Vendor Registration Form

1. Vendor Details

Vendor Name J.B. Oil Industries

JAddress with PIN code Hardoi Road, Sitapur (U.P.) - 261001

Company web site

(if any)
Mobile No 9415138024

Phone No. with STD

code

|Works/Factory address
with PIN code Vill- Rampurwa, Ram Nagar, Hardoi Rod, Sitapur (U.P.)261001

Phone No. with STD

9415138810
code

2.Category

Partnership

Please tick the applicable category & attach relevant copies of incorporation/Partnership
Deed/Registration certificate of Enterprise

3a. Classification of Industry

MSME

3b. Type of Industry

MSME

Please attach relevant registration documents

4.Nature of Business

|Manufacturing

Please tick the applicable category &In case of Dealer/Representative/Agent of any company give
complete details with a copy of authorization certificate mentioning validity date for each product

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 5.Name of Directors in case of Public/Private Limited

Sr. No Name Status

N.A

Please attach list of Directors separately

6.Name of Proprietor / Partner | M.D. IC.E.0. I Dealing Officer

Sr. No Name Contact Nol

Designation e-mail
Skype id
1 Mr. Purushottam Das Agarwal Partner Accounts@jboil.in 9696254071

2 Mr. Shiv Kumar Agarwal Partner Accounts@jboil.in 9415047095

3 Mr. Anand Kumar Agarwal Partner Accounts@iboil.in 9415138810

4 Mr. Anoop Kumar Agarwal Partner Anoop@jboil.in 9415138024

5 Smt. Chandni Agarwal Partner Accounts@jboil.in

7. Details of Products & Services

Licensed/
Sr. No Product / Services Installed Annual Production of preceding
Year
Capacity
1 Rice / Broken 10 Tonns/hour 3.00 Lakh gtls

Please attach catalogue, literature &Leaflet, if any

8. AnnualTurn Over of Previous Year: 86 CR

9. Details of technical Collaborations | JV

IName & address of Current or

SI. No. Product / Services Year
collaborator/JV Not

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 10. Details of Major customers along-with list of
items supplied

Sr. No Name & address of customer Item supplied Year Value

1 Olam Agri India Pvt. Ltd Rice 2022-23

2 Sailor Exports Ltd. Rice 2022-23
3 Shree Mahadev Enterprises Rice 2023-24
4 Radico Khaitan Ltd. Rice Broken 2023-24

Please attach copy of Purchase Orders & name of person with contact details for reference check

11. Valid Taxation Details

State TIN NIA GSTIN 09AAAFJ7211L1ZB

JPAN Service Tax

AAAFJ7211L NIA
Regn No
ECC
Regn NIA Service
NJA
No category

|Range NIA Address Excise

N/A
of Range

Division NIA Commissionerate NIA

Please attach relevant Registration documents

In case of exemption category for Service Tax, please attach previous year I.T. return copy
12. Bank Details

Name of account holder J.B Oil Industries

Name of Bank Union Bank Of India

Account Type
(Current/Cash credit CC
account)
|Account No 560101000129456

Branch Name &Address Union Bank Of India, Vijay Laxmi Nagar Station Road, Sitapur (U.P.)
|IFSC Code for ....

RTGS/NEFT UBINO912760
Please attach original cancelled cheque for bank account evidence

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13. Details of specific certification viz. ISO etc.

Sr. No Certification Validity Certifying Agency

1 ISO 9001

2 ISO 14001

3 ISO 45001

4 Others
5

Please attach copy of respective certificates

14. Details of Any recognition / Award received

Sr. No Recognition / Award Title Year of Award Issuing authority

Note:

-Wherever space is inadequate attach extra sheet by mentioning Annexure No

For J.B. OL INDUSTRIES

Parter
Authorized Signatory

Declaration

Weconfirm that the information furnished above is correct to the best of my knowledge &belief. In the
even of any information given by melus is found incorrect/false at any time, Iwe understand our
registration willbe cancelled with-out notice, besides any other appropriate action.

Signature of Authorized Person Anand Kumar Agarwal

Name in capital letters ANAND KUMAR AGARWAL

Date 04-11-2023

Place Sitapur (U.P.)

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