ATC Supplier Master Data Base Template

Details of Supplier
Company Name*
Name of Parent Company (if any)
Company Incorporation certificate Number
Place of Registration
Date of Registration of Company/ Firm
Company PAN Number*
Company ESI Number*
Company PF Number*
DIN Number
TDS Vendor Type*
Default TDS Section*

Business Address/Corporate Office ( Full address with City and Postal Code ) *

Vendor code with ATC ( If available )* for Updation Only

Country
Contact Person (S)*
Telephone Number *
FAX
E-mail ID *
Website

*TYPE OF ORGANISATION (Please check) ü

Type of Organizational Structure Corporation Private Limited Liability Company Other ( ) Please explain
Partnership Public Limited
Sole Proprietor Non-Profit Organisation
Documents required - For PVT/LTD - COI , Partnership - Partnership Deed ,Proprietor – Declaration latter as per ATC format
Type of services (Please check all that apply) ü
Type of Vendor
TSP COLO HTLT ST_Consult Dismantling EB Rectification
ant

MCNOC O&M THA Security & Surveillance Others

Acquisition
Specify here in case of Other :-
Type of Organization (Please check all that apply)ü
Service R&D Firm University
United States Government Agency Consulting Utility
Foreign Gov`t Agency Manufacturing Retailer
Staffing/Temp Agency Construction Other
Specify here in case of Other :-

*Company Size (Per Small Business Administration standards, Federal Regulation) ü

MSMED Certificate
Large Scale Small Business Medium Scale MSMED Number Starting Date

** In case of MSMED : Certification required with Validity

** In case of non MSMED: Declaration in company latter head
 *CONTACT DETAILS
Management Team (Board Members / MD / CEO / Proprietor / Partner) Escalation Matrix
Name Designation Department Contact details PAN No Remark (if any) Details Level 1 Level 2 Level 3
Name

Designation

Department

e-mail address

Single Point of Contact for ATC TIPL : Mobile number

Financial data
Current Year Prior Year Two Years Ago
Annual Revenue as per Balance Sheet ( Value is in INR )

* Compliance information (Please check) üû

Yes No Number with Certificate (If Yes)

Do You have ESI Number ?

Do You have PF No ?
Do You have Central LABOUR LICENCE ?
Do You have ISO/OHSAS Certification ?

** In case of ESI and PF : Certification required with Validity

** In case of Non ESI/PF: Declaration in company latter head
GST, Bank and Other information for All applicable States , mention NA wherever is not applicable do not make any field blank
Enable Circle Supplier Site Name* No. of Bank Bank Account Bank Account
Supplier Code (If Register (GST) LABOUR
State * Circle * ( where vendor can Supplier Name* available )* Office Address* GST No* Employee LICENCE NO. Bank Name* Branch Name* No*
start the work )* Capex Opex s Name*
ANDAMAN AND IND West Bengal
NICOBAR ISLANDS
ANDHRA PRADESH IND Andhra
Pradesh
ARUNACHAL PRADESH IND Assam & NE
ASSAM IND Assam & NE
BIHAR IND Bihar
CHANDIGARH IND Punjab
CHHATTISGARH IND Madhya
Pradesh
DAMAN AND DIU IND Gujarat
DELHI IND Delhi
GOA IND Maharashtra

GUJARAT IND Gujarat

HARYANA IND Haryana
HIMACHAL PRADESH IND Himachal
Pradesh
JAMMU AND KASHMIR IND Jammu &
Kashmir
JHARKHAND IND Bihar
KARNATAKA IND Karnataka
KERALA IND Kerala
LAKSHADWEEP IND Kerala
MADHYA PRADESH IND Madhya
Pradesh
MAHARASHTRA IND Maharashtra

MANIPUR IND Assam & NE

MEGHALAYA IND Assam & NE
MIZORAM IND Assam & NE
NAGALAND IND Assam & NE
ODISHA IND Orissa
PUDUCHERRY IND Tamilnadu
PUNJAB IND Punjab
RAJASTHAN IND Rajasthan
SIKKIM IND West Bengal
TAMIL NADU IND Tamilnadu
TELANGANA IND Andhra
Pradesh
TRIPURA IND Assam & NE
UTTARAKHAND IND Uttar Pradesh
(W)
UTTAR PRADESH IND Uttar Pradesh
(E)
UTTAR PRADESH IND Uttar Pradesh
(W)
WEST BENGAL IND West Bengal
Dadra & Nagar Haveli IND Gujarat
Laddakh IND Jammu &
Kashmir
Corporate IND Corporate
Kolkata IND Kolkata
Mumbai IND Mumbai

Mandatory Document List *

Sl no. Document & Approvals Remarks

1 Self-certified copy of PAN (Declaration in case PAN is in individual name and vendor is in the name of Proprietor ship firm) Mandatory

2 Self-attested copy of Identity Proof of owner (Voter ID card/Passport/Driving License) in owner/partner Mandatory

3 Self-certified copy of GST registration Mandatory

Ø  Copy of cancelled cheque in case of Preprinted name of account holder, otherwise copy of bank statement/pass book
4 Mandatory
Ø  Bank attested RTGS mandate form (Affidavit & indemnity required in case payee name is different from vendor name)

5 Copy of PF Registration (self-attested) Mandatory

6 Copy of ESi Registration (self-attested) Mandatory

7 Certificate of incorporation/partnership registration certificate/declaration in case of Individual firm for owner name. Mandatory

8 Self-certified copy of Address proof (like Electricity bill/Landline telephone bill/gas connection bill/Water connection bill etc) Mandatory

9 MSMED Certificate (if applicable), In case non MSMED a letter  on Vendor letter head as non-applicability of  MSMED Mandatory
10 Duly filled KYC (Vendor Registration Form) with signature & stamp on every page Mandatory

11 Various Act Declaration signed by vendor for non-applicability Mandatory

12 Details in MDM EXCEL FORMAT Mandatory

SCM HEAD / Nominated person approval for
Ø  New Code Creation
13 Ø  Code Block & Unblock Mandatory
Ø  Extension of vendors to legal entities & circles
Ø  Any type of changes & modifications
14 Watchlist report mandatory (Except Govt Vendor). w.e.f 21.05.2019 Mandatory

15 Signed off FCPA code of conduct w.e.f 21.05.2019

16 Undertaking on Vendor Letter Head i.e. no conflict of interest / potential conflict of interest involving the Directors, Mandatory
Promotors, key managerial personnel’s of *Company Name

17 NO PO No Work Mandatory
Other ( ) Please explain

Sate
 Level 4

ears Ago

Reason along with declaration (If No)

Payment TDS/No
IFSC Code* Method * n-TDS
Vendor*