vendor creation form revised jan 2012
Post on 21-Apr-2015
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TIONVENDOR CREATION Form (on the Letter Head of the vendor)
Please fill in the information in CAPITAL LETTERS. • Vendor Name :
• Vendor’s Address :
• Telephone No. :
• Mobile No. :
• Email id :
• PAN NO (Attach attested copy of PAN CARD) :
• SERVICE TAX NO (Attach copy of Form ST-2 if applicable ) :
• VAT / TIN No. (if applicable) :
• State in which VAT/ TIN is registered :
• MSMED registration No. (Attach copy of MSMED Registration certificate)
*** Vendor ’ s Bank Details
1.Name of the Bank :
2. Branch Address :
3. Location of the Branch (City) :
4. Type of Account (Saving / Current) :
5. Bank Account No. :
6. IFSC code (Attach cancel copy of the cheque) :
7.MICR Code of the Branch :
Please note: Kindly get the bank details attested by bank. Without attestation the forms
will not be accepted.
___________________ ________________________(Signature of vendor) *** (Signature of Bank Officer)(Along with Rubber Stamp) (Along with Rubber Stamp)
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I / We hereby declare that the particulars given above are true, correct and complete and
that I/ We have read, understood and agree to abide by the Terms and Conditions
governing the NEFT payment facility as appended hereto and/or as displayed on the
website at www.icicibank.com I / We undertake to keep ICICI Bank informed of any
changes in any of the above mentioned details.
Place :Date :
______________________________(Signature of vendor)(Along with Rubber Stamp)
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