Vendor Registration Form

Registration For The Chandrapur District Central Co-Operative Bank

1. Name of the vendor (do not use special character i.e. &,',$,*,$)

2. Registered Office

a.	Address
b.	Contact Person
c.	Designation
d.	Land Line No
e.	Mobile No
f.	emailID

3. Sales Office Tick here if Address are the same.

a.	Address
b.	Contact Person
c.	Designation
d.	Land Line No
e.	Mobile No
f.	emailID

4. Local representative office

a.	Address
b.	Contact Person
c.	Designation
d.	Land Line No
e.	Mobile No
f.	emailID

5. Business Type Authorised Dealer Authorised Distributor Manufacturer Others

Name of the company

6. Vendor Category linen Chemicals Garbage bags Furnitures Electrical panel Electrical distribution box Electrial maintains materials Electrical Generator Electrical Audio Visual Equipment Electrical appliances Electrical work contractor Civil Hardware Civil Building Civil Painting Civil Sanitary Civil Plumbing Civil Pest Controlling Civil Gardening Civil Office Furniture Civil Workshop material Stationary and General Civil Building material supplier and petty contractor Printing Telephone Instrument Printer cartridge refilling Computer and accessories Hardward & Software Sport Scrap Catering, Tent servicing Office automation Vehicle Fire fighting material Service Provide (Housekeeping,Security etc.) Office Furniture Steel Furniture

If any Other (Please Input Product other than list)

7. Statutory Registrations

SrNo	Particulars	Inputs
a.	Trade License; Factory License. (i.e. For purchase of medicines drug license is required)
b.	PAN No
c.	GST NO
d.	Drug License No
e.	Other 2

8. Financial Details (based on Audited financials)

SrNo	Particulars	Last FY	Last -1 FY	Last -2 FY
1.	Total Turnover
2.	Gross Profit
3.	Net Profit
4.	Turnover of Product Offered

9. Details of Major/Government/Semi Government Customer

SrNo	Name of Customer	Empanelled For	Contact Name	Contact Number
1.
2.
3.
4.
5.

10. Bank Details

a. Bank Name
b. Branch Address
c. Account Name
d. Account Number
e. Account Type (Saving/Current/Cash Credit/Overdraft)
f. IFSC Code
g. MICR Code

11. Certificates

SrNo	Particulars	Tick as per applicability
1.	GST Registration	Yes No NA
2.	State Sales Tax Registration	Yes No NA
3.	FDA Certificate	Yes No NA
4.	Excise Registration	Yes No NA
5.	Proof of registration of the firm/Establishment/Factory License.	Yes No NA
6.	Service Tax Certificate	Yes No NA
7.	PAN card in Firm’s Name	Yes No NA
8.	Authorization certificate of dealership (agreement with principal (Along with SSI/NSIC Certificate if any)	Yes No NA
9.	Relevant ISO Certificate, if any	Yes No NA
10.	Proof of Registration with any Central Govt . Organization	Yes No NA
11.	Purchase orders issued by any Organization	Yes No NA
12.	Any Other Certificates	Yes No NA
13.	Copy of Audited financials	Yes No NA
14.	Cancelled Cheque	Yes No NA

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