VENDOR REGISTRATION & INFORMATION FORM(VRIF)

FORM NO . KPTL/PU/T6
NAME OF THE VENDOR
Item category
VENDORS ADDRESS & CONTACT DETAILS
Address of Head Office/Correspondance office

Address of Head Office/Correspondance office City PIN State

Contact Detail of Office Telephone No. Fax No. E mail ID

Company Web Site (if any)

Contact Person (s) Details Name Mobile E mail ID
a) Owner/CEO/Director
b) Marketing Head
c) Marketing Officer
ORGANIZATION DETAILS
Nature of Business ( select any of these -Manufacturer, Authorised dealer/Stockist, Trader,service provider)
Status of company (select any one Govt/Semi Govt., Public limited, Pvt. Ltd, Owner driven etc)
Is your company registered under company's act, if yes provide registration no.
If your are Manufacturer fill up Annexure "A"also
If you are Authorised dealer/Stockist mention the Name and address and contact details of the Principal
If your are traders mention the Name of the all the product and their respective Brands
If you are service provider, specify brand/make, if any
Are you a Small-Scale Industry Or MSMED
If yes, please provide registration details
If no, please fill up the Annexure "B"
Year of Establishment
What is the total number of employees in the organization as on date of filling up of the application form?
Whether QMS (ISO: 9001) / EMS (ISO: 14001) /OHSAS 18001 Certified(Certificate to be enclosed) Pl see Note 2
Other Product/System certifications(Certificate to be enclosed)
List of Machineries/Tools/Equipments for Production & material handling(Enclose separate list if needed)
Testing/Inspection facilities available(Enclose separate list if needed)
In or from which countries will your organization be providing goods or services to our organization?
Sources of major raw materials
Sources of major imports, if any
FINANCIAL DETAILS
Annual turnover of last three Year (Rs. In lacs) FY 1 FY 2 FY 3

CUSTOMERS' DETAILS (For similar nature of products/ services)

Name and contact of three major customers Customer 1 Customer 2 Customer 3
Name of customer
Contact person
Mobile Number
BANK DETAILS
Name of your organisation as per bank record
Name of your Bankers
Branch & Address
MICR Code
RTGS/NEFT IFSC Code
Bank Account No.
Email: ( Where information of payment made is to be sent)
(Fill Letter for Direct Payment to Account Annexure "C"
STATUTORY DETAILS
Excise details ECC No Excise Division Excise Registration No.
(provide copy of Registration certificates)
Sales Tax details - GST details VAT CST TIN
(provide copy of Registration certificates)
PAN & Service Tax PAN Service catgory Service tax Reg. No.
(provide copy of Registration certificates)
Whether Income Tax cleared(Furnish copy of IT Clearance Certificate)
Whether Clearance from Pollution Control Board(If applicable, certificate to be enclosed)
RELATIONSHIP TO GOVERNMENT ORGANIZATION(S) OR PUBLIC OFFICIAL(S)

“Public/ Government official(s)”

It includes a person in any of the following categories:
o An individual elected or appointed to a legislative or administrative position of any municipality, state, province, country, or territory.
o Officers and employees of companies under government ownership or control such as state owned banks and hospitals and universities.
o It includes not only individuals such as elected officials, customs and tax inspectors and government procurement officials, but also the employees of Government department, Municipalities, Government agencies, State-owned
enterprises.
o A political candidate or a political party or party official.
o Any person acting in an official capacity for a government organization, department, or agency.
o An officer or employee of a public international organization such as the International Monetary Fund, the European Union and the World Bank, United Nations or the World Trade Organization, or any department or agency of
such organization; or a person acting in a public function, including a director, officer or employee or other agent or representative.

To the best of your knowledge, is any key employee with respect to the proposed project and/ or senior management member of
your organization a Public Official?
If yes, please provide a list of all government offices and positions held. Indicate whether these are appointed or elected YES NO
positions, and for how long the person concerned held such positions

To the best of your knowledge, is any key employee with respect to the proposed project and/ or senior management member of
your organization related (by blood, marriage, current or past business association or otherwise) to a Public Official? If yes,
please explain. YES NO
If yes, please describe the relationship between such person(s) and the Public Official(s).

To the best of your knowledge, does any Public Official or a member of a Public Official’s family have any interest, or stand to
YES NO
benefit in any way, as a result of the agreement? If yes, please explain.
PROCEEDINGS

Has the organisation or you or any key employee with respect to the proposed project and/ or senior management member of
your organization, ever been convicted under any criminal law or any other serious crime in the country where the services will
be rendered or in any other country (other than traffic violations)? Are there any legal proceedings of this nature pending? YES NO
Describe the charges for which the organisation or you or any key employee of your organization have been convicted or have
proceedings currently pending, and when did it happen

THIRD PARTY CONFIRMATION

Are you aware of and agree to abide by the provisions of applicable laws, including but not limited to the KPTL ABAC third party
declarations and other related laws and regulations referred within, in providing goods and services under the proposed YES NO (if No, provide reason)
agreement?
I confirm that, the information furnished above is correct to the best of my knowledge and belief.

Name :- _________________________________ (Signature of Proprietor)

Place : __________________
Date: ____ /_____/_______ (Seal of Vendor)
For office use (to be Filled by Kalpataru Ltd.)
Recon. Account (Account Dept. Should Fill Up)
Cash Mgmnt Group (Account Dept. Should Fill Up)
Withholding Tax (Account Dept. Should Fill Up)
Schema Group, Vendor (Account Dept. Should Fill Up)
Approved for vendor code creation by HOD (Purchase) Vendor code
 FACTORY VISIT REPORT

Name of visiting Officer

NAME OF THE VENDOR
ADDRESS & CONTACT DETAILS
Address of plant/manufacturing unit
City & State City PIN

Area of plant/unit in SQF

Unit is single/multi location
Contact Person (s) Details Name Mobile
a) Manufacturing /Plant Head
b) Despatch Head/ Officer
c) Quality Head/ Officer
PLANT & MACHINERY DETAILS
Technological collaboration, if any
No. of product being manufactured
Details of product Product 1 Product 2
Name of product
Relevant BIS code follwed, if any
Make of major plant and Machinery
No. of production line & capacitty
Total installed capacity/annum
Present operating capacity/annum
Manpower details Engineers Technicians
No.of manpower
No. of operating shifts
RAW MATERIALS DETAILS
Details of major raw materials Raw Material 1 Raw Material 2
Name
Brand & Source
No.of days Inventory hold
QUALITY CONTROL DETAILS
Type of On line quality checks
Quality control lab is set up
Type of periodical check in lab
Details of major instruments Instrument 1 Instrument 2
Name
Make
Calibration Frequency
Any quality certification (ISO9000/14000)
GENERAL WORKING ENVIORINMENT
Layout of plant and machineries
Level of Housekeeping in the factory
Safety measures taken for labor
Pollution level (air/water/solid/noise)
Treatment for Pollution and waste generation
Remark

Recommendation for Approval: YES / NO

Approval For :
Sign of Assessor:

To be filled by Purchase team

Recommended for enlistment Yes/No

Comments, if any
Signature
Date

State

E mail ID

Product 3

Semi skilled

Raw Material 3

Instrument 3
 ANNEXURE “B” TO VRIF

(Draft of MSMED Letter to be submitted by the vendor to Kalpataru Group Company on his Letter Head in case he is not Re

Date:

To,
The _______________________
___________________________
___________________________
___________________________
___________________________

101, Kalpataru Synergy,

Opp. Grand Hyatt,
Santacruz (E),
Mumbai 400055.

Dear Sir/Madam,

Sub: Declaration under Micro, Small and Medium Enterprises Development Act, 2006.

We are not registered micro or small or medium enterprise under the Micro, Small and Medium Enterprises Development A

We shall inform you and submit a copy of the memorandum for your records as and when we make our application for
Board for Micro, Small and Medium Enterprise.

Thanking You
Yours truly,

(Signature of Proprietor/Partner/Chief Executive)

Name in Capital letters Rubber Seal
 ANNEXURE “C” TO VRIF

(Draft of Payment Authorization Letter to be submitted by the vendor to Kalpataru Group Company on his Letter Head)

Date:
To,
The ___________________
_______________________
_______________________
_______________________
_______________________
101, Kalpataru Synergy,
Opp. Grand Hyatt,
Santacruz (E),
Mumbai 400055.

Dear Sir/Madam,

Sub: Authorization for payment of bills by RTGS/ NEFT.

We hereby authorize all the entities in the Kalpataru group to directly credit our Bank Account mentioned below with the pa
against our bills for supplies/services rendered by us to all entities in the group and send us the intimation on follo
address/Mobile No.:

Our Email Address: Mobile No.:

The Details
Name of our Bank account for payment through RTGS/ NEFT are as under:
of Bank:____________________________________________________
Branch :____________________________________________________
Address : ____________________________________________________
MICR Code :____________________________________________________
RTGS/NEFT IFSC Code : ___________________________________________
Bank Account Number : ____________________________________________

We undertake to
1)      Inform you for any changes in the aforesaid bank details.
2)      Refund any wrong/excess payment of money received by us in case of erroneous transfer of funds to our account w
of receipt of intimation from you.
3)      Inform and refund to you on any excess/erroneous money received by us.

Thanking You
Yours truly,

(Signature of Proprietor/Partner/Chief Executive)

Name in Capital letters Rubber Seal
( Please attach a copy of cancelled cheque for reference)
 Annexure D
DECLARATION FORM

(A) DECLARATION ON EMPLOYMENT OF RELATIVES IN KALPATARU GROUP OF COMPANIES / COMPETITOR

We, hereby declare that the following employee(s) of Kalpataru group of Companies / or of Competitor Companies / are

Employee Name of
Sr. Name Designation
Code Company

If NO, then please tick on NO

(B)  DECLARATION ON ASSOCIATION IN ANY BUSINESS WITH KALPATARU GROUP OF COMPANIES / COMPE

We hereby also declare and certify that my following relative(s) is/are associated with any type of business or have inte
Companies / Competitor Companies.

Name of Associated with Type of

Sr. No. Name
Company effect from Business

If NO, then please tick on NO

(Signature of the Supplier Authorized Representative)

Name of Company/ies

Name & Designation of Authorized Signatory

Stamp & Seal of Company

RATION FORM

P OF COMPANIES / COMPETITOR COMPANIES

s / or of Competitor Companies / are my relative(s):

Location Relation

GROUP OF COMPANIES / COMPETITOR COMPANIES

h any type of business or have interest in business with Kalpataru Group of

Location Relationship

Place:
Date:
 GST REGISTRATION DETAILS

GST Registration Number (Please attach copy of Registration

Certificate)

Registered Address with GSTN

Pin code
State of GST registration (include list if multiple)
Date of registration
Nature of supply (Goods / services)
Whether material supplied from SEZ / EOU (Y/N)
Whether material supplied from J&K (Y/N)
Certificate Copy attached (Y/N)
Email Id registered under GST

LIST OF MATERIALS SUPPLIED/SERVICES PROVIDED

Materials / Services Description HSN ( For Materials ) SAC ( For Services )

(Signature of Proprietor/Partner/Chief Executive) Rubber Seal

NOTES:

1) In case of multiple GST registrations under the same Vendor name, kindly fill all details as above for all GST registrations and
submit all GST registration certificates

2) Vendors with annual Turnover less than 20 Lakhs fall under exempt category, accoridngly they need to submit declaration in
specified format attached herewith.
 PRE BID QUESTIONNAIRE

NAME OF THE VENDOR

Item category
OWNERSHIP AND KEY STAKEHOLDER(S)
If your organization is a privately owned, list all the owners of your organization. For publicly
traded Companies, list all shareholders holding more than 5%.
NAME ADDRESS

List the members of senior management team (executives) and/ or board of directors? NAME

Do you have any jointly-owned organizations? Who are the key subsidiaries or jointly-owned
organizations that will be involved in the proposed project/partnership? YES

ORGANIZATION NAME RELATIONSHIP

List the name(s) and title(s) of the individuals who will be responsible for working with our
organization. NAME DESIGNATION

List all previous or current relationships with KPTL/ other stakeholder department of the project
and the period when such relationship was active? NAME OF THE PROJECT BRIEF DESCRIPTION

Do you have or had a personal relationships with the official/ employee working with KPTL
/other stakeholder department of the project? If yes, list all the name(s) and relationship(s) for
the same.

Do you plan to use any other entities or individuals, including subsidiaries, affiliates,
partnerships or joint ventures, consultants, intermediaries, public relations agencies, marketing
agencies, logistics providers, freight forwarders, customs brokers or any individuals other than
your own employees to perform services under the proposed agreement? If yes, identify their
name and address, their relationship to you, and the activities they will perform. YES

NAME ROLE/ACTIVITIES
 FORM NO . KPTL/PU/T6

OWNERSHIP% NATIONALITY

OWNERSHIP% NATIONALITY

NO
PERCENTAGE OF
OWNERSHIP OF BIDDING
ORGANIZATION IN
DATE/PLACE SUBSIDIARY(IES)/JOINTLY
LOCATION ESTABLSHED OWNED COMPANIES

OWNERSHIP% NATIONALITIES

WORK ORDER/AGREEMENT
START DATE END DATE VALUE OF PROJECT REFERENCE NO

NO
RELATIONSHIPS TO
YOUR
ORGANIZATION ADDRESS SPOC CONTACT DETAILS