Application Form for empanelment (Separate sheet for each category / product should be enclosed) 1. Name of the Company 2. Product/Item (Make/Brand) 3. Whether Manufacturer/ Authorised dealer/ Distributor/ Authorised Service provider (Relevant Documents to be enclosed) Note: Authorisation must be directly from Manufacturers. The authorisation from distributors & others will not be accepted. 4. Name and Address Name : Address : E-mail/ Fax/ Telephone No. 5. Turnover details (for the item specified above) Year No. Value in Rs. 2004 - 2005 2005 - 2006 (Relevant documents to be enclosed) 6. List of major customers for the item specified above for the years 2004 - 2005 and 2005-2006 (Name of the customer, Address with telephone no./fax number, contact person, Purchase order no. Date, value, quantity etc.) 7. Certifications obtained relevant to the product in terms of quality, functionality, performance, efficiency etc., should be mentioned and enclosed.(Such as Patent rights if any,ISO,MS certification,NOVELL and etc) 8. Service centres/ facilities Location Full address with telephone no./fax number Manpower details with designation Contact person's 9. APGST Number : 10. CST or VAT Number : 11. PAN Number : 12. Details of Application fee : Demand Draft No. Date Amount Bank 13. Any other relevant information/ Certificates (in bidders format) 14. List of documents enclosed Signature of vendor With office stamp
