* Company Description (max 10,000 characters):
Required field - please enter data
* Please explain the scope of your business activities (max 10,000 characters):
Required field - please enter data
* When was your business established?
Select
2009
2008
2007
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1804
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1802
1801
1800
Required field - please enter data
* How many employees does your business have?
Select
0-10
11-20
21-50
51-200
Above 200
Required field - please enter data
* How many sales persons does your business have?
Select
1-3
4-8
9-15
Above 15
Required field - please enter data
* Does your business perform telemarketing?
Select
Yes
No
Required field - please enter data
Please indicate your customer segmentation according to the market share and number of customers that each of following segments represent:
Customer Segment
Market Share (1-100%)
Number of Customers
Ministry of Health
Select
1
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3
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5
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95
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98
99
100
Select
1-5
5-10
10-50
50-200
Above 200
Public Hospitals
Select
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80
81
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83
84
85
86
87
88
89
90
91
92
93
94
95
96
97
98
99
100
Select
1-5
5-10
10-50
50-200
Above 200
Private Hospitals
Select
1
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5
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81
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88
89
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91
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95
96
97
98
99
100
Select
1-5
5-10
10-50
50-200
Above 200
Veterinary Hospitals
Select
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80
81
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83
84
85
86
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88
89
90
91
92
93
94
95
96
97
98
99
100
Select
1-5
5-10
10-50
50-200
Above 200
Dental clinics
Select
1
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89
90
91
92
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95
96
97
98
99
100
Select
1-5
5-10
10-50
50-200
Above 200
Laboratories
Select
1
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5
6
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89
90
91
92
93
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95
96
97
98
99
100
Select
1-5
5-10
10-50
50-200
Above 200
Nursing/senior citizens' homes
Select
1
2
3
4
5
6
7
8
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89
90
91
92
93
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95
96
97
98
99
100
Select
1-5
5-10
10-50
50-200
Above 200
Genecology clinics
Select
1
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97
98
99
100
Select
1-5
5-10
10-50
50-200
Above 200
Surgery clinics
Select
1
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100
Select
1-5
5-10
10-50
50-200
Above 200
Imaging Centers
Select
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98
99
100
Select
1-5
5-10
10-50
50-200
Above 200
Other:
Select
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81
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88
89
90
91
92
93
94
95
96
97
98
99
100
Select
1-5
5-10
10-50
50-200
Above 200
Please specify your company's shareholders and their shareholding percentage:
Shareholder's Name
Shareholding Percentage (1-100%)
Select
100
99
98
97
96
95
94
93
92
91
90
89
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3
2
1
Select
100
99
98
97
96
95
94
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91
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89
88
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5
4
3
2
1
Select
100
99
98
97
96
95
94
93
92
91
90
89
88
87
86
85
84
83
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81
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3
2
1
Select
100
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90
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2
1
Select
100
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1
Business Documentation
Please attach business documentation, such as: regulatory approvals, working permits, authority approvals, partner contracts, etc
Note: This information will be kept confidential
Financials
Please attach a statement with your 2007/2008 profit and net income.
Note: This information will be kept confidential.
