REGISTRATION FORM FOR CLASS A ELECTRICAL CONTRACTOR
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marks field are mandatory
Details of Registration Form
Please Tick (
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इंदौर क्षेत्र
उज्जैन क्षेत्र
Name of Firm / Company / Contractor :
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Postal Address of Firm
Address of Firm :
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State :
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Select
Arunachal Pradesh
Assam
Andaman And Nicobar Islands
Andhra Pradesh
Bihar
Chhattisgarh
Chandigarh
Daman And Diu
Delhi
Dadra And Nagar Haveli
Goa
Gujarat
Haryana
Himachal Pradesh
Jharkhand
Jammu & Kashmir
Karnataka
Kerala
Lakshadweep
Meghalaya
Manipur
Madhya Pradesh
Maharashtra
Nagaland
Orissa
Other
Punjab
Pondicherry
Rajasthan
Sikkim
Tripura
Tamil Nadu
Uttarakhand
Uttar Pradesh
West Bengal
Division :
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District :
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City :
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Pin Code :
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Communication Reference of the Company/Firm
Phone No. [Office] with STD Code :
Fax No. [Office] with STD Code :
Mobile No :
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E-Mail ID [Firm] :
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Essential Pre Qualification Requirement
"A" Class Electrical Contractor Licence issued by the Electrical Safety Department,Govt. of MP.
"A" Class Licence Number :
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Date
Valid up to date :
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Issuing Authority :
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Issued on the name of :
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Attachment :
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Note : Self attested Copy of Licence essentially be submitted, failing which the case for registration shall not considered.
P.W.D. Registration
Registration Number:
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Date
Branch of Registration :
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Class of Registration :
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Valid up to date :
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Issuing Authority :
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Issued on the name of :
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Attachment :
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Note : Self attested Copy of Registration essentially be submitted, failing which the case for registration shall not considered.