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 *

ALTERNATE PHONE NUMBER

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

PAY

RECEIPT FILE

LEGAL STATUS

NAME OF PROPRIETOR

GENDER

NAME & DESIGNATION OF AUTHORIZED PERSON

NAME

DESIGNATION

PARTNER DETAILS

DIRECTOR DETAILS

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 *

PRODUCT LIST

PRODUCT RELATED DOCUMENTS

MACHINERY DETAILS

UPLOAD DOC *

SAMPLE DOCUMENT

MANPOWER DETAILS

FOR PRODUCTION *

FOR QUALITY CONTROL *

MANAGERIAL *

UPLOAD DOC *

SAMPLE DOCUMENT

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 *

BIS LICENSE

BIS LICENSE APPLICABLE

BIS LICENSE ITEM DESCRIPTION

ITEM DESCRIPTION

CML NO

IS NUMBER

BEE STAR RATED CERTIFICATE

BEE CERTIFICATE APPLICABLE

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

ISO CERTIFICATE

ISO CERTIFICATE APPLICABLE

CERTIFICATE NO

ISSUED DATE

VALID UPTO

ISO CERTIFICATE FILE UPLOAD

ISO CERTIFICATE ITEM DESCRIPTION

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 )

MANUFACTURER/ AUTHORISED DISTRIBUTOR REGISTRATION FORM

MANUFACTURER/ AUTHORISED DISTRIBUTOR INFORMATION

MANUFACTURER INFORMATION

AUTHORIZED PERSON DETAILS

PAYMENT DETAILS

LEGAL STATUS

NAME & DESIGNATION OF AUTHORIZED PERSON

PARTNER DETAILS

DIRECTOR DETAILS

STATUTORY INFORMATION

REGISTRATION STATUS OF UNIT

PRODUCT DETAILS

PRODUCT LIST

PRODUCT RELATED DOCUMENTS

MACHINERY DETAILS

MANPOWER DETAILS

ELECTRIC POWER / PHASE

INFRASTRUCTURE DETAILS

TURNOVER

QUALITY CERTIFICATE INFORMATION

BIS LICENSE

BIS LICENSE ITEM DESCRIPTION

BEE STAR RATED CERTIFICATE

BEE CERTIFICATE ITEM DESCRIPTION

ANY OTHER LICENSE

OTHER LICENSE ITEM DESCRIPTION

ISO CERTIFICATE

ISO CERTIFICATE ITEM DESCRIPTION

DOCUMENT UPLOAD

TERMS AND CONDITIONS

OTHER MANDATORY DOCUMENT