1. GENERAL
Name of the supplier			Address
Door no			Street Name
Area			City
District			State
Pin Code No			E-mail address

Nature of Business
Manufacturer			Sole selling Agent
Dealer			Trader
Agent			Assembler
Others (Please specify)

Nature of the Company
Proprietor			Partnership
Private			Public Ltd.,
Others (Please specify)
Main Commodities Supplied / Service Rendered
Key Person Name			Designation
Contact No.

2. Tax Information
GST No. with Date			PAN No.
M.S.M.E. VENDOR			M.S.M.E Certificate No.

3. Technical
Are you registered under ISO 9001?		Yes	No
If no, do you have documented quality system		Yes	No
Environment (ISO-14001)		Yes	No
Safety (OHSAS-18001)		Yes	No
If yes, enclose evidence of compliance		Yes	No
If no, do you have documented quality system		Yes	No
Do you have a quality manual		Yes	No

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4. COMMERCIAL
Please enclose Balance sheet of last 3 years		Yes	No
Are your products covered by warranty, if so, state period and scope of warranty
Do you have any association with Anupam Rasayan India Limited®, if so please mention the name of the unit and contact person Certificate No.
Enclosed the E-Payment Mandate / Original cheque		Yes	No

Further comments if any

List of enclosures
1. PAN CARD - XEROX
2. COMPANY LICENCE COPY
3. CENTRAL BOARD OF EXCISE AND CUSTOMS COPY
4. E-PAYMENT MANDATE – ORIGINAL COPY
5. ORIGINAL CANCELLED CHEQUE
6. GST CERTIFICATE COPIES
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