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

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 )