Enrollment Form for e-Procurement

Fields marked with ( * ) are mandatory.

Company Name* : Java JRE 6 or above not available, Please install and retry.
  Note: Company Name is automatically populated from your digital certificate. If it is other than your
Company Name, check that your digital certificate is of type CLASS III with Organization Name.
Existing NLC Vendor Code* :
  
Company Details
Correspondence Information
Address* : Note: Please do not type name of your Company, city, state, country and pin/zip code in the address box.
City* : State* :
Country* : PIN/ZIP Code* :
Telephone* : FAX No :
Web Site : E-mail* :
Commercial Information
Type of Ownership*: NSIC *: Yes   No
Others

MSME *: Yes   No
Type of Business*: Manufacturer
Dealer
Distributor 		Agent
Others
Does Company supply their products directly:    Yes   No
Others
Whether Proprietor/
Partner(s)/Director(s)
Belongs to*:		 Scheduled Caste Scheduled Tribe Other Backward Class Others Women
Pan No *:
GST Registration Details
GST STATUS*:
GST IN NOs.:


Contact Details
Person Information
Name* : Designation :
Email Id* :
  Telephone No :
Mobile No :   Fax No :
Login Information
UserID *: user id should not be less than 6 characters
Password* : your password should not be less than 6 characters
Confirm Password* :
Bank Details
Bank Name*:
Branch*:
Branch Code*:
Account No* :
IFSC Code : Micr No :
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