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Registration form for Vendors
Name Of the Supplier*
Type of Vendor Business*
PAN No.
Name/ Type of Business
Factory License Number
License Renewed upto
Main Products
Range
Capacity
 Registered Office
Address
Locality*
City
State
Country
   Pin code* Company URL
Contact Person* Designation*
Phone* Mobile phone*
   Fax e-mail ID*
 
Head Office
Address
Locality
City
State
Country
   Pin code
Company URL
Contact Person Designation
Phone Mobile phone
   Fax e-mail ID
 
Factory
Address
Locality
City
State
Country
   Pin code
Company URL
Contact Person Designation
Phone Mobile phone
   Fax e-mail ID

Tax Information
Sales Tax
VAT(Value Added Tax) Registration Number
   CST(Central Sales Tax) Number
   ST (Service Tax) Number
   TAN(Tax Account Number) Number
Excise Registration
Excise Registration Number
    Excise Rsnge
    Commissionerate
   Division
    ECC(Excise Control Code) Number
Service Tax Registration Number
ESI Registration No./ Code No.
PF Registration Number
Trade License No.
Trade License Issued by
Trade License Valid upto date

Dealership Information
Details of dealership
Name of Original Manufacturer
Contact Person
Designation
E-mail
Telephone No
Mobile No
Fax
URL
Plant and Machinery

Office Details
 Manpower
Category Number
Officer
Staff
Inspector
Skilled Workmen
Semi-Skilled Workmen
Unskilled Workmen
 Instruments for Inspection
Instruments Number Date of Calibration Caliberating Agency

Banker And Business Details
Banker's Name*
 Banker's Address
Address
Locality*
City
State
Country
   Pin code* Company URL
Contact Person* Designation
Phone* Mobile phone
   Fax e-mail ID
 Business turnover in the last 3 years
Year Amt(rs./Lakhs)
 Last 3 major project completed
Year Project Name Project Description

Income Tax Clearance Position
Whether ISO 9000/Equivalent Quality System Standard Certified checked />   Yes checked />   No
Other Remarks

Signature
Digital Signature*
Full Name*
Date*
Designation*
For Office use only:
eForm Service Request Number eForm Filling date



This Form is hereby registered:
Digital Signature of the authorising officer
Date of Signing