Construction of Integration Facility (Civil and Structural Work) at Keltron Controls, Aroor

KERALA STATE ELECTRONICS DEVELOPMENT CORPORATION LIMITED

KELTRON CONTROLS

Aroor P.O., Alappuzha District, Kerala - 688534, India.

Phone: +91 478 2872323 - 26 , +91 478 2830700, Fax: +91 478 28723 22 Email: [email protected], [email protected]

APPLICATION FORM FOR VENDOR REGISTRATION

1 Name of the firm

2 Name and Designation of the contact person

3 Land & Mobile Phone Nos. of the contact person

4 Office Address City State Country PIN

a) Regd. / Head Office

Land / Mobile Phone Nos.

b) Branch / Sales Office

Land / Mobile Phone Nos.

c) Factory / Workshop

Land / Mobile Phone Nos.

5 Excise Reg. No.

7 Excise Division

8 Excise Commissionerate

9 SSI/MSME Status

10 SSI/ MSME Reg. No. ( If applicable, Attach Certificate copies)

13 VAT Reg. No.

14 PAN No. (Attach PAN copy)

15 Service TAX No.

16 Co. Registration No. (CIN)

18 Name of Bank

22 Type of Account

23 Kind of Ownership

a) If a limited concern, Name and address of Directors & Managing Director

b) If Single owner, Name and address of the Proprietor & Manager, if any

c) If Partnership, Name and address of Partners.

24 Letter of authority from Manufacturer as sole Distributor / Dealer with details of distributorship / dealership, if applicable.

25 Whether firm is ISO certified or having any other certification

26 Name of the person who has taken the Digital Signature

27 Contact No. (Mobile & Land)

1 I / We …………………………………. (Name of Partners / Proprietors or Share Holders) do herby declare that the entries made in this application form are true to the best of our knowledge and that we shall be bound by the acts of duly constituted attorney.

2 I / We also hereby declare that all materials related to KELTRON Controls, Aroor shall be treated as CONFIDENTIAL and no information shall be passed on to any unauthorized person without written permission of the Chief General Manager, Keltron Controls, Aoor.

3 I /We also undertake the responsibility to inform all subsequent changes in the constitution or working of firm, affecting the accuracy of the answers now given will be promptly communicated to your Establishment.

4 (Name and designation) whose signatures are given below is an authorized representative of the firm.

(Specimen Signature of Firm's authorized representative)

Date : Signature of Authorized Signatory

(with firm's seal)

Select, Excess (+), Less (-)

Tender Inviting Authority: Kerala State Electronics Development Corporation Ltd., Keltron Controls

Name of Work: Construction of Integration Facility (Civil and Structural work) at Keltron Controls, Aroor

Contract No: KSEDC/KCA/ADMN/017/2025-26

Name of the Bidder/ Bidding Firm / Company :

Sl. No. Item Description Item Code / Make Quantity Units Estimated Rate in Rs. P Addition / Deduction Addition / Deduction Values Currency Convertion against each Item Quoted Currency in INR / Other Currency BASIC RATE In Figures To be entered by the Bidder in Rs. P GST (If applicable in Percentage) GST Amount in Rs. P HSN / SAC Code

1 Construction of Integration Facility (Civil and Structural work) at Keltron Controls, Aroor

1.01 Construction of Integration Facility (Civil and Structural Work) for LRS of VPA at Keltron Controls, Aroor as per the attached Drawings and General Terms & Conditions with Annexure-A as elaborated in Tender Document. item1 Job Excess(+) Full Conversion INR

Total in Figures

Quoted Rate in Figures Select %

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