Application for Vendor Registration
Date : -
To,
Account Officer, (CPD), C.A. ( CPD ) Deptt. , MCGM
Central Purchasing Department,
Bakri Adda, N.M.Joshi Marg, Byculla (West),
Mumbai- 400011
I /We the undersigned hereby request MCGM to register myself/our Organisation/ establishment as Vendor with MCGM. Required information
is submitted as below.
Sr.No. POINTS DETAILS
1 NAME OF THE VENDOR –
* (Certified true copy of the registration certificate of Company/
Society/Firm/Institution/Organization/Trust etc. to be
furnished )
2 TYPE OF ORGANIZATION a) Sole Propreitorship Concern b) Partnership Firm
(Pl. tick mark whichever is applicable) c) Private Limited Company d) Public Limited Company
e) Government Undertaking f) Individual Consultant
g) Joint Venture h) MCGM Employee
i) Registered Society j) Charitable Trust
k) Bank l) Individual
m) Foreign Vendor n) Others. Pl.Specify
3 OFFICE ADDRESS :-
House number and street
Street 2
Street 3
CITY 1 / Postal Code (Mandatory)
Telephone Number / Mobile Number
(Present Office Address of Vendor for communication)
E-mail ID (max. 35 charactors) (Compulsory)
4 BANK ACCOUNT DETAILS :
Type of Bank : a) State Bank & Associates b) Nationalized Bank
(Pl. tick mark whichever is applicable) c) Scheduled Bank d) Private Bank e) Co-op. Bank
Type of Account with code: a) Saving Bank A/c -Code no. 10 b) Current Bank A/c -Code no.11
(Pl. tick mark whichever is applicable) c) Cash Credit A/c. -Code no. 13
Bank Account Number (In the name of Vendor to be registered)
Name of the Bank
Name of the Branch
Address / Telephone No
MICR NUMBER (9 digit Code No. of the Bank & Branch
appearing on the MICR cheque issued by the bank)
IFSC CODE
* (Blank, cancelled cheque to be submitted)
5 INCOME TAX PERMANENT ACCOUNT NO. (PAN)
(Pan card must be in the name of Vendor to be registered)
*Certified true Copy of PAN card to be submitted
6 GST Registration No.–
*Certified true Copy of certificate to be submitted
7 TAX RATE & TDS SECTION
9 I.T. EXEMPTION - CERTIFICATE NUMBER –
*Original certificate to be submitted
EXEMPTION RATE (Reason for Exemption)
DATE ON WHICH EXEMPTION BEGINS / ENDS BEGINS ENDS
10 Works Contract Tax rate ( Tick mark appropriate ) 1) 1%, 2) 2% 3) 4% 4) Other Pl.Specify
11 Number:-
Number of Partners/Directors/Trustees/Office Bearers, Proprietor, each Partner of partnership firm, each direcror, each trustee,
Others - Specify each office bearer should furnished information in
Annexture "A" *
Please state whether Vendor Code already exist with MCGM with
12 Yes No.
same Vendor Name or with same PAN
If yes, please state Vendor Codes
Please state reasons for having more than One Vendor
13 SRM user ID and password link required for E-tendering
purpose Yes No.
* Annexture "A" (Mandatory for Proprietor/Partner/Director/Trustee/Office Bearer)
I hereby declare that the information submitted by me/us is true, correct and complete to the best of my knowledge & belief. If the
transaction is delayed or not effected at all for reasons of incomplete or incorrect information, I would not hold MCGM responsible
for the same.
I will indemnify the MCGM in all matters in case information furnished by me/us is found incorrect in future.
I understand that mandatory information like PAN details, GST/Bankers' Guarantee details , Proofs for Annexture "A", etc. along
with documentary evidence is furnished at the time of submission of this registration form. I agree to pay Rs.100/- in cash as
Charges towards Vendor Registration.
Name & Signature of the Vendor/authorized person
along with Rubber Stamp/Seal of organization
Vendor Registration Charges are exempted to Government organisation.
Charges towards administrative cost for updating the details like name of bank, branch, account no. address etc. due to subsequent
changes are Rs.5000/- or Rs.1000/- as applicable depending upon award & execution of contract and reasons of subsequent changes.
Timing for submission of Vendor application :11.00 a.m to 5.00 p.m on all working days except 2 nd & 4 th Saturday, Sunday & Govt Holidays.
and for accepting cash at MCGM Collection Counter (C.F.C.): 8.00 a.m to 8.00 p.m on all days except Govt Holidays.
In case of any enquiry pertaining to e-tendering process(including User-ID,Password etc.) Please contact IT cell
at Gr.flr.,Worli Data Centre,1Z Store Building,Dr.E.Mozes Road,Worli Naka,Mumbai-400 018. Tel No.(022)24811275
For Office Use Only
SAP vendor Code Created in SAP
BY ON
|
SRM Link Created in SAP
BY ON
|
Annexture "A" (Personal Details)
1 Name of Proprietor/Partner/Director/Trustee/Office Bearer ,
Other (Specify):-
Proprietor/Partner/Director/Trustee/Office Bearer/Others
2 Position / Designation / Status :-
(pl.specify)
3 Residential Address :-
4 Address Proof :- (1) AadharCard/(2) Passport/(3) Voters Identity Card/
(4) Driving License/(5) Electricity bill * / (6) Telephone bill * /
(7) Bank account Statement/Bank Pass Book * /
(8) Rent Receipt* (Certified copy of any one documents)
5 Pan Card Number :-
Copy to be submitted
6 Aadhar Card no. :-
Copy to be submitted
7 Directors Identification Number (DIN Number) :-
Copy of proof to be submitted
8 Contact Number :- LandLine :-
Cell No. :-
9 email address (max. 35 charactors)
Note : e-mail address be legible
* With respect to Sr.No.4, Certified documents submitted as proof of address for electricity bill, Telephone Bill, Bank account statement/
Bank Pass Book, Rent Receipt should not be more than three months old from the date of application.
I hereby declare that the information submitted by me is true, correct and complete to the best of knowledge & belief.
If the transaction is delayed or not effected at all for reasons of incomplete or incorrect information, I would not hold MCGM
responsible for the same. I will indemnify the MCGM in all matters in case information furnished by me is found incorrect in
future.
Date: Name & Signature
