Sterlite Technologies Limited

IFFCO Tower, 3rd Floor | Plot No. 3, Near IFFCO Metro Station,
Sector 29, Gurgaon 122001, Haryana, INDIA

Dear Sir/Madam,
We are in the process of sending the payments through RTGS/NEFT/Fund Transfer method, for starting this
process, we need following information from you immediately. We request you to send this form to following
address after filling the all the below information.

Kind Attn:-
“Vendor Payment Registration Form”
Please attach attested true copy of your Registration Certificate of GSTIN, PAN, Withholding tax (TDS)
exemption/lower rate certificate (if any) and ONE cancelled Cheque along with this form.
Please read the form carefully and fill the field of each line.
Please note that if you have received this form and submitted to us with all the information duly filled along
with the copies of all the registration certificates, please ignore this.

Name of the Vendor Emerald Telcominfra Pvt. Ltd.

Address for Communication Office Number 145 & 146, D Wing,

Clover Center, Camp, Pune
Street 7 Moledina Road

City Pune

District Name Pune

State Maharashtra

Pin Code 6 DIGIT ONLY 411001

Telephone WITH STD CODE 020-41216892

Fax WITH STD CODE

Email-id Sourabh.shrivastava@etelinfra.com

Company Web Site (if any) www.etelinfra.com

Name and Designation of Contact Person (s) Mr. Sourabh Shrivastava

BANK DETAILS (for direct credit facility) ECS payment

MICR Code / Bank key 411240008

Registered Address: E1, MIDC Industrial Area, Waluj, Aurangabad - 431136, Maharashtra, INDIA. CIN - L31300MH2000PLC269261
 Sterlite Technologies Limited
IFFCO Tower, 3rd Floor | Plot No. 3, Near IFFCO Metro Station,
Sector 29, Gurgaon 122001, Haryana, INDIA

Bank Account No. 50200001212254

Account Name (Beneficiary Name) Emerald Telcominfra Pvt. Ltd.

Bank control key Current/ Saving/ Loan/CC CURRENT

Name of the Bank HDFC Bank Ltd.

Bank Address and Phone no in short KP Housing society, Gen. Thimaya Road, East
Street, Camp, Pune

Bank City Pune

Bank Branch East street

IFSC RTGS number11 DIGIT only . HDFC0000148

IFSC NEFT number11 DIGIT only. HDFC0000148

Branch Code

GSTIN/INCOME TAX DETAILS

PAN No. AADCE1467H

GST Reg No. 27AADCE1467H1ZO

State of registration Maharashtra

For multiple locations please fill the required

details below

GST Reg No.

State of registration

Materials Name and HSN code supplied by you

to Sterlite

Service Description and SAC Codes, you are

providing to Sterlite

Please use below space if you need additional space to fill the data related to GSTIN

Registered Address: E1, MIDC Industrial Area, Waluj, Aurangabad - 431136, Maharashtra, INDIA. CIN - L31300MH2000PLC269261
 Sterlite Technologies Limited
IFFCO Tower, 3rd Floor | Plot No. 3, Near IFFCO Metro Station,
Sector 29, Gurgaon 122001, Haryana, INDIA

WITHHOLDING TAX DETAILS

Recipient type

TDS Section

TDSRate(I.T)

Surcharge

Edu.Cess

Higher.Edu.Cess

Reasons for exemption

Validity

DECLARATION BY VENDOR
I confirm that, The information furnished above in the VENDOR REGISTRATION FORM

is correct to the best of my knowledge and belief.

(Signature of Proprietor/Partner/Chief Executive)

Name(In Capital Letter) – DEVEN TAYADE

Date : 15 Jul 20

Registered Address: E1, MIDC Industrial Area, Waluj, Aurangabad - 431136, Maharashtra, INDIA. CIN - L31300MH2000PLC269261