Application for Registration of Contractor (Class III)

1. Vendor Details Name :

Registration Number :
Application Number :
2. Type of vendor :
3. Name of father/husband (in case of individual) :
4. Caste :
5. Religion :
6. Date of Birth :
7. Nationality :
8. PWRD Wing :
9. Permanent Address : Street name 1 :
Street name 2 :
Village/Town :
District :
Pincode :
Mobile No :
10. Present address : Street name 1 :
Street name 2 :
Village/Town :
District :
Pincode :
Mobile No. :
11. Class & Category : CLASS III
12. Financial Year :
13. PAN Number :
14. GST Number :
15. Bank Details : Bank Name :
Branch Name :
Account Number :
16. Registration Date :
17. Registration Renewal Date :
18. Address of Regd. Office (Mandatory for Partnership Street Name1 :
Firm/Company Street Name2 :
Village/Town :
District :
Pin Code :
Mobile No :
19. Address of Individual/Proprietor in case of Proprietorship Firm.For Partnership firm, include address of all
Partners. For Company, include address of designated person :
Sl. No. Partners/Directors Name Age Address
20. Contact person/Authorized Signatory details : Name of Authorised Signatory. :
Street Name1 :
Street Name2 :
Village/Town :
District :
Pin Code :
Mobile No :
Email Id :
21. Completed Works :
Works executed in the last 5 years (Current Financial Year not to be included) :
Sl. No. Prime/Sub Contractor Project Name Details
22. Quantities of work executed in the last 6 years (Current Financial Year not to be included) :
Sl. No. Prime/Sub Contractor Work Item Quantity Financial Year
23. On going works :
Sl. No. Prime/Sub Contractor Project Name Details
24. Key Personnel for Works and Administration :
Sl. No. Work Position Name Qualification Experience
25. Details of Machinery Owned :
Sl. No. Type of Equipment Numbers Owned Machinery Details
26. Financial Turnover from Civil Engineering Works in the Last 5 years (Current Financial Year Not To Be
Included) :
Sl. No. Financial Year Turnover(INR)
27. Litigation History :
Sl. No. Employer Cause of Dispute Status
28. Vendor History :
Sl. No. Class Action Date
29. Brief description of requirement :
Contractors Declaration
I declare that the data and credentials submitted/document attached by me for the mentioned year for vendor data
update is correct.
Date : 01-01-1970
Place : Signature of the Applicant