VENDOR REGISTRATION FORM

NAME OF THE COMPANY (IN FULL):_________________________________________

ADDRESS:________________________________________________________
________________________________________________________
City:_________________________
Pin Code:_____________________
Telephone No: ________________

Fax No:_________________

E-mail Address:_____________________________________________________

ADDRESS FOR CORRESPONDENCE

Same Above
City:__________________________
Pin Code:______________________
Telephone No:

__________________

Fax No:__________________

E-mail Address:__________________
CONCERN PERSON with contact no. : _________________________________
CONTACT PERSON with contact no. (ACCOUNTS): ______________________

FINANCIAL DATA
(1) Bank Name:
Branch:
Address:
Bank A/C Name:
Bank A/C. No.

(2) Bank Name:

Branch:
Address:
Bank A/C Name:
Bank A/C No.

IFSC Code:

IFSC Code:

C.S.T. NO.
L.S.T. NO.
EXCISE REG.NO.
ECC NO.
DIVISION
CUSTOM HOUSE
INCOME-TAX PAN NO.
PAN NO:
SERVICE TAX NO:

DATE
DATE

(a) LIST OF PRODUCTS TRADING IN

Document No: HIPL-RSBY-VR-F-01

PRODUCT
CATAGORIES
(PRINTER , PCS,
NETWORKING,
SMART CARDS,
EQUIPMENT, ETC.)

DISTRIBUTO
R

DEALER

MAJOR
CUSTOMERS

ANNUAL
BUSINESS
(RS.)

(b) CUSTOMER DETAILS

CUSTOMERS

NAME OF THE END USER

CONTACT
DETAILS

EMAIL ADDRESS

ANNUAL SALES TURNOVER / TOTAL CAPITAL EMPLOYED (APPROX)

FOR LAST 3 FINANCIAL YEARS:

Document No: HIPL-RSBY-VR-F-01

Year

ANNUAL SALES TURNER

(RS.)
Including
Excluding
Taxes &
Taxes &
Duties
Duties

CAPITAL EMPLOYED (RS.)

Total
Owners
Funds

Borrowings

NAMES AND ADDRESS OF (1) OTHER MFG. UNITS (2) SISTER CONCERNS (3)
ASSOCIATE CONCERNS
(4) SUBSIDIARIES :
FOR OFFICE
USE ONLY

(A). MANAGEMENT:
Details of Directors / Partners / Proprietor / Concerned People:
NAME
DESIGNATIO QUALIFICATION
DETAILS OF
N
S
REVEVANT
WORK EXPERIENCE

NO. OF
YEARS

(G) ANY MAJOR PROBLEMS/:

LITIGATIONS
(I) New Products

DECLARATION: I hereby declare that the information furnished in this form is correct to the
best of my knowledge. I undertake to inform you at the earliest of any change in the details
mentioned in this form.
Signature

Name

Designation

Rubber stamp of our concern:

Document No: HIPL-RSBY-VR-F-01

Document No: HIPL-RSBY-VR-F-01