Gujarat Narmada Valley Fertilizers Co.

Ltd
(An ISO 14001 Company)
Regd. Office :
P.O.:Naramadanagar–392 015,
Dist. Bharuch, Gujarat, India
Phone : (2642) 247001-2
Fax : (2642) 247122 / 247059

Application Form For Registration/Enlistment As

An Approved Supplier For Supply of Goods to GNFC
Important Instructions:
a. The applicant should fill up the form with details/data applicable and send Hard Copy of
the application duly signed and stamped addressed to The Head (Materials
Management) at the above address.
b. Complete and definite answers must be given to all questions, otherwise the application
may not be considered. If any matter is not applicable, please write “Not Applicable”
against the same. If space is insufficient, separate annexure may be attached, which
must also be signed by the same person/persons signing this application.
c. This form is not transferable
d. GNFC reserves the right to accept or reject the application without assigning any
reason(s)
e. Along with the application, the applicant to furnish following details/documents :
 Copy of TPA (Third Party Agency) approval, if available any
 Copies of purchase orders executed for other reputed organizations
 Customer list
 QAP Details
 Catalogue / Literature
 Financial results / Balance sheets of last two years
 Inspection facilities; Order back log, if any; Vendor’s position with respect to Finance
 Details of Sister Concerns/Organizations, Subsidiaries, if any

1 Name of the Company : .

2 Office Address : .

. .

Telephone/Cell No : .

Contact Person: . Designation: .

Fax: . e-Mail: .

3 Factory/Works Address : .

. .

Telephone/Cell No : .

Contact Person with designation : .

Fax: . e-Mail: .

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 Weekly Off Day: .
4. Brief Description of Product(s) applied for : .
. .

5. Registration details of the Firm (Please enclose copy of registration certificate)

(Whether registered under (a) The Indian Companies Act (b) The Indian Partnership
Act 1932 (c) The Indian Factories Act 1948 or (d) Any other Act / If Not Who are the
owners?)

Ans : .

Note :
a. In case of a Company,
i. a complete list of Directors with their names, address,
telephones is to be given as attached sheet,
ii. Details of issued, subscribed and paid up Capital should also be
furnished.
iii. Latest Income tax Clearance Certificate must accompany with
this application.

b. In case of Partnership,
i. names and addresses of all the partners with details of capital invested by each
partner are to be given as attached sheet.
ii. Income tax clearance certificate of each individual partner in addition to the
Income Tax clearance certificate in the name of the firm should be furnished
with this application.

6. Sales Tax / Excise Registration / PAN Details of the Applicant Firm :

a. TIN :

b. CST Registration. No. :

c. ECC No., Range, Division & Commissionorate :

d. PAN :

7. Name and Address of the Banker :

8. Financial Details of the Applicant Firm : (Please attach Financial results / Balance
sheet of Last Two Years covering details of Total Sales, Pretax Profit, Net profit after
tax, capital employed, Reserves, etc.)

 Financial results / Balance sheet of Last Two Years enclosed : Yes / No

9. Employee Details :
(a) Managerial: (b) Production: .

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 (c) Q.C./Inspection: (d) Other: .

(f) Total: .

10. Nature of the Company :

(a) Micro Enterprise (b) Medium Enterprise (c) Small Enterprise (d) Other

Ans : .

(Note : Investment in Plant & Machinery : Micro Enterprise=up to Rs. 25 lacs, Small Enterprise=Rs. 25 lacs
to Rs. 200 lacs, Medium Enterprise=Rs. 200 lacs to Rs. 1000 lacs. Other=Rs. 1000 lacs plus)

11. Category of the Firm :

a. Manufacturer (b) Manufacturer’s Dealer / Distributor (c) Stockist

Ans : .

Note :
(a) If applicant firm is a manufacturer, details/documents to be furnished as attached sheet
are : (i) Location of manufacturing works/Factory/Factories owned, (ii) Production capacity
(Specifying each item separately), (iii) Details of arrangements for quality control of
products such as laboratory tests, In-process Inspection etc., (iv) Details of Inspection
facilities available in your premises for pre-shipment inspection, (v) Whether Products /
Items are tested to any standard specifications, (if so copies of original test certificates
should be submitted), (vi) Details of major equipments / machines available, (vii) technical
collaboration(s), if any.
(b) If applicant firm is a manufacturer’s dealer/distributor, details/documents to be furnished
as attached sheet are : (i) Name and address of manufactures(s)’s, Products/Items
manufactured by each, (ii) Valid Dealership/Distributorship Certificate of Manufacturer(s),
(iii) Whether you have facilities to offer “after sales services", (iv) Whether you are in a
position to supply the equipment/spare parts for which your Principals desire registration
and the extent of stocks maintained together with value thereof.
(c) If applicant firm is a Stockist, details/documents to be furnished as attached sheet are: (i)
Location of Godown(s), (ii) Detail of articles or class of articles normally stocked and the
extent of such stocks, (iii) Approximate annual turnover and the facilities you have for
replacement of stocks

12. Registration as Approved Vendor with Other Organizations :

(a) Are you on the list of approved suppliers/contractors of D. G. S & D., Government
Undertakings, Fertilizer plants or other authority? If so, give Registration Nos. &
dates with full details.

Ans : .

(b) Are you registered as regular vendor with the following? If so, please give details
of items and capacities for which you are registered with them with zerox copy of
their letter.
(a) EIL (b) UHDE (c) TDC (d) PDlL (e) Any other

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 Ans : .

13. Are you already doing business with GNFC and if so, since when? Also please furnish
copies of GNFC’s Purchase Orders.

Ans : .

Did you applied for registration in GNFC before, and if so when and what results?

Ans : .

14. Are you prepared to abide by the General Conditions of Purchase (GCP) and/or Mini-
GCP of GNFC?

Ans : Yes / No

15. e-Tendering : Depending on Nature of items/Value of enquiry, GNFC may opt for e-
Tendering. Are you prepared to create Infrastructure required for e-Tendering (PC,
Internet & digital signature certificate) ?

Ans : Yes / No

16. Do you have a Quality Policy Manual ? (If yes, please attach copy)

Ans : Yes / No

17. Quality Assurance Plan :

Please tick in the column “d”, “e” or “f” as applicable against each entry
System Procedure Adequate
in Effect Written records
A b c d e f
1 Bought Out Is there a system for control of the
Materials bought out materials quality ?
2 In Process Is In-process materials inspected /
Inspection tested ?
3 Final Inspection Is finished materials inspected / tested ?
4 Out Going Audit Is out-going finished goods checked for
packing identification ?
5 Materials Quality Are rejected materials identified and
Identification kept aside ?
6 Gauge/Instrument Are gauges/instruments periodically
Control inspected and calibrated ?
7 Sub Contractor Is there a system to assure conformance
Control to specifications ?
8 Documentation Do you have Quality Assurance Manual ?
Do you have inspection & testing
instructions ?
9 Records Do you have adequate inspection
records to show

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 (a) Nature/number of
observations
(b) Number/type deficiencies
found
(c) Disposition of materials
(d) Inspection identification
18. Are you having any of the following Accreditation/Certification? : (If yes, please
specify & attach copy)

(a) ISO 14001, (b) ISO 18000 (c) ISO 9001.

Ans : Yes / No

19. Is your shop/product(s) IBR Approved : (If yes, please enclose copy)

Ans : Yes / No

DECLARATION BY DIRECTOR / PATNER / PROPRIETOR

I/We hereby declare that information provided above is true to the best of my/our
knowledge. I/We undertake to inform GNFC at the earliest, any change in details mentioned
above.

Date : Signature :

Seal / Stamp of the company Name & Designation :

Note : If this application is from a proprietorship firm, it should be signed by the proprietor and if from a
partnership firm, by all partners or one of them who holds the power of attorney duly authorizing him to sign for
and bind the firm in all contractual obligations. If from a Limited Liability Company, the application should be
signed by the managing Director or one of the other Directors, or a duly constituted attorney who has the
necessary authority to do so. When this application is signed by a person who holds a power of attorney
empowering him to do so much power of attorney in original together with a certified copy should be submitted
along with the application.

Check List :

Documents/Details Enclosed

1. Third Party Approval (TPA) Copy Yes / No

2. Purchase Orders Copies Yes / No
3. Customer List Yes / No
4. QAP Details Yes / No
5. Products Catalogue / Literature Yes / No
6. Financial Results of Last three Years Yes / No
7. Copy of letter of Bankers for Working Capital Limit Yes / No
8. Copy of latest Income Return filed Yes / No
9. Inspection Facilities Yes / No
10. Details of Order back Log, If any Yes / No
11. Details of Sister Concerns / Subsidiaries Yes / No
12. Company Registration Certificate Yes / No
13. Quality Policy / Manual Yes / No

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