1. No category

ASSAM POLICE HOUSING CORPORATION LTD.
CONTRACTOR FRESH / RENEWAL / UP-GRADATION
REGISTRATION FORM
Recent Passport
Size Photo
(3.5 CM x 3.5 CM
A)
Registration Applied For :
1.
Name of Contractor
2.
Type of Contractor
:
Individual:
Proprietorship
Partnership Firm
Company
(Tick the appropriate box)
3.
Name of Father/Husband in case of Individual :
a) Cast
:
b) Religion
:
c) Age
:
4.
Name of Authorised Signatory in case of Firm
/ Proprietorship / Company / Individual
5.
Address (Permanent)
:
6.
Present Address
:
7.
Financial Year
:
8.
PAN Card No.
:
9.
VAT No.
:
10. Bank Account No. with Bank & Branch name
11. Registration
:
Financial Instrument (Name & No.) :
/ Renewal Fees :
B) Existing Details of the Contractor
Contractor ID
:
Manual R/No if any
:
Registration Date
:
Amount : (Rs.)
C) Address of Reqd. Office (Mandatory for Partnership Firm / Company :
Village / Lane :
House No.
:
City / Town
:
P.O.
:
P.S.
:
District
:
PIN
:
State/Country :
D) Address of Individual / Proprietor in case of Proprietorship Firm. For Partnership Firm /
Company include addresses of all owners.
Address 1
Name
:
Age
:
House No.
:
Address 2
Address 3
Village/Lane :
Town / City :
P.O.
:
P.S.
:
District
:
PIN
:
Note : Attach extra sheet if necessary to include name and address of all members in a partnership
Firm / Company. For Public Ltd. Company included only major stakeholders.
E) Contact Person / Authorised Signatory Details :
Name
:
House No.
:
City / Town
:
P.O.
:
P.S.
:
District
:
PIN
:
Tel / LLNo.
:
Mobile No.
:
Fax
:
E-mail ID
:
Nationality
:
F) Necessary documents to be submitted as per Annexure – A / B / C
ANNEXURE – B
RENEWAL / UP-GRADATION FOR THE YEAR 2015-16
THE FOLLOWING DOCUMENTS ARE REQUIRED
1.
One application form with Court Fee Rs. 8.25
2.
Previous year’s Registration Certificate
3.
Up-to date sales tax clearance certificate (VAT)
4.
Up-to date income tax clearance certificate (PAN & Annual turnover)
5.
Up-to date labour license
6.
Completion Certificates
7.
Passport Size Photograph.
8.
An Affidavit of Sole Proprietorship (as applicable)
9.
Certified Copy of Registration under Firm & Society, Assam (as applicable)
10. Deed of Partnership Firm (as applicable)
11. Appointment letter of Engineer including.
12. Declaration with certificate of key personnel :
(i) For Class – I(C) – one diploma Engineer (Civil)
(ii) For Class – I(B) – one diploma Engineer (Civil) & one Graduate Engineer (Civil).
(iii) For Class – I(A) – one diploma Engineer (Civil) & two Graduate Engineer (Civil)
13. Machineries : (either owned or lease / hire) :
1.
Truck
2.
Vibrator
3.
Pump Set
4.
Concrete Mixture Machine
5.
Generator Set
6.
Concrete Cube Test Moulds
7.
Steel Form
8.
Tripper Truck
Note :- Machinery’s age and Registration Number / Make Number will be required.
ANNEXURE – C
PROFORMA FOR SOLVENCY CERTIFICATE
CLASS I(A) / CLASS I(B)
SOLVENCY CERTIFICATE
This is to certify that to the best of our knowledge and information M/S ………………………………...
…………………………………………………. having partner / Directors ………………………………...
…………………………………………….. having marginally noted address, a customer of our bank are
respectable and can be treated as good for any engagement up to a limit of Rs. …………………
(Rupees ………………………………………………………………………………………………..………)
Bank Seal
Signature with rubber stamp of
Branch Manager
Note :
In case of partnership firm, certificate to include names of all partners as recorded with the
Bank.