1.

Name of Company with

Correspondence address (As per GST, to Claim Input Tax Credit)

Country:

Tel. Nos.( Mention STD Code )

Fax No. –

Web Site address:

PAN (Permanent Account Number)

Date of Incorporation

VAT / TIN / GST Number

2.

Reasons for barcoding :

If buyers requirement (Mention Name of Buyer, their Contact Name &Number)

3.

Contact Person For Correspondence:

Designation:

Mobile No.:

Email :

4

Name –Chief Executive/MD

Mobile No.:

Email   :

5

Name-Head IT:

Mobile No.:

Email:

6

Name - Head Packagaing / Barcode Implementation

(Responsible for Barcode Implementation)

Mobile No:

Email :

7

Turnover of your Company of last

Financial year (Rs in Lacs)

Would like to receive SMSs on mobiles:

                           Yes No

8

Total no. of  different products

(SKU’s manufactured / distributed)

Brand Names owned

9

Is your company registered with SSI     If yes provide regn. no.

10

Nature of Business

(Please tick your primary business)

        Manufacturer               Distributor

         Exporter                      Others please specify

11.

DD/ Pay order No.

Dated          

 Rs.

Drawn on:

Signature & seal:

Name :Designation