Contractor Registration Application Form (For New/renewal/change Of Class/change Of Voltage Grade/change Of Area Of Operation/inclusion Of Additional Item Of Work)

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Contractor Registration Application Form
(For New/Renewal/Change of Class/Change of voltage grade/Change of area of
Operation/Inclusion of additional Item of work)
Please tick (√) type of registration required and strike whichever is not applicable
Please read the Information Booklet carefully before filling the form.
Fee Amount
Bank
Branch
D.D.No.
Date
Rs.
a. Name of the Contractor (Individual/Proprietor/Firm/Company/ Society/Cooperative
Society):
(As it appears in the Licenses/Registrations/Certificates)
(Attach 2 Nos Passport size photographs taken not before 6 months)
b. Address for communication
House/Flat/Plot Number
Floor/Street Number
Apartment/Village Name
Area/Mandal Name
City/Town/District
PIN
Telephone Number
Mobile/Cell Number
Email Address
c. Status of the Contractor:
(Please tick (√) whichever is applicable)
Individual/
Unregistered
Registered
Private
Public
Societies/
Govt./
Others
Proprietary
Partnership
Partnership
Limited
Limited
Cooperativ
Quasi
Firm
Firm
company
company
e society
Govt
1
If Individual or Proprietor
i) Technical Qualification, if any
:
Yes / No
tick (√) whichever is applicable and strike whichever is not applicable. If yes, enclose copy of
engineering degree certificate issued by recognized University
ii) Social Status of the Individual or Proprietor :
SC / ST / Others
tick (√) whichever is applicable and strike whichever is not applicable. If SC/ST enclose copy of
community certificate
2
i) If Partnership firm/ company/Society/Co-operative Society
Sl.No.
Names of Partners/Directors
Sl.No.
Names of Partners/Directors
1
4
2
5
3
6
tick (√) against the person who is authorized to represent the firm/company/society to sign the
documents and furnish copies of certificate of registration from registrar of firms/companies/
societies, partnership deed, memorandum and articles of association.
ii) Does the contractor comes
:
Yes / No
under purview of Industrial Act?
If yes, Enclose a copy of certificate of registration issued from the Department of Industries
Registration/
Date of
Type of Industry tick (√) whichever is applicable
License No.
registration
SSI
Ancillary
SSSBE
Tiny
Others
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