REQUEST FOR ALL INDIA CUSTOMER CODE

PARTY DIVISION NAME : HINDUSTAN DORR OLIVER LIMITED

ADDRESS :
DORR OLIVER HOUSE CHAKALA
ANDHERI (EAST) MUMBAI 400 099
(with District & Pin Code)

PAYING AUTHORITY NAME: HINDUSTAN DORR OLIVER LTD

DORR OLIVER HOUSE, CHAKALA
ADDRESS :
ANDHERI (EAST)
MUMBAI 400 099
(With District & Pin Code)

CONSIGNEE NAME :
___________________________________________________
ADDRESS : (Full address)
_________________________________________________
__________________________________________________

TIN NO._________________ LST REGN NO ________

CST REGN NO.
SRIN NO._____________________ ECC NO.

PAN NO.________________________________
RANGE_______

DIV. ___________CLT__________

BRANCH :
BRANCH PARTY CODE:
DIVISION CODE

SECTOR : PSU
(GOVT./PSU/PRIVATE/SSIC/DEFENCE/RAILWAY)
SEGMENT CODE:__________________________________________________________________________
DESTINATION :

STATE ASSAM

IF PRIVATE PLEASE INDICATE IF SSI UNIT (YES/NO)_________________________________________

Contact Person:
Phone No & Fax No:
E Mail address:
Signature &
Stamp/Seal