Notice for Empanelment of Venders

Page no. 1

Format for the Covering Note to the Application Form APPLICATION FOR VENDOR REGISTRATION IN BALMER LAWRIE & CO LTD., PERFORMANCE CHEMICALS AND GREASE & LUBRICANTS DIVISIONS

REF: Advertisement for Online Vendor Registration Please fill the details against the respective fields, sign & stamp all the pages. Application No. (Pl. enter the System generated no. while submitting online application) Name of the Party (Note to vendors: Please note that all future correspondence – tender enquiries, purchase orders etc. as well as payments will be made in the name provided against this field.) M/s……………………………………………………………………… …………………………………………………………………………… Address:

Basic Information a) Manufacture / Supplier / Contractor etc. regarding the vendor Type of Company b) PSU / Public Limited / Limited Co. / Partnership / Proprietary etc. Categories Applied for (Please enter the category as per category/ description given, If required please add further rows) PO copies / Note to vendors : Please ensure that the relevant documents are tagged Completion for quick reference. certificates enclosed 1) (Names of Parties- illustrative List). 2) (If required please add further rows). 3)

Page no 2 Amount of the Highest Value Note to vendors: Please ensure that the relevant documents PO executed & Name Of the are tagged for quick reference. Party 1) PO Amount in Rs.: : 2) PO Date: : 3) Name of the Party/ : Organisation : 4) Job / Material : Description in brief:

Amount mentioned in the Note to vendors: Please ensure that the relevant documents Solvency Certificate & name are tagged for quick reference. of the issuing bank. 1) Amount in Rs. 2) Name of the issuing Bank 3) Date of issue

Financial Limit Min : Sought in Rs. Max: Job Location sought Please Tick Performance Grease & Lubricants ( √ ) if Chemicals Division, Division, Manali, interested in Location Manali, Chennai Chennai Area you are willing to work or else (X)

Turnover Details: Note to vendor: Please ensure that the relevant documents are tagged for quick reference. Please provide details for the last 3 financial years. Year Turnover in (Lakhs) Rs.

Profit in Lakhs) Rs.

Page no. 3 Declaration :

1) I hereby certify that I am the authorized signatory of this firm / organization / establishment.

2) All the data furnished above is true & accurate to the best of my knowledge.

3) In case it is established that any of the data furnished by me / us is false, inaccurate or misleading, I hereby accept that my application will be rejected outright.

4) I have ensured that all the relevant documents have been tagged appropriately for quick reference during scrutiny of my Application

No. ………………………….

Signature

Date :

Name :

Designation :

(Please affix Seal / Stamp of the organization here)