APPLICATION FORM FOR EMPANELMENT OF CONSULTANTS/CHARTERED ACCOUNTANTS WITH IT&C DEPARTMENT, GOVERNMENT OF ANDHRA PRADESH 1. NAME OF THE APPLICANT : 2. ADDRESS : (With Email, Mobile No) 3. (a) CONSTITUTION OF APPLICANT : /Nature of establishment (Whether Proprietary /Partnership/Company) (b) NO.OF ASSOCIATES CONTINUOUSLY ASSOCIATED : FOR THE LAST 5 YEARS 4. DATE OF CONSTITUTION OF FIRM : 5. WHETHER EMPANELLED ON ANY OTHER : GOVERNMENT/BANK PANELS 6. TURNOVER/REVENUE FOR THE PREVIOUS 3YEARS : 7. INCOME TAX PAN NO. : 8. COPIES OF LAST 3 YEARDS INCOME TAX : RETURNS FILED (for CA Firms)/ ANNUAL REPORTS (for Consultants Firms) 9. REMUNERATION EXPECTED (Pl quote in rupees) : 1. Attracting IT MNCs/Majors. : 2. Due diligence studies on IT companies : for eligibility on land allotment 3. Verification reports for incentive claims such : as Investment Subsidy/Power Subsidy, etc 4. Compliance Reports - on whether IT company : is adhering to ICT Policy conditions Place : Date : Signature of the applicant
