Postal address with Telephone, mobile, fax nos. and email ids
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a ) Head Office/Registered Office
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3 . Registration is sought as
AUTHORISED DISTRIBUTOR
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>
IV
Registered Options
(v)The Industries (Development and Regulations) Act 1951
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 |
|---|---|---|---|
Place :
ertyer
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 Stockist. If Dealer/distributor give manufacturer’s territory represented | If Dealer/Distributor/Stockist, Name and address |
|---|---|---|
| Brief description of materials for | Brief description of materials for Brief description of materials for | Brief description of materials for Brief description of materials for |
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