Customer Registration

Kindly fill in the following details about your esteemed organization for the updation of our database. We assure you that all information provided by you shall be kept confidential.

CUSTOMER REGISTRATION FORM

Category (Manufacturer / Trader / Dealer etc)* Please fill this field

Major Product / Service Please fill this field

GENERAL INFORMATION

Name of The Customer* Please fill this field

Name of The Promoter Please fill this field

Date of Incorporation* Please fill this field

Status of The Customer* Please fill this field

ADDRESS FOR CORRESPONDENCE

House Number & Street* Please fill this field

City* Please fill this field

Postal Code* Please fill this field

State* Please fill this field

Telephone Number* Please fill valid number

Fax Number Please fill valid number

REGISTERED OFFICE

House Number & Street Please fill this field

City Please fill this field

Postal Code Please fill this field

State Please fill this field

Telephone Number Please fill valid number

Fax Number Please fill valid number

FACTORY / WORKS

House Number & Street Please fill this field

City Please fill this field

Postal Code Please fill this field

State Please fill this field

Country Please fill this field

Telephone Number Please fill valid number

Fax Number Please fill valid number

Company Website Please fill this field

CONTACT PERSON DETAILS

Name* Please fill this field

Department* Please fill this field

Designation* Please fill this field

Mobile Number* Please fill valid number

E-Mail Id* Please fill valid email id

Alternate E-Mail Id* Please fill valid email id

TAXATION DETAILS

Income Tax Number (Pan)* Please fill this field

Excise Registration Number* Please fill this field

Excise Range* Please fill this field

Excise Division* Please fill this field

Excise Commissionerate* Please fill this field

Tin Number* Please fill this field

VAT / CST Number* Please fill this field

Service Tax Registration Number Please fill this field

BANK DETAILS

Banker's Name Please fill this field

Bank Branch Please fill this field

House Number & Street Please fill this field

City Please fill this field

Postal Code Please fill valid code

State Please fill this field

Bank Account Number Please fill this field

IFSC Code (Please get this code from your bank branch) ( 11 Digit) Please fill this field

FINANCIAL DETAILS

Financial Year

Please fill this field

* Kindly specify the figures in INR Crores and enclose the audited financial reports for the same.

REFERENCES

List Your Top Five Clients

Please fill this field

Are You A Customer/Vendor To Any Of The Vedanta Group Companies? (Yes / No) (If yes, please enclose the order copies)

Please fill this field

OTHERS

Is any of your relatives working in one of the Vedanta Group Companies? (Yes / No) Please fill this field

If yes, kindly provide the following details

Name* Please fill this field

Designation Please fill this field

Company Please fill this field

Location Please fill this field

I / We declare that the information furnished above is correct to the best of my / our knowledge.

I / We undertake to inform you at the earliest of any changes in the details mentioned above.

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