Pwd_application Form - 4
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- Words: 396
- Pages: 2
Application for Registration of Contractor (Class III)
1. Vendor Details
2. Type of vendor : 3. Name of father/husband (in case of individual) : 4. Caste : 5. Religion : 6. Date of Birth : 7. Nationality : 8. PWRD Wing : 9. Permanent Address :
Name : Registration Number : Application Number :
Street name 1 : Street name 2 : Village/Town : District : Pincode : Mobile No :
10. Present address :
Street name 1 : Street name 2 : Village/Town : District : Pincode : Mobile No. :
11. Class & Category : 12. Financial Year : 13. PAN Number : 14. GST Number : 15. Bank Details :
CLASS III
Bank Name : Branch Name : Account Number :
16. Registration Date : 17. Registration Renewal Date : 18. Address of Regd. Office (Mandatory for Partnership Street Name1 : Firm/Company Street Name2 : Village/Town : District : Pin Code : Mobile No : 19. Address of Individual/Proprietor in case of Proprietorship Firm.For Partnership firm, include address of all Partners. For Company, include address of designated person : Sl. No.
Partners/Directors Name
Age
Address
20. Contact person/Authorized Signatory details :
Name of Authorised Signatory. : Street Name1 : Street Name2 : Village/Town : District : Pin Code : Mobile No : Email Id :
21. Completed Works : Works executed in the last 5 years (Current Financial Year not to be included) : Sl. No. Prime/Sub Contractor Project Name
Details
22. Quantities of work executed in the last 6 years (Current Financial Year not to be included) : Sl. No.
Prime/Sub Contractor
Work Item
Quantity
Financial Year
23. On going works : Sl. No.
Prime/Sub Contractor
Project Name
Details
24. Key Personnel for Works and Administration : Sl. No.
Work Position
Name
Qualification
Experience
25. Details of Machinery Owned : Sl. No.
Type of Equipment
Numbers Owned
Machinery Details
26. Financial Turnover from Civil Engineering Works in the Last 5 years (Current Financial Year Not To Be Included) : Sl. No.
Financial Year
Turnover(INR)
27. Litigation History : Sl. No.
Employer
Cause of Dispute
Status
Class
Action
Date
28. Vendor History : Sl. No.
29. Brief description of requirement : Contractors Declaration I declare that the data and credentials submitted/document attached by me for the mentioned year for vendor data update is correct. Date : 01-01-1970 Place : Signature of the Applicant
1. Vendor Details
2. Type of vendor : 3. Name of father/husband (in case of individual) : 4. Caste : 5. Religion : 6. Date of Birth : 7. Nationality : 8. PWRD Wing : 9. Permanent Address :
Name : Registration Number : Application Number :
Street name 1 : Street name 2 : Village/Town : District : Pincode : Mobile No :
10. Present address :
Street name 1 : Street name 2 : Village/Town : District : Pincode : Mobile No. :
11. Class & Category : 12. Financial Year : 13. PAN Number : 14. GST Number : 15. Bank Details :
CLASS III
Bank Name : Branch Name : Account Number :
16. Registration Date : 17. Registration Renewal Date : 18. Address of Regd. Office (Mandatory for Partnership Street Name1 : Firm/Company Street Name2 : Village/Town : District : Pin Code : Mobile No : 19. Address of Individual/Proprietor in case of Proprietorship Firm.For Partnership firm, include address of all Partners. For Company, include address of designated person : Sl. No.
Partners/Directors Name
Age
Address
20. Contact person/Authorized Signatory details :
Name of Authorised Signatory. : Street Name1 : Street Name2 : Village/Town : District : Pin Code : Mobile No : Email Id :
21. Completed Works : Works executed in the last 5 years (Current Financial Year not to be included) : Sl. No. Prime/Sub Contractor Project Name
Details
22. Quantities of work executed in the last 6 years (Current Financial Year not to be included) : Sl. No.
Prime/Sub Contractor
Work Item
Quantity
Financial Year
23. On going works : Sl. No.
Prime/Sub Contractor
Project Name
Details
24. Key Personnel for Works and Administration : Sl. No.
Work Position
Name
Qualification
Experience
25. Details of Machinery Owned : Sl. No.
Type of Equipment
Numbers Owned
Machinery Details
26. Financial Turnover from Civil Engineering Works in the Last 5 years (Current Financial Year Not To Be Included) : Sl. No.
Financial Year
Turnover(INR)
27. Litigation History : Sl. No.
Employer
Cause of Dispute
Status
Class
Action
Date
28. Vendor History : Sl. No.
29. Brief description of requirement : Contractors Declaration I declare that the data and credentials submitted/document attached by me for the mentioned year for vendor data update is correct. Date : 01-01-1970 Place : Signature of the Applicant
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