Postal address with Telephone, mobile, fax nos. and email ids
No. 20, Flat B, 1st Floor, 1st Cross, Sampige Road, Malleshwaram, Bengaluru-560003
a ) Head Office/Registered Office
Bengaluru
b ) Branches/Sales Office
Mumbai
c ) Factory
NA
d ) Godown
NA
3 . Registration is sought as
SERVICE CONTRACTOR
a ) Floor area of Factory (ies) in square meters
NA
b ) No. of workers employed
NA
c ) No. of staff employed
NA
d ) List of machinery in your factory(ies)
NA
e ) List of testing facilities at your end
NA
b ) Whether you are usually holding ample stock of item(s) for which registration is sought
NA
c ) Whether you have adequate facilities for after Sales Services, give details
NA
a ) Whether you always hold adequate stock of the items for which registration is sought
NA
b ) Whether you have adequate facilities for after sales service, give details.
NA
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>
I
a ) if a Limited concern, name & addresses of Directors & Managing Director
Private Limited
b ) If Single Owner, name & addresses of Proprietor & Manager, if any
NA
c ) If Partnership, name & addresses of Partners
NA
Registered Options
(vi) And if so, the No. and date of Registration or license held under the act.
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) | Signature by all Partners/Competent Authority/Proprietor |
|---|---|---|---|
| 1 | M K S SHARMA | OPERATIONS DIRECTOR | |
| 2 | S D RAMESHA | DIRECTOR | |
| 3 | M K SHIVARAMU | DIRECTOR | |
| 4 | V B PARVATHIKAR | DIRECTOR |
Place :
Bengaluru
Signature with Official seal
Enclosure to registration form
| Brief description of materials for which registration is sought | Whether you are manufacturer, dealer or distributor or Stockiest. If Dealer/distributor give manufacturer’s territory represented | If Dealer/Distributor/Stockiest, Name and address |
|---|---|---|