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Contractor Registration - Application Form: (Please Tick Against Which Registration Is Sought)

This document contains a contractor registration application form for firms seeking to register with Krishnapatnam Port. The form requests information such as the name, address, and contact details of the applicant firm. It also asks for details of the firm's legal status, partners or directors, the types of work being applied for, labor licenses and policies held, tax registrations, bank details, and authorized signatories. The applicant must declare that the information provided is true and understands the registration is liable for cancellation if any details are found to be incorrect. Relevant documents must be attached and port officials will verify the application before recommending approval or rejection.

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Prasanta Kumar Lenka
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46 views3 pages

Contractor Registration - Application Form: (Please Tick Against Which Registration Is Sought)

This document contains a contractor registration application form for firms seeking to register with Krishnapatnam Port. The form requests information such as the name, address, and contact details of the applicant firm. It also asks for details of the firm's legal status, partners or directors, the types of work being applied for, labor licenses and policies held, tax registrations, bank details, and authorized signatories. The applicant must declare that the information provided is true and understands the registration is liable for cancellation if any details are found to be incorrect. Relevant documents must be attached and port officials will verify the application before recommending approval or rejection.

Uploaded by

Prasanta Kumar Lenka
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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CONTRACTOR REGISTRATION – APPLICATION FORM

1) Name of Contractor / Firm / Company : ________________________________________________

2) Address & Phone No. for Communication : ____________________________________________________


____________________________________________________
____________________________________________________

3) Mobile Number (If Any) : ____________________________________________________

4) Email ID : ____________________________________________________

5) Status of the Contractor / Firm : Please tick whichever is applicable.

Individual/ Unregistered Registered Pvt. Ltd. Public Society/Co- Government Others


Proprietary Partnership partnership Co. Ltd. Operative
Firm/Co. Firm / Co Co.

6) If Partnership Firm / Limited Company / Societies / Co-operatives

S No Name of Partner / Director S No Name of Partner / Director


1 5
2 6
3 7
4 8

7) Items of Work (Please tick against which registration is sought)

S No Work Pl Tick Remarks


1 Civil Works
2 Manpower Supply
3 Fabrication Work
4 Transport Works
5 Stevedoring Works
6 Supply of Vehicles (LMV / HMV)
7 Supply of Equipments (With / Without Manpower)
8 Loading & Unloading
9 Bagging
10 Housekeeping
11 Security Services
12 Annual Maintenance Contract (With Manpower)
13 Survey Contract
14 Other Pl specify

8) Labour Related Details (Relevant Copies to be Attached)


S No Licence / Policy / Licence Applicable Valid Valid Remarks
Registration Number for (No. of From Upto
Workmen)
1 Labour Licence Issued by JCL,
Guntur
2 Inter State Migrant Issued by JCL,
Labour Licence Guntur
3 PF Registration No.
P.O. Bag No. 1, Muthukur Manadal, Distt Nellore (A.P.) www.krishnapatnamport.com
4 ESIC Registration No.
5 Motor Transport Issued by JCL,
Workers Registration Guntur
6 WC Insurance Policy Issued by any
Insurance Co.

9) Commercial Details (Relevant Copies to be Attached)

S No Registration Registration Number Date of Issue Remarks


1 VAT Registration
2 PAN Number (I.T. Act)
3 TIN Number
4 Service Tax
Registration
5 Central Excise
Registration
6 Co. Registration No.

10) Bank Details:

S No Name of Bank Branch Account No. IFS Code

11) Details of Authorized Signatory / Representative:

S No Name Designation Mobile No. Email ID Specimen Signature

12) Details of Authorized Signatory / Representative (One From Accounts & One from HR):

S No Name Designation Mobile No. Email ID Specimen Signature

DECLARATION

I/We declare that the particulars given in this application are true to the best of my/our knowledge and
belief and understand that it is liable for cancellation of registration if proved, otherwise.

Place : ___________________________

Date :____________________________ (Signature of Contractor)


Name : ______________________
Authority: __________________

NOTE : This form shall be signed by the person competent as detailed below:-
a) Proprietorship Firm : Individual / Sole Proprietor of the firm.
b) Partnership Firm : By the partner who holds general power of attorney authorising him/her
to sign for and on behalf of the firm in contractual obligations (copy to
be enclosed).
c) Companies : By Managing Director or any person who holds general power of
attorney in his favour from the firm giving him/her the authority to do
so (copy to be enclosed).
P.O. Bag No. 1, Muthukur Manadal, Distt Nellore (A.P.) www.krishnapatnamport.com
FOR KPCL OFFICE USE ONLY DATE: ________________

All documents verified.

Recommended for Registration : YES / NO

Reasons for Rejection : ______________________________________________________________________________________________

(HOD-Concerned Deptt) (HOD-Accounts) (HOD-HR) (Director & C.E.O.)

P.O. Bag No. 1, Muthukur Manadal, Distt Nellore (A.P.) www.krishnapatnamport.com

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