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RAJASTHAN ELECTRONICS & INSTRUMENTS LTD.

[A Public Sector Enterprise]

2, Kanakpura Industrial Area. JAIPUR-12

REGISRATION FORM [VENDORS]

1
Name of the firm
TRUE POWER EARTH SOLUTIONS

2
Complete address with
D-10, SECOND FLOOR, VIBHUTI KHAND-2,
GOMTI NAGAR, LUCKNOW-226010

Telephone No. Telex No. Fax No.

& Telegraphic Address

a
Registered Office
D-10, SECOND FLOOR, VIBHUTI KHAND-2, GOMTI NAGAR, LUCKNOW-226 010

b
Manufacturing Plant
PLOT NO.7,PRAGATI VIHAR,TAKROHI, INDIRA NAGAR,SHAHEED BHAGAT SINGH WARD,
LUCKNOW

c
Branch Office if any
TRUE POWER EARTH SOLUTIONS,
G-2, D-242, SECTOR-63, NOIDA, UTTAR PRADESH

3
Name & designation of the
MR. DHRUV DUBEY
AGM

person to be conceded

4
Name & designation of the Chief
MR. HARI OM TIWARI
PROPRIETOR

Executive

5
Activity (Tick whichever is
Manufacturer
[
]

applicable)
Authorized Distributor
[
]

Authorized Dealer
[
]

Authorized Stockist
[
]
6
Is your firm in Public / Private Ltd.
PROPRIETORSHIP

Company

7
Registration No. of firm &
date &
NSIC NO.-NSIC/GP/LKO/2015/0018234 DT.28-01-2016

authority with whom registered


THE NATIONAL SMALL INDUSTRIES CORPORATION LIMITED

8
Date of commencement of
28-JULY-2012

business

9
Financial status
CA CERTIFICATE ENCLOSED
a
Bankers Name & Address
DIRECTORATE OF AGRICULTURE KRISI BHAWAN LUCKNOW, UTTAR PRADESH.

b
Number of last Income Tax
PAN NUMBER AHYPT9412E
Clearance Certificate & date

(Attach zerox copy)

c
Annual Turn Over of last 3 year
CA CERTIFICATE ENCLOSED

d
Term loan taken from Financial
NOT APPLICABLE
Institution (s) / Bank (s). Please

furnish details

10
CST & LST No. & Date (Attach
VAT- 09850028788
zerox copies)
CST 09850028788C

COPIES ENCLOSED
11
Central Excise Duty Applicable or
NOT APPLICABLE
not

12.A
TO BE FILLED IN BY DISTRIBUTORS,
DEALERS & STOCKISTS

Name & Address of


Articles for which
Value of normal
Name of the
Principal
Agency help
stocks for these items
concerned person of
manufacturers With

principal
Telephone No.,

manufacturers
Telex No. &

Telegraphic

address

NOT APPLICABLE
12.B
TO BE FILLED IN BY MANUFACTURER
a
Brief of Manufacturing facilities
Attach Annexure
available

b
Brief of Testing facilities available
Attach Annexure

c
Registration No. under

SSI NO.-090271101753PART-II/2013
NSIC NO.-NSIC/GP/LKO/2015/0018234

d
Brief description of the items
manufactured (Attach 2 sets of

detailed specification &


catalogues / literature for these
items
GI CHEMICAL PIPE EARTHING
COPPER BONDED EARTH RODS
COPPER EARTH RODS
GROUND ENHANCEMENT COMPOUND
LIGHTNING PROTECTION SYSTEM

e
Collaboration if any
NOT APPLICABLE

f
Registration No. under
NOT APPLICABLE
i)
Patent Act.
NOT APPLICABLE

ii)
Trade & Merchandise Act
NOT APPLICABLE

g
Brief details of Fixed & Current
BALANCE SHEET ENCLOSED
Assets

13

Type of articles / items


a
For which Registration sought

(Attach details specifications &


CATALOGUES ENCLOSED
catalogues)

b
Details of rate contacts for such
NIL
items (if any)

c
Details of test approval /
CPRI TESTED
certificate for each items (Attach
ROHS CERTIFICATION
zerox copies)

14
Are you or any of your Partner (s)
NO

/ Director (s) are related to any of

the employee of REIL? If so give

name & details

15
Any other details

Signature & Seal of Authorised Signatory of the party

Place
Name

Date

Designation

Note:
The form should be filled complete in all respects and all necessary documents should be furnished without
which request for registration is liable to be rejected.
We reserve the right to consider or reject the request without assigning any reason. The registration shall
not bind REIL for placement of any order / business.