Application Form For Registration of FIRM for Supply of Local Purchase Material
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marks field are mandatory
Details of Registration Form
Name of Firm / Company / Contractor :
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Postal Address of Firm :
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House/Plot No. :
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Area/Locality :
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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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Pin Code :
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Full Address :
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CONSTITUTION OF FIRM
Type of Ownership :
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Select
Proprietary
Partnership Firm
Indvidual
Govt.Co.
Limited Firm
Others
Communication Reference of the Company/Firm
Name Of Contact Person:
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Designation:
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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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Name Of Representative:
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Bank Details
Branch Name :
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Account Name :
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Bank Name :
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Account Number :
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Please Enter Valid Account No.
IFSC Code :
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Essential Documents
TinNo/Service Tax No. :
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PAN Card :
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Invalid PAN Card No.
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Only .jpg or .pdf Formate is Allowed
Firm's Address Proof
:
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Proof for Bank details :
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Owner's Photo Identity Proof :
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Pan Card :
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TinNo/Service Tax No. :
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