REGISTRATION FORM
A. GENERAL INFORMATION:
Name of Organisation:
Registered Office Address:
City: Pin:
District: State:
Phone:
Fax:
Website Address:
Contact Person 1
Name:
Designation:
Email:
Mobile:
Phone:
Ext:
Fax:
Branch/Factory Address :
City: Pin:
District: State:
Phone:
Fax:
Email ID:
Contact Person 2
Name:
Designation:
Email:
Mobile:
Phone:
Ext:
Fax:
REGISTRATION FORM
B. REGISTRATION DETAILS:
State Sales Tax/VAT No.
CST No.
Excise Registration No
PAN
TAN
Trade License Number
Organization Status
(Select any one)
Public Ltd
Private Ltd
Partnership
Proprietorship
PSU
LLP
Other (please       specify)
SSI Unit
Yes
No
If Yes, Reg No.
Organisation Type (Select any one)
Manufacturer
Trader - Wholesale
Trader - Retail
Distributor/Dealer
Service Provider
Contractor
Other (please        specify)

In case of Trader / Distributor/Dealer mention the name of the companies whose products are being dealt with: In case of Contractor mention in detail about type of work done, contract value, duration, location etc.
PF Registration No.
ESI Registration No.
Service Tax Regn No.
ISO Registration
ISO Registration
Yes
No
If Yes, Reg No.
REGISTRATION FORM
C. OTHER DETAILS:
Major Products/Areas/Services dealt with. (Attach product wise detail technical specifications etc if any).
Annual Production.
Annual Turn Over in lacs.
Major customers/Clientele : Provide self-attested photocopies of the credential certificates.
Company Name:
Company Name:
Company Name:
Contact Person:
Contact Person:
Contact Person:
Designation:
Designation:
Designation:
Address:
Address:
Address:
City:
City:
City:
PIN:
PIN:
PIN:
District:
District:
District:
Contact No:
Contact No:
Contact No:
Mobile:
Mobile:
Mobile:
Other information (if any):
Place.
Date.
captcha

Name & Signature by authorized Signatory with seal
Self-attested photocopies of all registrations numbers must be submitted with the application.