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How to fill out the Application Form For Empanelment For: online
Completing the Application Form For Empanelment is an essential step for vendors seeking approval. This guide offers step-by-step instructions to help you accurately fill out the form online, ensuring all required information is provided clearly.
Follow the steps to complete the application form effectively.
- Click the 'Get Form' button to access the form and open it in your preferred document editor.
- Fill in the common details for all vendors in block letters. This includes the name of your firm, type of firm (sole proprietor, partnership, private limited, or public limited), along with its registration number if applicable. Ensure to enclose the necessary documents such as the Gumasta, partnership deed, articles of association, and memorandum of association.
- Provide the registered office address and the local operating office address. Make sure both addresses are current and complete.
- Enter the name of the owner, partner, or proprietor who is mainly responsible for the application. Include reliable contact information like telephone numbers for both registered and local offices.
- List the name and mobile number of the person who will maintain communication regarding the application process.
- Include the fax number, the email address of the firm, and the email address of the authorized signatory for further correspondence.
- Indicate the date of establishment, incorporation, and the month and year of the commencement of business.
- Provide the turnover for the last three years and disclose whether your firm was blacklisted by any institution in that time.
- Attach the required copies of certificates relevant to your field of operation issued by the appropriate authority or organization. This may include a valid license for electrical contractors or registration with the Council of Architecture for architects.
- Enter your PAN number and include a copy of the PAN card. Also, provide the service tax registration number, along with a copy.
- Fill in the TIN registration number and attach a copy as well.
- Detail your bank account information including the account number and IFSC code. Ensure to attach a cancelled cheque for verification.
- Include any relevant details of registration with government authorities, if applicable.
- Select the type of work opted for as indicated in Annexure II. Note that you can only choose one type in this form.
- If additional space is needed, attach separate sheets mentioning the serial number of the relevant item.
- Sign the form, and ensure the seal or official stamp of your firm is included before submission.
- After completing all fields, save the changes, then you can download, print, or share the form as necessary.
Complete your Application Form For Empanelment online to ensure a smooth application process.
Related links form
Empanelment is the act of assigning individual patients to individual primary care providers (PCP) and care teams with sensitivity to patient and family preference. Empanelment is the basis for population health management and the key to continuity of care.
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