Vendor Information Form

All the below Information’s 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: __________________________________________________________

1
*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