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Description (All are Mandatory) 1 Customer's Name & address Customer Name : Street 1: Street 2: Street 3: Pin code

: City : State: Country : 2 Delivery Address Name : Street 1: Street 2: Street 3: Pin code : City : State: Country : 3 Payment Currency

4 Contact Details Name Tel No. Mobile No. Fax No. E-mail id: 5 Local and Interstate Registration Number*** LST.No: C.S.T No: TIN No Service tax reg no: PAN: 6 SSI Registration Number and Date: *** 7 Service Tax Registration Number:*** 8 Pan Number:***

13 Payment Terms (Credit Days) Fields Highlighted in Yellow are mandatory Information

Details ( For Updation)

VIZAG GENERAL CARGO BERTH PVT LTD City office : 26-3-10/A, Garuda Mansion (1st floor) Chittaranjan Das Marg,Sea Horse Junction, Visakhapatnam-530001 530001 (A.P) India -------------------DO------------------------------

-------------------DO------------------------------

INR

M Gopalkrishna

m.gopalkrishna@vedanta.co.in>

28762762632 28762762632 AADCV3277E SD 001 AADCV3277E NA NA AADCV3277E

atory Information

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