INDUSTRIAL RUBBER COMPANY

Postal address with Telephone, mobile, fax nos. and email ids
NO,239, ManayeripattI road, Vendayampatti, Thanjavur dist, Thanjavur-613402
Mobile No: 936025356
a ) Head Office/Registered Office
no 11/a Ground floor 3rd street East side,Vin Nagae, Kattur, Trichy-620019
3 . Registration is sought as
MANUFACTURER
a ) Floor area of Factory (ies) in square meters
27000 sq.ft
b ) No. of workers employed
50
c ) No. of staff employed
30
a ) Are you a sole dealer/distributor or Regional dealer/distributor. State territories held and attach copy of valid authorized
TAMILNADU
7 . Whether firm is ISO certified or any other certification, mention details and documentary evidence
8. Group of Items/service for which registration is sought <a href="sites/default/files/ANNEXURE_c.pdf" target="_blank">(Refer Annexure-C for Group details)</a>
III
9. Letter of authority from OEM as dealer/distributor with details of dealership/distributorship, if applicable
c ) If Partnership, name & addresses of Partners
DHANALAKSHMI - No 11/a 3rd Street, East Side, Vin nagar, Kattur-620019
Registered Options
(ii) The Indian Partnership Act, 1932.
Upload duly signed and stamped letter containing above additional information
12. Sales Tax Registration No. (attach copies of GST Certificates)
13. Are you registered under NSIC and submit NSIC registration as a proof
14 . Are you registered under MSME and submit “Udyam Registration Certificate” as a proof
15 . Are you on the list of approved/registered supplier in Dept. of Atomic Energy or any of its units/any Govt./Semi-Govt. dept./GeM (Govt. e-Market)
16 . Bankers Name, address, Account no
Declaration
Sr. No. Name Position(Whether Proprietor, Partner or Share Holder) Contact Details Email ID/Phone Number
1 DHANALAKSHMI Managing Partner admin@irctyre.cm
Place :
Trichy
Signature with Official seal
Industrial rubber company
Enclosure to registration form
Brief description of materials for which registration is sought Whether you are manufacturer, dealer or distributor or Stockist. If Dealer/distributor give manufacturer’s territory represented If Dealer/Distributor/Stockist, Name and address
Solid Tyres Manufacturer
Declaration

a.We (name of the firm) do hereby declare that the entries made in this application are true to the best of our knowledge.

b. We also declare that all the material/documents provided by ITER-India, IPR shall be treated as CONFIDENTIAL and no information shall be passed on to any unauthorized person/firm without written permission of ITER-India, IPR

c. We also undertake to inform all subsequent changes affecting the accuracy of the answers given in this registration form will be promptly communicated to your organization

d. Ms/Mr. whose signatures are given below is an authorized representative of this firm

a. We
INDUSTRIAL RUBBER COMPANY
d. Ms/Mr.
DHANALAKSHMI
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