New Service Provider / Supplier Information Request Form

Quadrific Media Private Limited

Please fill in the fields below with your details.

CONFIDENTIAL INFORMATION
Your Company Name (Legal Name) Acumen Business Processes (I) Pvt Ltd
Status of the vendor: Individual / Proprietor / HUF /
Company
Firm / Company
DetailsCommunication

Address with Postal Code 10 Sumeet, 17 J B Nagar, Andheri East, Mumbai 400 059
(as on Letter head and Invoice)
State / Region Maharashtra
Country INDIA
PO Box (if applicable) NA
Name, Phone No. & Extension of Your Tanveer Shaikh 0091-9004616202
Representative
Fax No.(to which POs should be sent) NA

Your Email Address corporate@acumen.co.in

VAT / CST Registration No. /

Service Tax Registration Number AADCA0593QST001
Your Service Tax Category Enclosed
Permanent Account Number Enclosed - AADCA0593Q

Residential Status :(for tax purposes) Resident

Tax Dtails

In case of foreign vendors where withholding tax is applicable, following documents are required:
No PE declaration as mentioned in DTAA
(Double Taxation Avoidance Agreement) with
i respective country
NA
Tax residency Certificate from tax authorities
ii
of respective country. NA
Kindly note that, if in case, the Resident status changes you would inform Quadrific by written communication.
Please record the following bank details in writing along with cancelled cheque:
Payment Details

Bank Details: Bank of India

Bank of India, Chakala Branch, Opp Sangam Theater, Sir
M V Road, Andheri East, Mumbai, MH - 400093, India.
400013012
006727100040033
Overdraft Account
Acumen Business Processes (India) Pvt Ltd
BKID 0000067

Consulting Services and Software Development based on requirements

Specific Items / Services that you will supply to Quadrific
Is your company a Small Scale Industry Undertaking? Enclosed
(If YES, SSI Registration No. to be provided)
Name, Position and Signature of the person who has updated this form along with Company Stamp
The information shared by you in in this form includes your personal/sensitive personal information (Data) as understood in law. By sharing the Data
you are, at your option, permitting us, including our affiliates, agents, advisors, representatives or subcontractors (Authorized Entities) to use the Data
for such lawful purpose as may be necessary pursuant to the proposed commercial transaction between you and us including, making or receiving of
payments to or from you. You agree and understand that the Data will or may be shared or transferred by the Authorized Entities including their
affiliates, agents, representatives or subcontractors, for such lawful purposes as may be deemed necessary pursuant to our engagement.

Name: Tanveer Shaikh Designation: Principal Consultant

Signature & Company Stamp Date: 18th February 2017

Note: Please note that no payments will be made unless you have received a Purchase order (PO) from Quadrific
Media Private Limited. Please insist on PO from Quadrific before accepting order.
To be filled in by Quadrific Staff :

Vendor Request No: Requestor Name: