Barcode Solution Provider - Registration form - GS1 India
Barcode Solution Provider - Registration form - GS1 India
Barcode Solution Provider - Registration form - GS1 India
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<strong>Barcode</strong> <strong>Solution</strong> <strong>Provider</strong> - <strong>Registration</strong> <strong>form</strong><br />
(Instructions: All applicable fields are mandatory.)<br />
<strong>GS1</strong> <strong>India</strong><br />
330, 2 nd Floor, C Wing, August Kranti Bhawan,<br />
Bhikaji Cama Place, New Delhi – 110066<br />
Ph: 91-11-26168720/21/25 Fax: 26168730<br />
info@gs1india.org ; www.gs1india.org ;<br />
Company Details *<br />
Name of the Company: *<br />
Registered office:<br />
Town/City ________________________________ State_____________________________ PIN code:<br />
Tel No. (With STD code): _______________________________________Fax No. : _________________<br />
Web site: _______________________________________________Email: ________________________________________________<br />
Date of Establishment (DDMMYYYY <strong>form</strong>at):<br />
Sales Tax / VAT No: _________________________________________________________________________________________<br />
Please attach complete details of your offices across the Country.<br />
Turnover in last 3 financial years<br />
Year<br />
Turnover (Rs )-Group<br />
2010-11( unaudited)<br />
2009-10<br />
2008-09<br />
(Ps: Attach Annual Report or P&L statement of 2008-09 & 2009-10)<br />
Provide reference details (at least 3 customers) and volume of business done with them<br />
Sl No. Company Contact Person Designation Telephone/ mobile no. Email id Business done ( Rs)<br />
Please attach your company profile and describe your plan for promoting <strong>GS1</strong> standards.<br />
Please attach employee details, i.e. - Total no of employees (management, administration, sales, Pre-sales, Technical, General &<br />
other categories.<br />
Key person Details*<br />
Name: ___________________________________________________________________________________________________<br />
Designation: _________________________________________________________________________________________________<br />
Email ID: ___________________________________________________________________________________________________<br />
Address for correspondence:_____________________________________________________________________________________<br />
Town/City ________________________________ State_____________________________ PIN code: _________________________<br />
Phone no. (With STD code): _________________________________________________Mobile: _____________________________<br />
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Contact person for <strong>GS1</strong> <strong>India</strong>*<br />
Name: _____________________________________________________________________________________________________<br />
Designation: _________________________________________________________________________________________________<br />
Email ID: ___________________________________________________________________________________________________<br />
Address for correspondence:_____________________________________________________________________________________<br />
Town/City ________________________________ State_____________________________ PIN code: _________________________<br />
Telephone No. (With STD code):__________________________________________Mobile: __________________________________<br />
<strong>Solution</strong> details*<br />
<strong>Solution</strong> provider’s role(s)<br />
Hardware provider (Y/N); Software provider (Y/N); Test centre (Y/N); System Integrator (Y/N); Any other, please specify_____________<br />
Product type(s)<br />
Printer (Y/N); Label (Y/N); Scanner (Y/N); Reader (Y/N); Verifier (Y/N); Any other, please specify ________________<br />
Software application areas-<br />
Retail (Y/N); Healthcare(Y/N);<br />
Transport & Logistics (Y/N); Any other, please specify___________________________<br />
Payment details<br />
Option #1: Payment through electronic fund transfer (See note below)<br />
Option #2: Payment by Cheque or DD<br />
DD/Pay Order / UTR Number: _____________________________________________________ Dated: _________________________<br />
Drawn on (Bank name): ____________________________________________________ Amount _______________________________<br />
(The DD/Pay Order should be in favour of <strong>GS1</strong> <strong>India</strong>, payable at New Delhi. <strong>Registration</strong> is subject to realization)<br />
Bank details for electronic fund transfer (NEFT)<br />
Vijaya Bank, Bhikaji Cama Place Branch<br />
Current Account No. – 602000301000218<br />
In the name of <strong>GS1</strong> <strong>India</strong><br />
NEFT Code: VIJB 0006020<br />
MICR Code: 110029018<br />
Corporation Bank, Bhikaji Cama Place Branch<br />
Current Account No. – CBCA01000783<br />
In the name of <strong>GS1</strong> <strong>India</strong><br />
NEFT Code: CORP 0000373<br />
MICR Code: 110017008<br />
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