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Name of Firm
*
Contact Person Name
*
Mobile Number
*
Contractor Email ID
*
Service Order Number
*
Service Order Date
Contractor Validity From Date
Contractor Validity To Date
Location of Work - SBU
Department
*
Select Department
BILLING & REVENUE ASSURANCE
BIOMEDICAL ENGINEERING
BMC PHARMACY
COMMERCIAL
DENTISTRY
FOOD & BEVERAGES
GENERAL ADMINISTRATION
HOUSE KEEPING
INFORMATION TECHNOLOGY
LINEN & LAUNDRY
MAINTENANCE & UTILITIES
SECURITY SERVICES
Labour License No.
Labour License Date
Number of labour
*
Labour License Validity From Date
Labour License Validity To Date
Contractor Complete Address
*
Full Description of contract
(as per service order)
Please Checked the following check box if YES
Service Order / LOI
PF No. of labour/sup
ESI NO. / WC Policy
RC of vehicle
Labour License
Safety Clearance
Vehicle Insurance
Disclaimer
- Certified that the information mentioned above are correct to the best of khnowledge of the contractor. The contractor M/s.
will responsible for good conduct & safety of the above persons inside the plant. It is declared by the contractor that there is no irrigation case against aforesaid persons. I/c of security Caseis requested to please the above persons during the working hours as per rules of the Company
