EXTERNAL PROVIDER EVALUATION/RE-EVALUATION

FORM
1. Name of the Company :

Address for Communication :

Phone Number : Fax Number :

E - mail address:
2. Type of Organisation (Please Tick):
i. Proprietorship ii. Partnership
iii. Private Limited iv. Public Limited
3. Name of Contact Person/s :
Designation:
Office: Fax Number :
Phone Number
Residence: E - mail address :
4. Employee Details (Number of Employees):
Administration / Office
Factory
5. Nature of Company (Please Tick) :
i. Manufacturer : ii. Distributer / Dealer : iii. Agency :
6. Year of Establishment :
7. Other Information:
Sales Tax Number___________________ Exice Range:_______________________
ECC. No.: _________________________ Exice Regn. No.: ____________________
8. Name of the Bankers :-
9. Last Year Annual Turnover:
10. List of Products (Use Separate Sheets if required) :

11. Product Specification (Please specify if IS Standard is applicable in separate sheet if required)

Minimum Quantity (To offer at a Time):

12. Order Quantity :
Maximum Quantity (To offer at a Time):
13. Quality Control / Inspection (Please Tick) :

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 EXTERNAL PROVIDER EVALUATION/RE-EVALUATION
FORM
Own Laboratory : Outside Testing Facility : None :
14. Will a Test Certificate Accompany Each Consignment:
Yes No
15. Please Give Details of the Inspection And Test Equipment used for Q.C. of End Products.

16. Are you a Certified Company for Quality System : - Yes No

If Yes, Please Give Details:

17. Nearest Stock Point From Coimbatore :-

18. Any Other Information :-

Date External Provider’s Signature

TO BE FILLED BY OFFICE

Forwarding Authority ‘ s Comments :-

Forwarding Authority ‘ s Signature

TOP MANAGEMENT‘S Comments:

Approved / Not Approved Signature

Page 2 of 2 PUR/RI/01, 00, 01.05.17