Supplier Information Form

M&M Ltd. SBU

Supplier Code
(To be filled by Purchase Dept)

Name of supplier:

Shrimati Rukmani Devi Memorial Hospital

Address:

AjayrajPura Road , Kalwada

Jaipur
Pin Code

Contact Person:

302037

Lokesh Sharma

Mob. No.:

9799962725

Ph No.:

1412168402

Fax no.:

Email Address:

drlokeshsharma1988@gmail.com
(Please mention correct & valid email address as all the payment advices will be forwarded to this mail ID)

Product:

Hospital

Service information:

Hospital Services

(Electrical/Computers etc)
Current Customer:
(Attached PO copies)

Commercial Information:
VAT TIN no.:
CST TIN no. :
Service Tax no.:
PAN:
ECC No.:
MSME:

wef
wef
CPOPS2620P

(Attach copy of PAN card)

(Attach copy of certificate compulsory )

(Micro ,Small and Medium)

ECS Details:

(Please fill Complete Bank details Correctly)

Benificiary Name:

SMT RUKMANI DEVI MEMORIAL HOSPITAL KALWARA

Name of Bank:

Corporation Bank

Bank Address:

Kalwada branch
Kalwada , Rajasthan

Account No.:
Type of account:
IFSC code for RTGS:
IFSC code for NEFT:
MICR:

Other Information:

186301601000121
Current
CORP0001863
CORP0001863
302017051

Pin Code

302037