VENDOR REGISTRATION FORM

REMINDER: No work should commence and no goods should be supplied or any services performed for
Walmart until the supplier has been set up in Walmart’s supplier system and the necessary contractual terms &
conditions have been entered into.

(Please fill the form in BLOCK letters only and please Tick  wherever applicable)

To be allotted by Walmart Vendor Master Team

VENDOR NUMBER

Please choose the entity/entities to register with (to be completed by the User Department ONLY)
WAL-MART INDIA PRIVATE LIMITED WM INDIA TECHNICAL CONSULTING SERVICES PRIVATE LIMITED

Requestor Name: Dept: Requestor’s Mobile No.

Mandatory supporting documents to be submitted with completed Vendor Form : 1) Copy of cancelled cheque printed with a/c
name, a/c no. and IFSC code 2) Copy of PAN 3) Copy of Registration Certificate of GST or the vendor is unregistered (the below
Page no.6 GST declaration duly signed and stamped by vendor). 4) Copy of MSMED certificate in case if it is applicable.

To be completed by Walmart Vendor Master

Entity Type (Basis PAN)

Type of Service Provider/Vendor: Tick any of the following in relation to the Vendor you wish to add:

Capex / Opex Supplier Landlords Import Real Estate Developer/Consultant/Agent

Charitable Organization Tax/legal consultants Customs broker/Agent License & Permit consultants

Freight Forwarder/Transport Other Service Provider If other, please specify_______________________________________________________

Description of Business and Activities to be Conducted by Vendor:

Kindly visit India Ethics and Compliance folder on share point to view and download Compliance policies, Anti-Corruption Global Policy and
Anti-Corruption procedures and Walmart International Giving Policies and Procedures. Please visit walmartethics.com for the Statement of Ethics.
1. During the course of providing services to Walmart, is the vendor or service provider expected to interact with Government Entities and/or
Officials for or on behalf of Walmart?' Yes No

As per the Anti-Corruption Procedures, each Responsible Business Unit must identify any Third Party Intermediary (‘TPI’) needed for its
operations. A TPI is a service provider, consultant, distributor, contractor, vendor, supplier, or other third party, whether an individual or
an entity, engaged or retained to assist the Company in any function or business that requires or involves interaction with any Government
Entity or Government Official on behalf of the Company. A supplier of only goods is not a TPI.
VENDOR INFORMATION:

Name of Vendor :
Payee Name :
Address 1 :
Address 2 :
City: State : PIN Code :

Contact Person : Email ID: Phone No.:

Contact Person Email ID: Phone No.:
for GST :
(Email ID which is regularly been used by the vendor should be filled mandatorily as Payment advices, TDS certificate and all other

important communications will be sent to this email ID only)

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Type of GST registration: (Please tick  one option)

Exempt/Not
Regular Composition Unregistered
required

*Please provide copy of registration certificate for confirmation * Exempt/Not required means not dealing in taxable goods/services.

Payment Terms : _______________________________

BANK INFORMATION:

Bank Name :

Bank Account No: IFSC Code

Bank Address:
City : State : PIN Code:
Attach completed ‘Electronic Funds Transfer Registration Form’ duly signed and stamped by the bank in case cancelled cheque not available(Refer Appendix B)
REGISTRATION NUMBERS:

Type Number
a) Permanent Account Number (PAN)
b) GST (Refer Appendix A) Ref: Appendix A
c) EM No/MSMED #
# In case of any subsequent registration under the MSMED Act, post the date of signing vendor
registration form, it is the obligation of the vendor to inform the Company and share proof thereof.
EXEMPTIONS, if any: (Vendors should provide supporting documents as appropriate)

Income Tax TCS Exemption Certificate

Income Tax TDS Exemption Certificate
Details of exemption claimed under GST (if any)

Vendor Signature and Stamp*

* Vendor stamp is optional for Proprietorships

Name
Title
Date (DD-MM-YY)

Attestation:
By signing this form, either as a requestor or authorizer, you are confirming that the transaction complies with all applicable company policies and
procedures, including the Global Anti-Corruption Policy and Anti-Corruption Procedures.

Requestor: ( Walmart Associate )

Signature

Name

Department

Title

Date

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To be completed by Walmart Vendor Master Team

I have reviewed above details and hereby confirm that the form is accompanied with all required supporting documentation, and
that the vendor with similar details does not already exist in SAP. We have reviewed the latest available TPI Database to verify that
the vendor is not blocked, rejected, pending decision therein or falling under list of inactive vendors maintained by the Anti-
Corruption Team.

Signature

Name

Title

Date

To be completed by Taxation Department

Nature of tax Applicable Section Applicable Rate

Income tax/TDS

GST
Work Contract Tax

Approver - Direct Tax Approver - Indirect Tax

Signature Signature

Name Name

Department Department

Title Title

Date Date

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 Appendix A: GST Information
Complete the form with information related to GSTN

VENDOR NAME :
(Full Registered name of Vendor)
PAN
Vendor Contact Person (For GST related Queries)
Name
Contact No.

Type of GST registration: (Please tick one option)

Regular Composition Unregistered Exempted / Not required

Vendor Addresses from

Walmart
where goods / services
Vendor State Location State Vendor Principal
will be supplied /
from where & Address to place of business in a
provided to Walmart Vendor State-
S.No goods / which goods particular state
stores (state wise) wise GSTIN no.
services will be supplied (Complete Address to
(Complete Address
supplied / service will be be provided)
along with PIN code to
provided
be provided)

Note: Please contact the sender of this form if additional rows are required to be provided for more information.
Note : All Fields are Mandatory - Please furnish copies of GST Registration certificate

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 Appendix B: Electronic Funds Transfer Registration Form
To be completed, duly signed and stamped by the banker, when cancelled cheque printed with a/c name, a/c no. and
IFSC code is not available (Appendix B need not be attached with the completed form, if it is not applicable)
1. Vendor name :

2. Bank Details:
a) Beneficiary Name :
(Name in the bank account)

b) Name of the Bank :

c) Address of the bank :

d) Contact person & No. in the bank :

e) Bank Account No. :

f) NEFT IFSC Code (11 digits) :

3. E-mail address of the vendor :

4. Name of Proprietor (in case of Proprietorship :

Firm)

5. Name & Signature of the Authorized person :

Note: Point 3, 4 & 5 are not mandatory filled.

Bank Confirmation:

We ,hereby, confirm that Mr./Ms./M/s. ……………………………………………………………………………holds account

with our branch and the details given above including the RTGS/NEFT IFSC codes are correct.

Signature of the authorized

official of the bank with bank stamp.

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 GST Declaration Form

To, Date :
Walmart India Pvt Ltd
Embassy Tech Village, Outer
Ring Road,Devarabeesanahalli,
Bangalore-560103.

Dear Sir/Madam,

“This is to confirm that we

(Name of Vendor) currently is not registered
under the GST Act because our turnover is not exceeding the minimum threshold limit. Once our turnover
exceeds the threshold limit we will register ourselves in GST and share the GST Number with Walmart
India Private Limited and charge taxes accordingly.”

Thanking you,

Proprietor / Partner / Director.

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