To be Filled by vendor in vendor Letter Head

Vendor Registration Form

1.

Name of Firm/Company

2.

Status of Organization
(Proprietorship/Pvt./Public Ltd.)

Proprietorship

Private Limited

Public Limited

If Other, Please Specify______________

3.

Year of Establishment

4.

Name of Proprietor/Director/MD

5.

Registered Office Address

6.

Address of H.O.; Sales Office,

Branch Office
Contact Person

7.

Contact Details

Designation
Phone No
Fax No
E-Mail ID

8.

Nature of Business
Manufacturing

Trading

Service

If Other, Please Specify______________

9.

Is the Firm registered with SME

Act
(MICRO, SMALL AND MEDIUM ENTERPRISE
DEVELOPMENT ACT, 2006)

Yes

No

If Yes, Please Attach Copy of Registration

Page 1 of 3

Others

Other

To be Filled by Vendor In Vendor Letter Head

Enclosures (Please Attach a Copy of Applicable Registrations):
Service Tax No :

____________________________________

PAN No :

____________________________________

TIN No / CST No:

____________________________________

CIN No.

_____________________________________

ESI No.

____________________________________

PF No.

_____________________________________

MSME No.

_____________________________________

Service Tax Category :

_________________________________ ___

TDS Rates & TDS Section : ___________________________________

TDS Exemption Certificate No (If Applicable) : _________________________________
(Attach Original Exemption Certificate)
Exemption Rate :
Date in Exemption Begins & Ends : Begins: DD/MM/YYYY Ends : DD/MM/YY
Bank Detail:
Please attach cancelled cheque copy
Beneficiary Name
Bank Name
Bank Address
Account No
IFSC Code

Page 2 of 3

For COMPANY Use Only

Vendor Code

Created By

Creation Date

Verified By

Creator Signature

Verifier Signature

Date:

Date:

Page 3 of 3

Verified Date