Kerala State Industrial Enterprises Limited (KSIE) | Application For Empanelment of Vendor

1) Name & Address of the corporate office/ Regional office

Firm / Company Name *

Address Line 1 *

Address Line 2

Place

City / Town *

Pin code *

State *

Tel

Mobile *

Fax

Email *

Website

2) Name & Full Address of the Production Centre/ Plant:

Name

Address Line 1

Address Line 2

Place

City / Town

Pin code

State

Tel

Mobile

Fax

Website

3) Authorised person's name and address :
With authorization letter

Name *

Surname

Address Line 1 *

Address Line 2

Place

City / Town *

Pin code *

State *

Tel

Mobile *

Email *

Website

Select designation

Upload Authorisation letter

4) Details of Partnership/Proprietor / Company :

Select type *

Upload copy of Partnership Deed, Reg. Certificate From Registrar of Companies in case of Company

5) Company/ MSME Registration No. :

Company / MSME Registration No. *

Upload copy attested copy of certificate part I & II in Case of MSME

6) Sales / Service Tax Registration :

VAT & CST Registration No.

Service Tax Registration No.

7) PAN/ TAN Number :

PAN No. *

PAN Upload Attest copy.

TAN No.

TAN Upload Attest copy.

8) In case of Company, Audited Balance Sheet: for the last Financial Year with Seal& Signature (enclose attested copy by Chartered Accountant with Seal & Signature)

Upload Audited Balance Sheet: for the last Financial Year with Seal& Signature.

Upload attested copy by Chartered Accountant with Seal & Signature.

9) List of Machines and production capacity /Trading capacity: (Enclose the list if any)

10.

10) Specific details of product with Brand Name / product Supplied

10.

Upload list of items & service with Seal & Signature if any

Authorization letter from Original manufacturer in case of Supplier/Agencies if any

Yes No

Upload Authorization letter