MANUFACTURER/ AUTHORISED DISTRIBUTOR REGISTRATION FORM

MANUFACTURER/ AUTHORISED DISTRIBUTOR INFORMATION

NAME OF MANUFACTURER /AUTHORISED DISTRIBUTOR *

TYPE

OFFICE ADDRESS IN CHHATTISGARH *

STATE *

DISTRICT *

PIN CODE *

MOBILE NO *

OFFICE PHONE NUMBER

EMAIL ID

MANUFACTURER INFORMATION

NAME OF MANUFACTURER

REGISTERED FACTORY ADDRESS AS PER UAM - MSME/ VALID NSIC/ IEM REGISTRATION

STATE

DISTRICT

PIN CODE *

FACTORY PHONE NO

MOBILE

PAN NO

PAN NO DOC

GST NO

GST NO DOC

GST ITEM SCHEDULE

AUTHORIZED PERSON DETAILS

AUTHORIZED PERSON NAME *

CONTACT NUMBER *

DESIGNATION

PAYMENT DETAILS

CSIDC BANK DETAILS (FOR NEFT & DEMAND DRAFT)
Bank Name	A/C NO	IFSC CODE	A/C HOLDER	FEES	GST@18	TOTAL
UCO BANK	18340110053447	UCBA0001834	Chhattisgarh State Industrial Development Corp. Ltd. (Marketing)	Rs. 10000	Rs. 1800	Rs. 11800

PAYMENT DATE

AMOUNT

PAYMENT MODE

BANK NAME

BANK BRANCH

DD NO

UNIQUE TRANSACTION REFERENCE (UTR) NUMBER

RECEIPT FILE

LEGAL STATUS

NAME OF PROPRIETOR

GENDER

NAME & DESIGNATION OF AUTHORIZED PERSON

NAME

DESIGNATION

PARTNER DETAILS

NAME OF PARTNER

DIRECTOR DETAILS

NAME OF DIRECTOR

COPY OF PARTNERSHIP DEED

COPY OF MEMORANDUM AND ARTICLE OF ASSOCIATION

COPY OF POWER OF ATTORNEY IN RESPECT OF PARTNER

COPY OF CERTIFICATE OF INCORPORATION

STATUTORY INFORMATION

GST NUMBER

GST HOLDER NAME

GST FILE UPLOAD

GST ITEM SCHEDULE

PAN NO

NAME OF PAN CARD HOLDER

PAN CARD FILE UPLOAD

SALE SERVICE CENTER FACILITIES *

SAMPLE DOCUMENT

REGISTRATION STATUS OF UNIT

MSME

MSME ISSUED DATE

MSME REGISTRATION NUMBER

UPLOAD DOC

NSIC

NSIC STATE

NSIC DISTRICT

NSIC ISSUED DATE

NSIC REGISTRATION NUMBER

NSIC VALID UPTO

UPLOAD DOC

IEM

IEM ISSUED DATE

IEM CERTIFICATE NUMBER

IEM VALID UPTO

UPLOAD DOC

PRODUCT DETAILS

CERTIFICATE ISSUED BY

CERTIFICATE/DOCUMENT NO

ISSUE DATE

PLACE

UPLOAD

NAME OF PRODUCT

ENLISTED IN PRODUCTION CERTIFICATE

DATE OF COMMENCEMENT

ANNUAL PRODUCTION CAPACITY

UNIT

PRODUCT RELATED DOCUMENTS

VALID CERTIFICATE FROM CENTRAL POLLUTION CONTROL BOARD (CPCB) FOR MANUFACTURING OF COMPOSTABLE BLOWN FILM (NURSERY BAGS, GARBAGE BAGS, CARRY BAGS)

VALID CIPET TEST REPORT OF BIODEGRADABILITY TEST

COPY OF INTERNATIONAL DATA CORPORATION (IDC)/GARTNER REPORT ENLISTMENT FOR DESKTOP

COPY OF QUARTER REPORT OF INTERNATIONAL DATA CORPORATION (IDC) SINCE LAST 3 YEARS FOR DESKTOP * MANUFACTURER /OEM SHOULD BE FROM THE ONE OF THE TOP 5 OEM IN ACCORDANCE WITH THE REPORT OF INTERNATIONAL DATA CORPORATION (IDC)

COPY OF ROHS (RESTRICTION OF HAZARDOUS SUBSTANCES) COMPLIANCE CERTIFICATE

COPY OF ISO 9001 AND ISO 14001 CERTIFICATE

COPY OF ENERGY STAR CERTIFICATE

MACHINERY DETAILS

UPLOAD DOC

SAMPLE DOCUMENT

MACHINE TYPE

NAME OF MACHINE

TYPE / HP

YEAR OF PURCHASE

MANPOWER DETAILS

UPLOAD DOC

SAMPLE DOCUMENT

FOR PRODUCTION

FOR QUALITY CONTROL

MANAGERIAL

ELECTRIC POWER / PHASE

ELECTRIC POWER *

CONNECTED ELECTRICITY PHASE

POWER LOAD *

AVAILABILITY DG SET

ELECTRIC BILL

BILL UPLOAD-1

ELECTRIC BILL

BILL UPLOAD-2

MENTION CAPACITY IN HP/KW

INFRASTRUCTURE DETAILS

LAND DETAILS

TOTAL PLOT/LAND AREA (IN SQ FEET)

BUILDING DETAILS

ADMINISTRATIVE AREA ( IN SQ FEET)

SHED DETAILS

PRODUCTION SHADE AREA (IN SQ FEET)

OWNERSHIP

TURNOVER

YEAR OF ESTABLISHMENT

YEAR

TURNOVER AMOUNT

YEAR

TURNOVER AMOUNT

YEAR

TURNOVER AMOUNT

CA CERTIFICATE DOC UPLOAD

QUALITY CERTIFICATE INFORMATION

QUALITY CERTIFICATION APPLICABLE

QUALITY CERTIFICATE UPLOAD

BIS LICENSE

BIS LICENSE APPLICABLE

BIS CERTIFICATE PRODUCT WISE DETAILS

PRODUCT

BIS LICENSE NO

ISSUED ON

EXPIRY ON

UPLOAD DOC

BIS LICENSE ITEM DESCRIPTION

ITEM DESCRIPTION

CML NO

IS NUMBER

BEE STAR RATED CERTIFICATE

BEE CERTIFICATE APPLICABLE

BEE CERTIFICATE PRODUCT WISE DETAILS

PRODUCT

CERTIFICATE NO

ISSUED ON

EXPIRY ON

UPLOAD DOC

BEE CERTIFICATE ITEM DESCRIPTION

ITEM NAME

ANY OTHER LICENSE

OTHER LICENSE APPLICABLE

CERTIFICATE NAME

CERTIFICATE NO

ISSUED ON

VALID UPTO

CERTIFICATE FILE UPLOAD

OTHER LICENSE ITEM DESCRIPTION

ITEM DETAILS

ISO CERTIFICATE

ISO CERTIFICATE APPLICABLE

CERTIFICATE NO

ISSUED DATE

VALID UPTO

ISO CERTIFICATE FILE UPLOAD

ISO CERTIFICATE ITEM DESCRIPTION

ITEM DETAILS

DOCUMENT UPLOAD

AGENCY AGREEMENT AS PER ANNEXURE-"H" FOR AUTHORIZED AGENT / DISTRIBUTOR

SAMPLE DOCUMENT

UNDERTAKING FILE UPLOAD *

SAMPLE DOCUMENT

TERMS AND CONDITIONS

I do hereby certify that the above furnished information is true & correct to the best of my knowledge and belief & adhere to terms & conditions. ( Terms & Conditions )