GMC CONTRACTOR FRESH REGISTRATION FORM / UPGRADATION / RENEWAL FORM
Recent Passport Size
(3.5 cm x 3.5 cm)
photograph
A) Registration Applied For:
1) Name of Vendor / Contractor:
2) Type of Vendor / Contractor: Individual Partnership Firm
Proprietorship Company
(Tick the appropriate box)
3) Name of Father / Husband in Case of
Individual
a) Caste:
b) Religion:
c) Age:
d) Nationality
e) Date of Birth
4) Name of Authorised Signatory in case
of Firm/ Proprietorship/ Company
5)) Class & Category Applied for:
6) Financial Year:
7) PAN No:
8) GST NO:
9) Bank Account No.
(Bank &Branch Name with Address)
10) Fees: Financial instrument
Amount (In Rupees)
(Name & No.)
a) Application Fees:
b) Registration / Renewal Fees:
B) Address of Regd. Office: (Mandatory)
Village/City/Town: House No:
P. O. : P. S.:
Pin: District
State: Country:
C) Address of Individual / proprietor in case of Proprietorship Firm, For Partnership Firm /
Company include addresses of all Owners/ Partners:
Name:
Age:
Date of Birth:
Nationality:
House No:
Village/City/Town:
P. O. :
P. S.:
District
Pin:
State:
Country:
Mobile No:
E-Mail ID
Note: Attach extra Sheet if necessary to include name and address of all members in a
partnership firm/ Company. For Public Ltd. Company include only major stakeholders.
D. Works executed as prime contractor in the last 5 years:
(Current Financial Year not to be included)
Contract/
Work Stipulated Actual
Work Value of Remarks/ Reasons
Project Name Employer Name Description of work Order Completion Completion
Order contract for delay
Date Date Date
Number
* Attach Certificate(s) from Engineer(s)-in-charge
Attach extra sheet if necessary
E. Quantities of works executed as prime contractor in the last 5 years:
(Current Financial Year not to be included)
Financial Years
Work Item Unit
* Attach Certificate(s) from Engineer(s)-in-charge
Attach extra sheet if necessary
F. Existing commitments and on-going works:
Stipulated Work Value Anticipated
Contract no. & Employer Value of Work Order
Description of work Place & State Completion remaining to Date of
Date Name contract Date
Date be completed Completion
G. Key Personnel for works and administration:
Sl. Experience (Years)
Work Position Name Qualification
No. Total With Contractor
H. Machineries owned:
Sl. Name of the Number Equipment Identification Condition of the
Average Age
No. Equipment/Machineries Owned No./Registration No Equipment/Machineries
* Attach extra sheet if necessary.
** Enclose supporting documents.
D. Financial Turnover from Civil Engineering works in the last 5 years:
(Current Financial Year not to be included)
Financial Year Turn Over (Rs.)
Attach Certificate from Chartered Accountant
E. Litigation History:
Sl. No. Employer Cause of Dispute Status
Contractor’s Declaration: I Sri/Ms ……………………………………………………………………………. declare that the
contractor data and credentials submitted by me for the year 20….. for Fresh
Registration/Renewal/Up-gradation is correct and true to my knowledge and any data submitted by
me if found false my Registration/Renewal is liable for cancellation without any reason thereof.
Signature of the contractor
Date:
Note: Provide 2 (two) recent passport size photographs of the contractor duly attested (one copy to be pasted and one spare copy to be enclosed). Also furnish Income Tax Clearance
Certificate.
(FOR OFFICE USE ONLY)
Date:
Registration No.
Chief Engineer Commissioner
Guwahati Municipal Corporation Guwahati Municipal Corporation
Guwahati Guwahati
