Product/s for which registration is sought *

Company/Firm Name *

Company/Organization Type *
----SELECT COMPANY/ORGANIZATION TYPE----Private LimitedLLPPartnershipSole Proprietorship

SSI Unit *
YesNo

Foreign Collaboration *
YesNo

Sister Concern/Other Group of Company *
YesNo

Contact Person *

Contact Person Phone No. *

Contact Person Email *

Address & Financial Details

Address of Registered Office *

Phone No *

Fax

E-mail *

Works / Location of Manufacturing Unit *

Phone No *

Fax

E-mail *

Bank Details

Domestic Vendor's Bank

Bank Name

Bank Account No.

Account Holder Name

Central Sales Tax No.

State Sales Tax No.

TIN/VAT No.

PAN No.

For Foreign Vendor

Bank Name

Bank Address

Bank Account No.

Swift/Sort Code

Beneficiary Name

TIN/VAT No.

TAX ID

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