R - Infra Vendor Registration Form

vendor registration form

Sections marked * are mandatory to fill.

General
Registered Office
*
Name
* Address Line 1

*
Address Line 2
* Street

* City

* State

* Pin Code

* Telephone no.
[ STD CODE ]

Fax no.
[ STD CODE ]

* e-mail id

* Web site
*
Contact
person’s name
* Mobile no.

Address for Registration

* Name

page 01 /17
R - Infra Vendor Registration Form

vendor registration form

Sections marked * are mandatory to fill.

* Address Line 1
* Address Line 2
* Street

* City
* State

* Pin Code
* Telephone no.
[ STD CODE ]

Fax no.
[ STD CODE ]

*
e-mail id
* Web site

* Contact person’s
name
*
Mobile no.

Factory/Works
*
Name
* Address Line 1

*
Address Line 2

page 02 /17
R - Infra Vendor Registration Form

vendor registration form

Sections marked * are mandatory to fill.

* Street

* City

* State

* Pin Code

* Telephone no.
[ STD CODE ]

Fax no.
[ STD CODE ]

* e-mail id

* Web site

* Contact person’s
name

* Mobile no.

Products & Services

*
Product Range

page 03 /17
R - Infra Vendor Registration Form

vendor registration form

Sections marked * are mandatory to fill.

*
Installed
Capacity
*
Average Monthly
Production

Ownership Information

Tick mark the appropirate

Govt. of India Undertaking

State Govt. Undertaking

Limited Company

Private Company

Co-operative Society

Partnership

Proprietorship

Other
Tick mark the appropirate
Manufacturer

Trader

Service Provider

Contractor

page 04 /17
R - Infra Vendor Registration Form

vendor registration form

Sections marked * are mandatory to fill.

Sub-Contractor

Year of Establishment

Financial Details
Bank Details
*
Name of bank
* Branch

*
Address Line 1
* Address Line 2

Pin Code

Telephone No.
[ STD CODE ]

* Account No.

* Account type

* IFSC code for

RTGS payment

9 digit code no.

as it appears
on the MICR
cheque
* BG Limit(in lakhs)

page 05 /17
R - Infra Vendor Registration Form

vendor registration form

Sections marked * are mandatory to fill.

* Overdraft /
cash credit
Limit (in lakhs)

Annual Results for Last 3 Years

Year 1
* Sales(Rs in lakhs)

* Other Income
(Rs in lakhs)
*
Profit before
interest & tax
(Rs in lakhs)

*
Profit after
interest & tax
(Rs in lakhs)

Year 2
* Sales(Rs in lakhs

* Other Income
(Rs in lakhs)
*
Profit before
interest & tax
(Rs in lakhs)

page 06 /17
R - Infra Vendor Registration Form

vendor registration form

Sections marked * are mandatory to fill.

*
Profit after
interest & tax
(Rs in lakhs)

Year 3
* Sales(Rs in lakhs

* Other Income
(Rs in lakhs)
*
Profit before
interest & tax
(Rs in lakhs)

*
Profit after
interest & tax
(Rs in lakhs)

Registration Details
*
CST TIN No.
* CST TIN Reg.Date

* VAT Reg. date

* VAT Reg. code

* PAN no.

page 07 /17
R - Infra Vendor Registration Form

vendor registration form

Sections marked * are mandatory to fill.

*
TIN (Tax
identification no.)
* Assessment
completed upto
*
* Excise control
code no.
* Excise reg.no

*
Excise reg. date

Range

Division

Commissionerate
*
Service tax no.
* Service reg. date

* Service reg. code

* Service category

*
Works contract no.
[ STD CODE ]

*
Works contract
Reg. date

page 08 /17
R - Infra Vendor Registration Form

vendor registration form

Sections marked * are mandatory to fill.

Withholding/tax
type

Tax code

Exemption no.

Exemption rate

Exempt from date

Exempt to date

Small scale
industries reg. no.

Valid upto

Micro, small and

medium
enterprises reg. no.

Valid upto

Organisational Strength

Graduate Diploma Skilled Unskilled

Administration

Commercial

Technical

page 09 /17
R - Infra Vendor Registration Form

vendor registration form

Sections marked * are mandatory to fill.

Manufacturing

Quality

Maintainence

Site
Management

Others

Total

Permanent
Employees (No.)

Casual
Employees (No.)

Temporary
Employees (No.)

Contract
Employees (No.)
*
Employers
Provident Fund
No.

* Date

*
No. of employees
covered

page 10 /17
R - Infra Vendor Registration Form

vendor registration form

Sections marked * are mandatory to fill.

*
ESI Reg. No.
*
Date
*
Workmen
compensation
insurance no.

*
No. of employees
covered

Manufacturing Facilities

In-house facilities

Description

Specification of
machine

Make of machine

Year of make

Year of
installation

page 11 /17
R - Infra Vendor Registration Form

vendor registration form

Sections marked * are mandatory to fill.

Outsourced
facilities, if any

Other Particulars

Major clients/
customers (value
more than 5 %
of annual sales)
served during
last 3 years.

Order value in Rs.

in lakhs

Location

Turnover (in lakhs)

Nature of supplies
(products and/or
services)

ISO Certified Yes No

*
Technical
collaboration Foreign Indigenous

Name
Description

Valid upto

page 12 /17
R - Infra Vendor Registration Form

vendor registration form

Sections marked * are mandatory to fill.

Details of regis-
tration with other
clients/
consultants for
products/
services sought
to be registered.

List of documents enclosed/upload

1. Nature of business
Manufacturer/Service provider/Trader

2. Deed of operation
Partnership deed.
certificate of incorporation.
Memorandum of association.
Articles of association.

3. Product Quality
Indian/International Standard confirmation.
Product tested/certified by independent inspection agency.
Product guarantee/warrantee.
Copy of quality tool/ISO certificate.
Test Certificates - Routine (sample), Acceptance (sample), & type test (whereever applicable)
Details of in house product testing facilities.
Small scale/micro, small and medium enterprises.
Copies of major orders executed in last three years.

4. Registration certificates enclosed

PAN and latest income tax clearance.
Sales tax/VAT registration with code and address.
Bankers solvency / credit limit certificate.

page 13 /17
R - Infra Vendor Registration Form

vendor registration form

Sections marked * are mandatory to fill.

Annual account for last three years(balance sheet, profit & loss account).
List of major customers.
Service tax registration with code and address.
Copy of Tax identification number.
List of products and services offered.

INSTRUCTIONS

1. Documents stated in the form can be scanned and uploaded. Alternatively such documents can also
be sent to the HOD CPG.
2. For any clarification please send an email to Mr.____________________at _________@_________.com
or Contact No.__________
3. Reliance ADAG reserves the right for registering or not registering any person or organization.
4. Vendor Registration Form is to be completed in all respects. If any item is not relevant, please write
“Not Applicable”.
5. Submission of incomplete application/ short receipt of documents shall be sufficient cause for outright
rejection and no further correspondence shall be entertained.
6. Quote Vendor Registration Form No. in all future correspondences.
7. Each page of Vendor Registration Form is to be duly signed at the bottom.
8. Vendor Registration on the approved list does not guarantee award of any order in your favour.
9. Reliance ADAG has a right to add or delete firm and alter or amend any of the above terms and condi-
tions and such additional/deletion amendments and alteration shall also be applicable to the firm already
registered from the date when they come into effect.
10. Reliance ADAG reserves the right not to issue the enquiry to any Registered Vendor in any particular
case, and also suspend, remove, demote or black list the vendor’s name in certain circumstances.

page 14 /17
R - Infra Vendor Registration Form

vendor registration form

Sections marked * are mandatory to fill.

LIST OF ABBREVIATIONS
CST - Central Sales Tax
VAT - Value Added Tax
Reg No. - Registration Number
Tel No. - Telephone Number
PAN - Permanent Account Number
TIN - Taxpayer Identification Number
HOD - Head of Department
CPG - Central Procurement Group
ADAG - Anil Dhirubhai Ambani Group
OEM - Original Equipment Manufacturer

DECLARATION
I/We certify that the information furnished above is correct and complete to the best of my/our knowledge and
belief. If at any time, I/We are found to have concealed any material information or given any false details,
my/our opinion shall be liable to summary termination wtihout notice or compensation.

Signature

page 15 /17
R - Infra Vendor Registration Form

vendor registration form

Sections marked * are mandatory to fill.

Vendor’s Authorized Signatory

Name

Designation

Sign

Date

Place

Technical/User Input

Requested By

Name

Sign

Department

Recommended By

Name

Sign

Department

page 16 /17
R - Infra Vendor Registration Form

vendor registration form

Sections marked * are mandatory to fill.

Approved By

Name

Sign

Department

To Be Filled By IT

Vendor Code

Approved By

page 17 /17