Milenium Technologies (I) Pvt.

Ltd
Peenya 2nd Stage, Bengaluru – 560058

Supplier Assessment Form

MTI/SUPPLIER/ Date:

1 Name of the supplier

and Address

2 TIN No

3 PAN No

4 Contact Persons

5 Contact Telephone/
Mobile No

6 Item/Service Procured

7 Initial Samples Batch

Supplied
Ok/ Not ok
8 Capability of supply
Ok/ Not ok
9 Suitability of Requirements
Ok/ Not ok
10 Results/ Decision
Accepted/Rejected

Approved Signature :

MTI/SAF REV : 00