FormatNo.

BBI/PUR/F/03-00
SupplierRegistration&AuthorizationForm Date 1/1/2017
Rev.Date
SupplierInformation
1.LegalNameofSupplier:
2.SupplierAddress:
3.ContactPersonName&E-mailAddress:
4.SupplierPhone/MobileNo.:
5.CreditTerms:
ForBBIUseOnly:
VendorNumber:
BBIContactPerson:
SupplierRegistrationDetails
RegistrationCategory RegistrationNo.
VAT/TIN
CST/TIN
PAN
ServiceTaxRegistrationNo.
MicroSmall&MediumEnterprisesNo.
ECCNo.
DateofRegistration
Range
Division
Commissionerate

ChapterID/HSCode/TariffHeading(Forpurchasingmaterial)

Please Note :- PAN Card / VAT TIN / CST TIN / Excise / Service Tax Registration Copy is must.
BankDetailsforElectronicPayments(RTGS/NEFT)
TheinformationprovidedinthissectionmustbeverifiedforaccuracyinordertoensureElectronicpayments
SuppliersFinancialInstitution:
successfullyposttothebankaccountspecified.
SupplierBankAccountName
SupplierBankAccountNumber
SupplierBankName&Branch
IFSCCodeforNEFT
IFSCCodeforRTGS
SendPaymentAdvicetoE-mailID
Please Note :_Copy of Cancelled Cheque is Must.
Authorization

BySigningbelowweareauthorizingElectronic(NEFT/RTGS)paymentstothespecifiedbankaccountaboveandhaveverifiedtheinformationabovefor
accuracy.AnychangestoTax,Bankaccountinformationande-mailcontactswillbecommunicatedtoBBIpromptly.

Signature:

Designation&NameofSigningPerson:
CompanySeal/Stamp