Organisational Information-Basic

• Name of the Organisation*
• Legal Structure*
• Contact No.*
• Fax
• Website
• Full Postal Address*

Contact Person Details

• Name*
• Designation*
• Email*
• Mobile*
• Phone*

Principal Officer Details

• Name*
• Designation*
• Email*
• Mobile*
• Phone*

Products/Services

Sr. No.	Product/ Services Descriptions	Size/ Range

Add Item Remove Item

Year of Establishment & Commencement of Business*
Details (Incase vendor is an authorised agent / channel partner / autorised reseller)*
Tender/ LOA No. (Otherwise write not applicable)*

Organisational Information-Statutory / Legal

Companies Registration No. with Registrar of Companies*
Registration of Shops and Estiblishments / Other Local Bodies*
Income Tax Pan Number*
Income Tax Ward & Range*
Service Tax Registration Number*
Vat Registratoin No.*
CST Registration No.*
Central Excise Registration No.*
Central Excise Range*
Category of MSME as Per MSME Act*
GSTN Number*	1.

Bank and Payment Mandate

Payment Mode* (NEFT/ RTGS/ ECS/ Cheque)
Name of Beneficiary*
Name of Bank*
Bank Branch Address*
Account Type* (Savings, Current, Cash Credit, Etc)
MICR Code* (9 digit micr code as appearing on cheque leaf)
IFSC Code* (11 digit IFSC code of the bank branch)
Declaration I/ We, hereby declare that the particulars given above are correct and complete in case the transaction is delayed or not effected at all for reasons of incomplete or incorrect information and for reasons beyond the control of otpc, I/We would not hold, OTPC responsivle. I/We declare that, whenever there is a change in the above details, I/We shall furnish the form afresh.