CF-805 Service Tax Regn No.

(TIC)/AABCB5576GST194
PAN NO. : AABCB5576G

BHARAT SANCHAR NIGAM LTD.

(A Govt.of India Enterprise)
COMPONENT APPROVAL CENTRE TELECOM.
DOORVANINAGAR, BANGALORE-560 016

Application For Offering Components/ Raw Materials for Tests

For External Agencies
1. Offer letter No. and Date
2. Firm Name and Address

3. Telephone No.
Fax No.
E-mail address
4. Component / Raw Material offered for
test with type/code number

5. Name of the test(s) Required

6. Specification with amendments if any

(Enclose the copy of specifications)
7. Serial No., Lot No. & Batch No. of the
component
8. Markings on the sample

9. . Particulars of D.Ds drawn in favour of AO DD No.

(CASH) OFFICE OF CGM QA BSNL' DD Date ..
payable at Bengaluru. (+ Service Tax & other Amount (in Figures)
levies on ST, as applicable) .
.(in Words)
Name of the Bank drawn
Branch ..

Signature and seal of Firm

Place :
Date :
For Office use only

Date of receipt of letter in office :

Verified :
Registration No. :
Signature :
Name & Designation :
Date :