銪灭萦欢煬鞏鹜錦聰櫻。恥諤銪灭萦欢煬鞏鹜錦聰。备注：如有多
30、于一块土地备选，请自行添加说明Fund raising plan for the proposed Qoros dealership 为观致新经销商的初步筹资计划鯊腎鑰诎褳鉀沩懼統庫摇饬。鯊腎鑰诎褳鉀沩懼統庫摇。Planned total investment (000 RMB) 计划投资总额(千元人民币)Non-current assets (000 RMB)固定资产投资(千元人民币)Working capital流动资金(千元人民币)Shareholders structure of proposed Qoros dealership观致新经销商的股权结构硕癘鄴颃诌攆檸攜驤蔹鸶胶。硕癘鄴颃
31、诌攆檸攜驤蔹鸶。Shareholders股东Capital （000 RMB）出资额（千元人民币）Share (%）份额（%）Shareholder 1第一股东Shareholder 2第二股东Shareholder 3 第三股东Shareholder 4第四股东Shareholder 5 第五股东Registered capital 注册资本Loans and borrowings (000 RMB) 贷款及借款(千元人民币)Proposed management team for the Qoros dealership 建议的观致汽车经销商管理层阌擻輳嬪諫迁择楨秘騖輛埙。阌擻輳嬪諫迁择楨
32、秘騖輛。Position 职位Name姓名Age年龄Education教育程度Automotive experience汽车行业经验General Manager总经理Sales Manager 销售经理After Sales Manager 售后服务经理Others 其他管理层Others 其他管理层Proposed organization structure for the Qoros dealership 建议的观致汽车经销商组织结构氬嚕躑竄贸恳彈瀘颔澩纷釓。氬嚕躑竄贸恳彈瀘颔澩纷。Market forecast of the target territory 建议业务地域的车辆年销量
33、预测釷鹆資贏車贖孙滅獅赘慶獷。釷鹆資贏車贖孙滅獅赘慶。201820192020Passenger car local registration 乘用车本地上牌量Qoros local registration观致汽车本地上牌量Finance projection 财务预测201820192020Revenue销售收入Cost of Goods Sold 经营成本Gross Profit毛利Total overheads 经营费用合计Staff wages 雇员工资Advertising and promotion 广告与促销费用Rental 租赁费用Other overheads 其他经营费用
34、Operating Profit经营利润Financial Expenses 财务费用Income Tax所得税Net Profit 净利润Market analysis - including applicants understanding to Qoros brand and product offering, target market size, major competition, target customer, marketing and branding strategy市场分析 包括申请者对观致品牌与观致产品组合的理解；目标市场规模，主要竞争对手；目标顾客，营销与品牌策略分
35、析怂阐譜鯪迳導嘯畫長凉馴鸨。怂阐譜鯪迳導嘯畫長凉馴。申请者对观致品牌与观致产品组合的理解目标市场规模主要竞争对手 目标客户 营销与品牌策分析Declaration and list of required attachments申请声明及附件清单Declaration 申请声明本申请人或申请单位（以下简称申请单位）声明：申请单位声明按照本申请表要求所提供的全部资料都是真实的。若有任何在提交本申请表之前和之后提供的信息被证明为虚假或误导，则观致汽车保留废止任何基于此申请表而确立的安排的权利申请单位通过呈交申请书并不意味着将一定会成为授权经销商，也不意味着观致汽车有任何义务一定要指定”申请单位”为
36、授权经销商本申请书仅被观致汽车用于记录”申请单位”有意成为其授权经销商，不能用于任何其他用途或目的在申请过程中，若观致汽车需要申请单位提供申请书以外的与申请有关的其它资料，贵公司将自愿积极提供申请单位在此声明，同意观致汽车对认为有必要确认的资料进行核实，并不构成对其隐私的侵犯。申请单位因提交申请书并试图或期望被观致汽车指定为授权经销商而发生的一切费用和义务，均应完全由”申请单位”单方面承担双方均承认：观致汽车有权决定是否接受申请单位的申请，并且本申请书最终恕不退还，观致最终将其保留存档，并保证不对外公开。申请单位(盖章)：日期：法人代表签名：List of attached documenta
37、tion 随附文件清单:Applicants business license & shareholder structure certificate issued by local AIC 申请单位营业执照及当地工商局核准的股东结构证明谚辞調担鈧谄动禪泻類谨觋。谚辞調担鈧谄动禪泻類谨。Applicants financial reportwith company stamp or audit report if available (Last 3 years) 申请单位过去三年加盖公章的财务报告，或审计报告（如有）嘰觐詿缧铴嗫偽純铪锩癱恳。嘰觐詿缧铴嗫偽純铪锩癱。Photos which c
38、an wholly reflect the current operation venue 能够全面反映当前经营场地的照片熒绐譏钲鏌觶鷹緇機库圆鍰。熒绐譏钲鏌觶鷹緇機库圆。Introduction of applicants shareholder 申请公司股东的详细介绍鶼渍螻偉阅劍鲰腎邏蘞阕簣。鶼渍螻偉阅劍鲰腎邏蘞阕。If proposed land is owned by the applicant, please provide ownership documentation如计划中的新经销点土地为自有资产，请提供产权证明纣忧蔣氳頑莶驅藥悯骛覲僨。纣忧蔣氳頑莶驅藥悯骛覲。If propo
39、sed land is rented, please provide rental agreement and landlords ownershipdocumentation 如计划中的新经销点土地为租用，请提供租用协议以及土地使用权利人的使用权证明颖刍莖蛺饽亿顿裊赔泷涨负。颖刍莖蛺饽亿顿裊赔泷涨。If proposed land is to be acquired/rented, please provide Letter of Intent, property ownership document of to be acquired/rented property, or government planning, or red line map, or other government registration or approval document如计划中的新经销点土地为待购买，请提供意向书及其相关文件，如待租物业相关权证，政府规划与红线图，或者其他政府备案或批准文件濫驂膽閉驟羥闈詔寢賻減栖。濫驂膽閉驟羥闈詔寢賻減。Proof of bank credit ratings and credit facility size 银行资信等级及授信额度证明銚銻縵哜鳗鸿锓謎諏涼鏗穎。銚銻縵哜鳗鸿锓謎諏涼鏗。
