SYNERA Partner Registration Form — Apply to Become a Synergan

Important: This form is for initial registration and evaluation. Submission does not guarantee partner appointment, territory exclusivity or any particular commercial entitlement. Fields marked * are required.

Your progress is automatically saved as you fill in each section. You can return to complete the form later.

Applicant and Business Details

Applicant / Primary Contact Name*

Designation / Role

Business / Firm Name

Business Constitution

Year Established

Website / LinkedIn / Business Profile URL

Business Email*

Mobile Number*

Business Address

GSTIN (if applicable)

PAN (optional at initial registration)

Do not upload identity or financial documents unless requested through an approved process.

Territory and Market Access

State(s) you wish to develop

Priority city / district / region(s)

Primary customer segment

Approximate relevant customer contacts

Describe your local network and how you would generate leads

Proposed first 12-month market development plan

Experience and Capability

Relevant experience (select all that apply)

Years of relevant experience

Current team / local resources

Who will lead sales and customer relationships?

Describe your sales, customer support and service-coordination capabilities

Financial and Operational Readiness

Indicative resources available to develop the territory

This is an indicative readiness question, not a fee or minimum investment commitment.

Working-capital readiness

Local resources available (people, office, transport, tools, storage, service coordination)

Product and Service Interest

Which PlasmaBerry products or services interest you? (select all that apply)

Jaladhara automatic sprinkler cleaning systemSolar module cleaning servicesRobotic / mechanized cleaningAnti-Dust Shield treatmentAMC / preventive maintenance / asset careInstallation / commissioning supportMonitoring / asset health checksOther PlasmaBerry products or services

Willingness to complete required product, service and safety training

Willingness to follow PlasmaBerry quality, safety and reporting processes

References and Supporting Information

Business reference 1 — name / organisation

Reference 1 contact details (with permission)

Business reference 2 — name / organisation

Reference 2 contact details (with permission)

Anything else PlasmaBerry should consider? (Additional comments)

Declaration and Consent

I confirm that the information supplied is accurate and complete to the best of my knowledge. *I authorise PlasmaBerry to contact the references provided and verify relevant business information for evaluation, where lawful and appropriate. *I consent to the use of my information for evaluating and responding to this registration. *

Applicant / authorised signatory name

Date

For queries: sales@plasmaberry.com

SYNERA is PlasmaBerry's partner programme. Registration is for evaluation and does not guarantee appointment, exclusivity or commercial entitlements. For queries: sales@plasmaberry.com