Rediffusion Brand Solutions Pvt.Ltd.

VENDOR REGISTRATION FORM

1 Name of Vendor (CAPS)
2 Registered Office
Address

City STATE Pin

Telephone no Fax Email
3 Correspondence Address

City State Pin

Telephone no Fax Email
4 Authorised Person Designation
Phone (Mobile) Email
5 Legal Status of the Firm (Ltd. Co. / Pvt. Ltd. Co. / Partnership / Proprietorship/LLP)
6 Nature of Business Specialisation
7 Statutory Details
PAN No ESIC No
G.S.T. Registration No
Whether registered under GST Composit scheme
Whether registered under Micro, Small & Medium Enterprises
If yes, provide certificate
Whether related party to Rediffusion Brand Solutions Pvt.Ltd &
any of it's employee.
If yes, name of the employee & nature of Relation
Whether TDS to be deducted ?
Whether any TDS exemption available (Yes / No) TDS Exemption Certificate No.
If Yes, TDS Exemption Certificate No. (attested copy required) Certificate Date
8 Bank Details
Bank Name Branch Name
Branch Address

City State Pin

Telephone no Fax Email
ACCOUNT Type BANK A/C No
BRANCH Code MICR NO
NEFT/IFSC Code SWIFT Code

Authorised Signatory Signatory Name

(Mandatory with Stamp) Date (dd/mm/yyyy)
All the above information provided are true and verified

For Office Use only

Vendor Registration Code Approved By