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Essar Refinery Integrated Management System

Vendor Registration Form

1.Corporate Information
Essar Oil Ltd.
Name Of Company : Qutbi Iron & Scale Mart

Address : 1182, Pankornaka, Ahmedabad - 380001

City : Ahmedabad Postal Code : 380001


State : Gujarat Country : India
Phone 1. +91-79-25321152 Fax No.2: +91-79-25382652
Phone 2. +91-79-25353728 Email: rsi_qism@msn.com
Fax No 1 Website :

Contact Person Name : Jujar A. Rangwala


Mobile No. : 1) +91-9879154652 2) +91-9227617352

2. Vendor Type (Pl tick in the box) 3. Tax Type (Pl tick in the box )
1. Chemical / Catalyst / Petroleum product supplier 1. VAT Registered - Raw Material supplier
2. Consumable Material & Spares Supplier 2. VAT Registered - Capital Goods Supplier
3. Transporter 3. CST Supplier
4. Contractor / Service Provider 4. VAT Un-registerd Vendor
5. Government / Statutory Body
6. Manufacturer
3. Industry Type ( Pl tick in the box)
1. Public Sector Unit 10. NSIC Registered Supplier
2. Private Business 11. Contractor
3. Dealer 12. Civil Service/Job
4. Catalyst Supplier 13. Electrical Service/Job
5. Chemical Supplier 14. Instrumentation/Electronics Service
6. Lube Supplier 15. Mechanical Service/Job
7. Import Vendor / Foreign Supplier 16. IT & Telecommunication Supplier
8. Cement Supplier 17. Raw material supplier/Govt. manufacturer
9. Supplier cum trader 18. Tor - Steel & Structural

4. Bank Details

Country of Bank : India Address : PO. Box. 101, Fuvara, Gandhi Road

Bank Name : Bank of Baroda


Bannk Account No. : 03280200003146 Bank Accounut Type: Current
Swift Code ( If Applicable) NA BIC (If Applicable)

5. Taxation Details. ( Kindly submit the photocopies of above certificates. )


Vendor ECC No.: Excise Commissionarate :
Excise Registration No. CST No. : 24570800243
Excise Range : CST Date : 30-06-1986
Excise Divison : VAT Reg. No. 24070800243
LST NO. : VAT Reg. Date.: 1/7/2002
LST Date.: Excise Indicator : Not Applicable
PAN No. :
MSMED (Micro, Small & Medium Enterprise) Status (If yes, please give details with the copy of certificate) :

Service Tax Registration :


With Holding Tax Type (As Applicable) :

6. Financial Information
2007-2008 2008-2009 2009-2010
1 Turnover
2 Profit After tax
3 Fixed Assets
4 Current Assets
5 Current Liablities

DOC No Rev No
EOL/COMM/P&C/R003 0
7. List of Major customers
Sr. no Customer Description of products suppliedTotal billing in last
financial year (Rs.)
1
2
3
4
5

8.Organisation Strength
Managerial Staff
Supervisory Staff
Skilled Labour
Unskilled Labour

9. List of Testing Facilities owned, if applicable

S. No. Equipment Description Accuracy & Range Last Calibration Date

1
2
3

10.List of Manufacturing Facilities ownes, if applicable:

S. No. Description of Machine & Make Accuracy & Range No of Machines


Installed

1
2
3
4
5

11. Quality System Particulars

1 Is company ISO 9000/ ISO 14000 accredited Yes /No


(If Yes, Enclose copy of certificates)

2 System for Customer Satisfaction Rating ,Process Yes / No


Control , Control of Non Conformities & Measuring and
Test Instruments and Conformance to safety
requirements exists ( If Yes , Enclose a brief of the systems )

We hear By declare that all the information required to be furnished for registration /
      
enlistment has been filled in correctly.

Signature and Seal of the CEO


Of the Company.

DOC No Rev No
EOL/COMM/P&C/R003 0