<p> Page no. 1</p><p>Format for the Covering Note to the Application Form APPLICATION FOR VENDOR REGISTRATION IN BALMER LAWRIE & CO LTD., PERFORMANCE CHEMICALS AND GREASE & LUBRICANTS DIVISIONS</p><p>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:</p><p>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)</p><p>4)</p><p>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:</p><p>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</p><p>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)</p><p>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. </p><p>Profit in Lakhs) Rs.</p><p>Page no. 3 Declaration :</p><p>1) I hereby certify that I am the authorized signatory of this firm / organization / establishment.</p><p>2) All the data furnished above is true & accurate to the best of my knowledge.</p><p>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.</p><p>4) I have ensured that all the relevant documents have been tagged appropriately for quick reference during scrutiny of my Application </p><p>No. ………………………….</p><p>Signature</p><p>Date :</p><p>Name :</p><p>Designation :</p><p>(Please affix Seal / Stamp of the organization here)</p>