Vendor Information Form

All the below Informations must be filled in CAPITAL Letters Only

https://www.eproc.bihar.gov.in

Type of Company: Individual

Company

Partnership

*Company Name: ___________________________________________________________

*Contact Person: ___________________________________________________________
Designation: ______________________________________________________________
*Dig Cert Serial No: _________________________________________________________
*Address: _________________________________________________________________
__________________________________________________________________
*City/District: ______________________________________________________________
* ZIP/PIN Code: ____________________________________________________________
*State: _____________________________________________________________
*Landline No: (With STD Code)___________________________________________
* Mobile No: _________________________________________________________
Fax No: ____________________________________________________________
*Email Address:_______________________________________________________
Website (URL): ____________________________________________________________
*PAN / TAX ID No: __________________________________________________________

*Bank Name :________________________________________________________

*Branch:____________________________________________________________
*BankAccount No :____________________________________________________
*Bank Code(IFSC Code) :_______________________________________________

Registration Details with statutory bodies (if any)

Registered with Department: ________________________________________________
Registration No_____________________________________________________________
Class of Registration: ________________________________________________________
Date of Registration: __________________________________________________
Valid Up to: __________________________________________________________
Note: - (*) mark are mandatory field, which must and should to be entered

I declare all above information is true and correct.

Signature