FT Tower, CTS No.

256 & 257,

Suren Road, Chakala,
Andheri (East),
Mumbai – 400 093, India.
Atom Technologies Limited Tel: +91 22 6649 7000
Fax: +91 22 6649 7151
E-mail: info@ftindia.com
www.atomtech.in

Atom Technologies Limited

VENDOR REGISTRATION FORM Date:

1. Organization :
(in full, in Block letters)

2. Type of work for which:

Registration is sought

3. Name & Telephone No. of contact person:

4. (a) Head Office/Registered Office/Address :

…………………………………………………………………………

Telephone No. …………………………………..

Fax No.
E-mail ID.

(b) Branch Offices :( Enclosed separate list, if required)

Telephone No. …………………………………..

Fax No.
E-Mail ID:

5. Name of the Directors/Proprietors /Partners:

Telephone N:
Fax. NO
E-mail ID:

6. Type of Organization
(Strike out those not applicable)
a) Proprietary
b) Partnership
c) Private Limited Company
d) Public Limited Company
e) Public Sector

7. TAX DETAILS.
PAN No:
GSTIN No.:

Corporate Office: FT TOWER, CTS NO 256 & 257, SUREN ROAD, CHAKALA, ANDHERI (E), MUMBAI - 400093, INDIA.
 FT Tower, CTS No. 256 & 257,
Suren Road, Chakala,
Andheri (East),
Mumbai – 400 093, India.
Atom Technologies Limited Tel: +91 22 6649 7000
Fax: +91 22 6649 7151
E-mail: info@ftindia.com
www.atomtech.in

8. Bankers Details
Name of the Bank
Type of A/C: Savings / Current
Account No.:
IFSC Code:
Branch
Address

9. Annual Turnover for last 3 years

Year Turnover (Rs. In Lacs)

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10. Registered under MSMED Act 2006 : Yes / No.

If yes, please provide certificate of registration.

11. Appreciation Mails / Letters Attached to be attached.

DECLARATION BY VENDOR

I Confirm that:

i) No employee or direct relation of any employee of Financial Technologies Group, are in any way connected
as Partner/Shareholder/Director/Advisor/Consultant/Employee etc. with the Company.

ii) The information furnished is correct to the best of my knowledge and belief.

Signature
Name of the Authorized Signatory
Designation
Date:
IMPORTANT INSTRUCTIONS

1. This form is to be completed in all aspects. If any item is not relevant, please write “Not Applicable”.

2. Submission of incomplete application/short receipt of documents shall be sufficient cause for outright
rejection, and no further correspondence shall be entertained.

3. Physical verification of facilities as well as statements made/submitted will be carried out as necessary.
Incorrect information, if provided, may result in the cancellation of the registration.

Corporate Office: FT TOWER, CTS NO 256 & 257, SUREN ROAD, CHAKALA, ANDHERI (E), MUMBAI - 400093, INDIA.