1

Customer Information Form

( Mandatory information fields are marked in *)

1 Scanned copy of letter (Please attach scan copy of letter for opening new customer party code)

Copy enclosed Yes No

2 Name of the Organisation *

3 Office Address *
(address for Invoicing)

City State Country

Zone Postal Code
a) Ph. No.
b) Fax No.
c) Email
d) Internet address
4 Registered Office Address

City State Country

Zone Postal Code
a) Ph. No.
b) Fax No.
c) Email
5 Factory Address

City State Country

Zone Postal Code
a) Ph. No.
b) Fax No.
c) Email

6 Type of Organisation * Proprietary Partnership Pvt. Ltd. Public Ltd. Others.

7 Are you a Govt. Entity. * Yes No

 Authorised Contact
8 Person(s) * a) Dept.
Mob.
No

b) Dept.
Mob.
No.

9 Nature of Business * Manufacturer Authorised Distributor Trader Service

Contractor Govt. Intermediary
Other consultancy services such as Taxation / HR / Legal etc
Sales related Business Consultant

10 Year of Establishment
Associate and Sister concerns if
any

11 PAN & TAN nos.*

12 SSI registration no & date

13 Service Tax Registration no &

date
14 Company profile/Last balance Please attach latest Balance Sheet or details regarding turnover and
sheet Net Profit for last 2 years.

Name

Designation

Dept.

Date