VENDOR EMPANELMENT FORM

Section 1: Company Details and General Information

1. Name of Company:
2. Street Address: 3. P.O. Box and Mailing Address:

Postal Code: City:

Country:
4. Office Tel: 5. Fax:
6. Email: 7. WWW address:
8. Sales Person name & mobile number:
9. Manager Name & Mobile No.:
10. Director / Country Head name & Mobile Number:

11. Parent Company (Full legal name)

12. Subsidiaries, Associates and/or Overseas Representative(s) - (attach list if necessary)

13. Type of Business (mark one only)

Corporate Partnership: Other (specify):

14. Nature of business:

Manufacturer Authorised Agent

Trader Consulting Company Others (specify):

If you mark "Authorised Agent" or "Trader", please provide proof or certificate(s) from your

manufacturer that you are authorized to offer their products to the UNFCCC.

15. Year established: 16. Number of Full-time Employees:

17. Operatinal Cities :

18. PAN No.: 19. GSTIN No.:

20: HSN Code: 21. VAT No./Tax I.D..:

22. CST NO.: 23. Service Tax Reg. No.:
24. ECC No..
25. Certificate of registration 26. CIN No.

Section 2: Financial Information (Please attach a certified copy of recent balance sheet)

27. Annual Value of Total Sales for the last 3 years:

vendor registration form Page 1

Year ____________ Turnover______________

Year ____________ Turnover______________

Year ____________ Turnover______________

vendor registration form Page 2

Bank Details

28. Bank Name:

Address:

29. Bank Account Number : NEFT/IFSC Code:

Type Of Account: SB / Current Nine digit MICR Code:

30. Please attach a listing of reference sources for services rendered by your entity within the last
12 months. Please also indicate fax numbers and contact person for your reference sources.
Name of company Address Phone # Fax #
1) ______________ __________________ _________________ __________________

2) ______________ __________________ _________________ __________________

3) ______________ __________________ _________________ __________________

31. List below up to ten (10) of your Core Goods/Services offered:

Authorised agents and Traders must submit proof of certificate from manufacturers that
they are authorized to offer the products listed.
Line Item Description National/International Quality Standard
to which items conforms

Section 3: Other

32. Please list any current legal disputes in which your company may be involved.

33. List any national or International Trade or Professional Organisations of which your Company
is a Member.

34. Certification:
I, the undersigned, warrant that the information provided in this form is correct, and in the
event of changes details will be provided as soon as possible.

vendor registration form Page 3

Name: Functional Title:

Signature: Date:

vendor registration form Page 4