VENDOR REGISTARTION FORM

Sl No Particular

Name of the company/Firm

Mailing address

3

Ph No

(1)

(2)

(3)

4

Fax no

(1)

(2)

E mail

Web site

Constitution of the firm (tick against applicable)

Govt of India Undertaking State Govt undertaking

Limited co

Pvt Ltd Co

Co Operative society

Partnership firm

Proprietor ship

Any other (specify)

Nature of business

(tick against applicable and attach documentary evidence for authorization)

Manufacturer

Agent

Distributor

Stockiest

Others

Year of establishment

Vendor Registration sought under items (give category code and description as per published category list)

Quality systems practiced

(ISO 9001,14001,18001,etc)

CH-PUR-F-14(1)/16-11-2009

Proof of above shall be

attached

12

CST reg No

13

TIN no

14

Central Excise Reg No

15

PAN No

16

Service tax Regn No

17

PPF Regn No

18

SSI/NSIC Reg No

(Indicate for which item and

validity. Also please enclose

the copy of registration)

19

Details of Financial

position provided?

Please provide details as per

Yes/No

annexure supported by

documentary evidences

20

Write up about technical

Yes/No

competence provided?

20

Bankers reference

21

Client list as per format

Yes/No

attached?

22

List of major orders

successfully executed in the

Yes/No

last five years as per

format attached?

23

Details of registration with

Yes/No

other PSUs as per format

and with copies of orders

24

Details of registration with

Yes/No

other IREL units as per

format and with copies of

orders

25

Details of collaboration

(foreign/indigenous OR

financial/technical)

26

Name and designation of

official to be contacted

Certified that the information provided above is true.

26Signature and seal

CH-PUR-F-14(1)/16-11-2009

LIST OF MAJOR CLIENTS/CUSTOMERS

(To be filled and submitted along with vendor registration form.)

Sl

Name and address of the

Names of contract

Total value of orders executed in last five years

No

organization

CH-PUR-F-14(1)/16-11-2009

LIST OF MAJOR CONTRACTS SUCCESFULLY COMPLETED

(Preferably in the last five years. To be filled and submitted along with vendor registration form. Also please attach relevant order copy preferably with work/supply completion certificate.)

Sl

Name of contract

Name and address of

Reference for Contact

Year of execution

Value

Status

No

the organization

(name and ph no)

CH-PUR-F-14(1)/16-11-2009

CURRENT VALID VENDOR REGISTRATION WITH OTHER PSUs/IREL UNITS

(To be substantiated with relevant, acceptable documentary evidence. Also please indicate if you are already registered with any other IREL units)

Sl

Name of organization

Address

Registered for (give details)

Validity of

No

registration

CH-PUR-F-14(1)/16-11-2009

LIST OF MAJOR CONTRACTS SUCCESFULLY COMPLETED WITH OTHER IREL UNITS

(Preferably in the last five years. To be filled and submitted along with vendor registration form. Also please attach relevant order copy preferably with work/supply completion certificate.)

Sl

Name of contract

Name and address of

Reference for Contact

Year of execution

Value

Status

No

the organization

(name and ph no)

CH-PUR-F-14(1)/16-11-2009

STATEMENT OF FINANCIAL COMPETENCE

(For three consecutive years ending the previous year on which the request for registration is made. The details are to be furnished from left to right from the latest to backward. The statement shall accompany audited Profit and Loss Account and Balance sheet for the relevant periods with relevant field highlighted)

Sl No

Period 1-specify

Period II specify

Period III-specify

1

Land

2

Buildings

3

Machinery

4

Sundry Debtors

5

Other assets

A

ASSETS

1

Capital

2

Reserves

3

Long Term Loans

4

Sundry Creditors

5

Other liabilities

B

LIABILITY

PROFIT & LOSS

C

Turn over

D

PBT

E

PAT

CH-PUR-F-14(1)/16-11-2009

STATEMENT OF TECHNICAL AND ORGANISATIONAL COMETENCE

(Please provide relevant information in brief including the details about the key personnels, human capital available, infrastructure facilities, technical tie-ups,patents owned, awards and accolades received,etc)

CH-PUR-F-14(1)/16-11-2009