Registration Form

APPLICATION FOR REGISTRATION OF INDIGENOUS VENDOR

Mandatory fields are in *bold

   

 GENERAL

  *Name of Organization

:

    
  *Office Address

:

    
  *Contact Person Name

:

    
   Fax

:

   Country      Area           Number  
           
  *TelePhone / Cell No.

:

    
           
  *Email Id (Please enter only one email address)

:

    
           
 MANAGEMENT INFORMATION ( Chief Executive )
  *Chief Executive Name

:

    
           
  *Designation

:

    
           
   Fax

:

   Country      Area           Number  
           
  *TelePhone / Cell No.

:

    
           
  *Email Id

:

    
           
  *Particulars of constitution of the firm

:

    
           
  *Type of Industry

:

    
  *Whether you have any collaboration ( financial / technical ) with foreign or domestic firm. If yes, please provide the address of the same.
  
 OTHER INFORMATION
  *C. S. T Registration No

:

    
  *State S. T. Registration No

:

    
           
   Trade Licence No.

:

    
 
  *Are you registered as small scale industries?

:

    
  *SSI Registration No

:

    
       
  *Are you registered with Excise?   

:

    
 
  *Excise Code No

:

    
           
  *Excise Registration No

:

    
           
  *Excise Range & Division Nos

:

    
           
  *Excise Collectorate

:

    
           
  *Permanent Account No

:

    
           
  *Are you a service provider / contractor

:

    
 
  *PF No

:

    
           
  *Labor License No

: