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VENDOR REGISTRATION FORM

Vendor Code

(To be Filled in by the ERP VMF Operator)

Company Name

Plant (KWPCL / JPL / BOTH)

Registered Address

House No./Building No*

Street Name *

City *

State *

Post Office * Pin Code

Telephone Number *

Fax Number

Country*

Registered Address Contact Person

Name *

Designation *

Land Line Number *

Mobile Number *

Email Id *

Communication Address

House No./Building No. *

Street Name *

City *

State *

Post Office *

Country *

Telephone *

Fax Number *

Communication Address Contact Person

Name *

Designation *

Land Line Number *

Mobile Number *

Email Id

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VENDOR REGISTRATION FORM

Vendor Type * (Service / Turnkey / Materials / Spares / Stationery/ IT/ HR/)

Industry / Details * Specialisation of the Vendor in Brief

Reference Customers * Reference Customers (Similar Work) by the Partner especially for orders larger than 1 Cr.

Vendor Group * Domestic Capex / Opex, Foreign Capex/Opex, Avantha Group company, One Time Vendor, Statutory Vendor, Transporter, Secured Loans, Mutual Fund

Is the Partner Directors / Partner Account Representative related to any Employee of APIL/ JPL/ KWPCL

If Yes give Details :

Is the Partner Directors / Partner Account Representative related to any Director of APIL/ JPL/ KWPCL

If Yes give Details :

SSI Number *

(Please provide the Registration Number under MSME Act 2006 and also attach a copy of Registration Certificate)

PF Code As per Labours Laws compliances (Attach copy of PF Registration Certificate)

Account Number * 1. Attach Cancelled Cheque along with

Certification of Bank Details from Bank. 2. Please attach duly certified Annexure 1 for

Electronic Clearing Facility.

Payee name *

Bank Name *

Bank Branch Address *

Account Type *

MICR Number *

Excise Registration No * (Attach Copy of Registration Certificate)

Service Tax Registration No * (Attach Copy of Registration Certificate)

CST/LST/VAT/TIN Registration No *

(Attach Copy of Registration Certificate)

PAN Number* (Attach Copy of PAN Card on Company Letter Head)

Labour Cess Registration (Attach Copy of Registration Certificate)

Import – Export Code

All Fields with * mark is Mandatory

Requestor to ensure all Mandatory information is duly filled and all attachments in place before sending the form for Vendor Creation

Vendor Representative Name & Sign

Certified that all details given by me above in the form are true. Date

Requested By Name & Signature

Certified that all the required details have been filled and attached before sending the form for Vendor Creation.

Date

Approved By & Date Finance Department

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Checklist for Vendor Creation

1. New format of Vendor Application Form Ver -2.0 and fulfil all columns. ( )

2. Copy of PAN with signed and stamp or copy of PAN card on Company Letter Head ( )

3. Original cancelled cheque (Yes/No) ( )

4. Certification of bank details from bank on attached format or Company Letter Head ( )

5. SSI Number (if he has…) with Self Attested document or if not then declaration on

attached format on Company Letter Head. ( )

6. Service Tax (if he has…..) With Self Attested document ( )

7. CST/LST/Vat/Tin (if he has……….) with Self Attested document ( )

8. Excise Number (if he has………….) with Self Attested document. ( )

9. Signed of Vendor on the Vendor Form (Vendor Representative Name & Sign) ( )

10. Approved by Finance (Name & Signature on the Vendor application Form) ( )

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SMALL SCALE INDUSTRIES DECLARATION

Whomsoever it may concern________________________________________________________,

this is to certify that we are not registered under Micro, Small and Medium Enterprises Act.

Yours sincerely,

_______________________

Date : __________________

Place :__________________

*Printout on Vendor’s letter head only *.

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Bank Details Required for Electronic Clearing Service

Company Name

Registered Address

Bank Name

Bank Branch Address

Account Type

Account Number

MICR Number

IFSC / NEFT Code of Bank

Authorized Signatories

Name

Date

Certified that the particulars furnished above are correct as per our records.

Signature of the authorized Official from the Bank with Stamp