Fields marked with Asterisk (*) sign are mandatory. All Attachments should be in PDF format ONLY. PAN Card copy compulsory for vendor registration. Vendor Type Services Vendor Material Vendor General Details Name of Vendor * Title * - Select -CompanyMr.Mr. and Mrs.Ms.M/S Street/House No * Address Line1 * Address Line2 Address Line3 PO BOX No Telephone No1 Telephone No2 Contact Person Name * Contact Person Designation Web Site Country * - Select -AfghanistanAlbaniaAlgeriaAmer.Virgin Is.AndorraAngolaAnguillaAntarcticaAntigua/BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshhBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia-Herz.BotswanaBouvet IslandBrazilBrit.Ind.Oc.TerBrit.Virgin Is.BruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral Afr.RepChadChileChinaChristmas Is.Coconut IslandsColombiaComorosCongoCook IslandsCosta RicaCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican Rep.Dutch AntillesEast TimorEcuadorEgyptEl SalvadorEquatorial GuinEritreaEstoniaEthiopiaFalkland IslndsFaroe IslandsFijiFinlandFranceFrenc.PolynesiaFrench GuayanaFrench S.TerritGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHeard/McDon.IslHOLLANDHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyIvory CoastJamaicaJapanJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslndsMartiniqueMauretaniaMauritiusMayotteMexicoMicronesiaMinor Outl.Isl.MoldaviaMonacoMongoliaMontserratMoroccoMozambiqueMyanmarN.Mariana IslndNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiue IslandsNorfolk IslandNorth KoreaNorwayOmanPalauPanamaPap. New GuineaParaguayPeruPhilippinesPitcairn IslndsPolandPortugalPuerto RicoQatarReunionRomaniaRussian Fed.RwandaS.Tome,PrincipeSamoa, AmericanSan MarinoSaudi ArabiaScotlandSenegalSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth KoreaSpainSri LankaSt Kitts&NevisSt. HelenaSt. LuciaSt. VincentSt.Pier,Miquel.Sth Sandwich IsSudanSurinameSvalbardSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTokelau IslandsTongaTrinidad & TobagoTunisiaTurkeyTurkmenistanTurksh CaicosinTuvaluUAEUgandaUkraineUnited KingdomUruguayUSAUzbekistanVanuatuVatican CityVenezuelaVietnamWallis, FutunaWest SaharaWestern SamoaYemenYugoslaviaZambiaZimbabwe State/Region City Postal code * Vendor E-Mail * Mobile No Fax No Contact Person No(Direct) Contact Person E-mail Overseas Office Business Details Are you ISO certified? Yes No Type of Certificate Validity of Certificate Issuing authority Year of certification Type of Firm * - Select -Joint VentureNGO FirmPartnership FirmPropritorshipPSU / Govt. Org.Public Ltd. Co.Pvt. Ltd. Co. Nature of Business * Stockists Agent Traders Manufacturing Dealers Distributers Consultancy Logistics Service Provider Contractor Address of WorkShop(For Manufacturer) / Name & Address of Principal (For Agent/Dealer/Stockist) Tax Details C.S.T. No Micro, Small & Medium Enterprises * Yes No Registered with Excise? * Yes No Excise Range Excise Division Excise Collectorate Registered under GSTN? * Yes No GST Ven. Class * - Select -RegisteredNot RegisteredCompounding SchemePSU/Government Organization MSME Registration no ECC No PAN No * PAN card attachement * Files must be less than 2 MB.Allowed file types: pdf. GST No * GST Doc attachment * Files must be less than 2 MB.Allowed file types: pdf. Documents I hereby confirm that I am making this vendor creation request on the basis of receipt of hard copies of the following selected documents and are in my custody for reference and audit. Vendor Name / Address ( Eg. Letterhead / Bill / Invoice / Challan) ECC / SS Indicator / Jurisdiction Address (Eg. Scanned Certificate to upload) Service Tax Reg No (Eg. ST Registration Certificate / Invoice / Bill) LST / VAT TIN / CST/ EPF / ESIC (Eg. Scanned Certificate to upload) Upload Zip/rar file * Files must be less than 2.5 MB.Allowed file types: rar zip. Declaration DECLARATION All the details provided in this questionnaire are correct and up-to-date as per the best of our belief and knowledge. We understand that we are liable for any dispute arising out of any discrepancy in the details provided here and take full responsibility for the same, if, as and when arises. Name * Designation Date * Location * Terms & Conditions Providing information in the "Vendor Information Form" does not constitute acceptance as an approved & registered vendor. The registration of vendor is the sole discretion of Excel Tech Group. Failure to enter all of the mandatory information will not enable us to post your vendor file to our database. Being a registered vendor does NOT guarantee the receipt of notification for all applicable solicitations or invitation to offer or the award of any purchase contract or award of any invitation for bid or request for proposal or request for qualifications. Vendor is responsible for the content of the information and its vendor's responsibility to keep all information current and provide any subsequent up dates, additional information as and when required and when desired by Excel Tech Group. EXCEL TECH GROUP reserves the rights to evaluate the vendor on periodical basis and decide the continuation / discontinuation of business with them based on the evaluation report. Representative of EXCEL TECH GROUP 'OR' their nominated agency has the right to visit vendor's premises for the verification of information with a prior intimation to them. At later date if it is found that the information furnished is untrue, inaccurate, not current, or is incomplete, we reserve the right to suspend or terminate the registration and recover the dues (if any) from you. Terms & Conditions * I / We have read the terms & conditions & hereby declare my / our acceptance for the same CAPTCHAThis question is for testing whether or not you are a human visitor and to prevent automated spam submissions. What code is in the image? * Enter the characters shown in the image.
