VENDOR REGISTRATION FORM

* mark fields are mandatory

Registration Category* Original Equipment Manufacturer
Distributor/Dealer/Stockist
Micro/Small Enterprise
Public Sector Unit
Govt. Dept
Consortium/State/Govt. Agencies
Others
If others, please specify
Name of Individual/Firm/Company* :
Registration Number* :
Registration Authority* :
Date of Registration* :

Name of the Chief Executive / Director / Owner / Partner:

Email: Mobile:
Landline. No. (prefix std code):

Name and designation of the contact person:

Address for communication:
Email: Mobile:
Landline. No. (prefix std code):

Company website address:

OFFICE ADDRESS
Address* :
Street* : City* :
District* : State* :
Pincode* : Mandal :
Telephone* : Fax :
Mobile(Start with 0)* :
Email* :
Alternate Email :
Branch Address
Address* :
Street* : City* :
District* : State* :
Pincode* : Mandal :
Telephone* : Fax :
Mobile(Start with 0)* :
Email* :
Alternate Email :
Firm Address
Address* :
Street* : City* :
District* : State* :
Pincode* : Mandal :
Telephone* : Fax :
Mobile(Start with 0)* :
Email* :
Alternate Email :
 APPLICANT PROFILE

1. Type of Ownership: Individual

(Enclose supporting document Partnership
attested by public Attorny) Ltd. Company(Private/Public)
PSU/Govt. Undertaking
Research Institute
Trust
Joint Venture/other tie-up for equipment, financial backing
or Project Management
Joint Ventures :
If Others :

2 a) Category of Industry as per Micro

MSMED Act, 2006 Small
Medium
SC/ST owned MSE
Women owned MSE
If you are Micro/Small Enterprise,please enclose Udyog Aadhaar (Memorandum
and Acknowledgement) & EM-II Certificate (if applicable) full set of self certified photocopy .
DIC / NSIC / KVIC / KVIB / CB / DHH Certificate, if applicable please submit self certified photocopy

b) Is your firm a startup? If so, please provide recognition certificate by

Dept. of Industrial Policy and Promotion
Yes
No

(c) Do you have ISO Yes Valid Upto:

9000/9001/9002 certification? No
If yes, please specify
& indicate validity

(d) In case of certification by other accredited institutions, please give details:

Institution:
Type of Certification:
Valid up to:

3 Is your firm / Co. registered Yes

No

If Yes, furnish below details and enclose supporting document for applicable category
a) As a proprietary firm? Yes
No
If yes, give the names of all firms
having the same proprietor:

b) Under Indian Partnership Act 1932? Yes

No
If yes, give the names of all firms
having same partners:

c) Under Indian Companies Act 1956? Yes

No
Details:
4. Nature of Business carried out: Manufacturer
(Attach Brochures / leaflets of Service / Subcontractor
products manufactured)* Authorized Agent
Dealer
Trader
Consultant
CivilWorks
Conversion/Outsourcing
Others, please specify

5. Items of Manufacture / Service / Civil

Works / Agency / Dealership /
Consultancy for which Registration
is sought:

6. List of product categoty being dealt Capital Items

with (Please put tick mark) Raw Materials (Metals / Ferro Alloys / Alum. Bars etc.)
Production Consumables (Graphite electrodes etc.)
General Consumables
Hand tools, Gauges and Instruments
Specific Tools
General Spares
Job work at supplier end / Conversion
Services
Civil works
Transportation
Stationery and other miscellaneous
Others, please specify

7. If manufacturer/sub-contractor Yes
No

8. If Agent, please give the details Territories

Principal held details of the agent agreements
Details of modalities of stock held
Maximum value of supply at any time
Facilities for after sales Service

Give related Details:

9. If stockist, please state the level of stocks
held, approximate stock in trade
normally held, maximum value of supply
that can be executed at any time, Surety/
testimonial establishing dependency and
capacity to execute contracts.

10. Value of movable/immovable property

with details. Self certified documents to
be submitted.

11. Details of Sales turnover and (a) Year:

sales tax paid in last 3 years: Details:
(Enclose Annual Reports)
(b) Year:
Details:

(c) Year:
Details:

12. Are you listed/ Approved contractor Yes

for other PSU/ Govt Department. No
If "Yes", Please give details and enclose Registration Document.
Details:

13. Have you ever been Black listed by Yes

any of the above. No
If "Yes", Please give details and enclose self-certified document.
Details:

14. Are already doing business with Yes

Midhani? No
If "Yes", Please give details:
(PO Number, Item Description)

15. Are you willing to furninsh Yes

security deposit? No

16. Are you willing to abide by Midhani's Yes

General Terms and Conditions of No
contract.? Accept

17. References of Your Customers : Please enclose self certified photocopies of orders executed during the last one year.
At least 2 PO's / Invoices executed during last one year for the material /service sought for registration
to be submitted
Material /
Sl.
Plant / Organization Service Order No. / Date Value in Rs.
No
Description
 PLEASE FURNISH THE FOLLOWING DETAILS

1 Floor area of factory :

2 Number of workers employed :

3 Number of employees in QC/Inspection :

4 Sources of raw materials :

5 Collaborators :

6 Any details of plant and machinery :

PLANT AND MACHINERY

1 Details of plant and machinery :

2 Inspection equipment :

3 Test facilities :

4 Any facilities being sought from others :

REGISTRATION PARTICULARS (Enclose documents for each)

1 Permanent Account No* :

2 GST Registration Number * :

The following information of Bank Account of the company, duly endorsed by the bank(required for electronic Fund Transfer -
EFT/RTGS) is to be submitted.

1 Name of Company* :

2 Name of Bank* :

3 Name of Bank Branch & Address* :

4 City/Place* :

5 Account Number* :

6 Account Type* :

7 IFSC code of the Bank Branch* :

8 MICR Code of the Bank Branch* :

9 Details of other Bankers :

(for reference purpose only)
 REGISTRATION FEE
For registration, please send non refundable registration fee Rs. 500/- plus applicable GST (Presently GST applicable is 18%.
Hence vendor has to pay Rs.590/-) in favor of 'MISHRA DHATU NIGAM LIMITED' payable at Hyderabad.

1 DD NUMBER :
or UTR No. of NEFT payment done

2 DD AMOUNT :

3 DD Date :

4 BANK NAME :

5 UTR No. /date for NEFT/RTGS :

The information furnished in this form is true to the best of my knowledge and belief. In case the same is found
incorrect, MIDHANI reserves the right to cancel the registration and also take any other action as deemed fit.

Signature

Date: Name & Designation *

[Rubber / Stamped]
Place:

Seal of the Company

* 1. Proprietor / Partner / Director

2. Company Secretary / Head of Administration (for foreign company's Indian Operation)

Note:
1. Vendor registration if done shall be valid for 5 years and thereafter supplier has to
renew the same

2. Please attach separate sheet whereever necessary

 Following documents are required
COPY OF REGISTRATION / MEMORANDUM AND ARTICLES OF ASSOCIATION (IF PUBLIC LIMITED COMPANY
OR PRIVATE LIMITED COMPANY)

CERTIFICATE OF INCORPORATION (IF PUBLIC LIMITED COMPANY OR PRIVATE LIMITED COMPANY)

PARTNERSHIP DEED (IF PARTNERSHIP FIRM)

LATEST LIST OF BOARD OF DIRECTORS/PARTNERS

MSME CERTIFICATE (OPTIONAL)

A. IF YOU ARE A MSE, PLEASE PROVIDE PROOF OF THE SAME ALONG WITH UDYOG AADHAR MEMORANDUM NUMBER
AND CERTIFICATE
B. PLEASE FURNISH CERTIFICATE IF YOU BELONG TO SC/ST OWNED MSE, WOMEN OWNED MSE

START-UP CERTIFICATE (OPTIONAL)

ISO 9001:2008 CERTIFICATE (OPTIONAL)

INCOME TAX RETURNS (LAST 3 FINANCIAL YEARS)

BALANCE SHEET AND PROFIT & LOSS STATEMENT (LAST 3 FINANCIAL YEARS)

GST CERTIFICATE

PAN CARD COPY

DEALERSHIP / CHANNEL PARTNER CERTIFICATE (OPTIONAL)

VALID REGISTRATION CERTIFICATE OF OTHER P.S.U. / GOVT. ORGANIZATION (OPTIONAL)

RS.500/- PLUS APPLICABLE GST (PRESENTLY APPLICABLE GST IS 18%) IN FAVOUR OF MISHRA DHATU NIGAM LIMITED,
PAYABLE AT HYDERABAD / RECEIPT OR PROOF IN CASE OF NEFT TRANSFER

EXPERIENCE CERTIFICATE (P.A.C. / PERFORMANCE CERTIFICATE / PREVIOUSLY EXECUTED P.O.

COPIES / CONTRACTS FOR THE SAME OR SIMILAR MATERIAL / SERVICE FOR WHICH REGISTRATION IS SOUGHT.
AT LEAST 2 POs / INVOICES WHICH ARE EXECUTED DURING THE LAST ONE YEAR TO BE SUBMITTED

VENDOR REGISTRATION CERTIFICATES GIVEN BY PSU'S/GOVERNMENT ORGANISATIONS (OPTIONAL)

Note: All the above documents should be self certified