Apply for Distribution

How can help you?

Apply for Distribution?

If you require further information or have any inquiries, please don’t hesitate to contact us. Furthermore, you are welcome to visit our office, where we will be happy to assist you in person and provide any additional details you may need. We look forward to connecting with you.

Fill the information to send request

Date *

Applicant Details

Select the desired province for distributorship *

Name *

Father Name

Email *

Contact Number *

Permanent Address

Current Address

Native Language *

Other Language

National ID (Tazkira) Number *

Education Level

Educational Details

School

University

Computer Skill

English Proficiency Level

Work Experience

Business Information (if you currently operate a business)

Type Of Current Business

Current Business Address

Area Of Business Activity

Existing Company Representations

Current Business Number Of Employees *

Sales and Investment Information

Amount Invested In Current Business (AFN)

Monthly Sales Of Current Business (AFN)

Have you previously worked with medicine manufacturing companies?

Yes No

If Yes, Company Names And Duration Of Cooperation

Transportation and Distribution

Vehicle Types Used For Distribution

Motorbike Car Cargo Vehicle Other

Vehicles Type And Number Of Used To Distribute Products

Areas / Districts Covered By Distribution

Market Information In The Relevant Area

Number Of Active Customers

Government Hospitals

Private Hospitals

Number Of Doctors

Wholesalers

Pharmacies

Workplace Information

Workplace Area (Office, Shop Or Warehouse)

Does the warehouse have suitable conditions for storing medicines?

Yes No

Is it possible to store sensitive medicines (if needed)?

Yes No

Have you allocated an office for the activities of Pharma One sales team?

Sales Team and Working System

Do you have an active sales team?

Yes No

How many members does your marketing team have?

Accounting System

Manual Computerized Online None

Can you provide a monthly sales report?

Yes No

Deposit / Guarantee

Can you transfer cash as a deposit/guarantee?

Yes No

If Yes, Write The Amount (AFN)

Amount Of Investment In Pharma One (AFN)

Estimated sales of Pharma One products in your coverage area (per year)

Q1 (First Quarter)

Q2 (Second Quarter)

Q3 (Third Quarter)

Q4 (Fourth Quarter)

Reason For Interest

Reason for your interest in Pharma One

Do you commit to follow Pharma One’s pricing and sales policies?

Yes No

Do you commit to protecting the reputation and trade name of Pharma One?

Yes No

Attached Documents

Upload Tazkira * Please attach a copy of your electronic tazkira (National ID), and submit them with this form to the office of Pharma One Medicine Manufacturing Company.

Upload Business License * Please attach a copy of your business license, and submit them with this form to the office of Pharma One Medicine Manufacturing Company.

Upload Business Profile Please attach office photos, if available.: info@pharmaone.com.af

Upload Warehouse and Office Photos Please attach warehouse photos, if available.: info@pharmaone.com.af

Confidentiality notice: All information you provide in this form will be kept by the company with full confidentiality and information security. It will be used only to evaluate your request and establish potential cooperation, and will not be shared with any third party without your consent.