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Payment Information
National Identity Card Number *:
Payment Method:
Bank deposit
money order
pay at office
Paid Account *:
paid Date *:
Which method do you use to send us payment details?
Upload :
Post:
Business Information
Business Name *:
Address *:
Line 2:
Line 3:
BR Number *:
BR Date *:
Which method do you use to send us BR ?
Upload :
Post:
Nature of The Business:
sole owner
limited company
partnersip
cooperation
Mobile Number *:
Land Line:
E-mail:
Fax:
Website:
Bank Account Number *:
Vat Number:
(if any)
License Number:
(if any)
License Date :
Which method do you use to send us License ?
Upload :
Post:
Name of the Owner/Directors/Partners:
Special Certificate:
Item Selection
Main Code
Sub1
Sub2
Sub3
Sub4
Sub5
Sub6
Sub7
Sub8
Sub9
Sub10
Sub11
Sub12
Sub13
Sub14
Sub15
Supply of Office Equipment
Supply of Office Consumables
Supply of office Services
Supply of School Equipment
Supply of Library Books
Supply of Sports Goods
Supply of materials for Garment
Supply of materials for Pottery Industry
Supply of Equipment for coir Industry
Supply of Equipment for Handicrafts
Fishery, Animal Husbandry and Agriculture
Supply of Health Security Equipment and Drugs and Services
supply of Food
Repairing of Vehicles and Supply of Spare Parts
Supply of Building Materials
Supply of Items for Road Development and Repairs
Supply of festival items
Transport Services
others
Other Information
Employee Details:
Employee
Position
Number of employees
Trained Employee
Engineer - Degree
Technical Officer - Diploma
Trained Technician
Other
Not Trained Employee
Other
Equipment Details:
Equipment
Amount
Past Supply Details:
Institution
money spent
date of completed
Current Supply Details:
Institution
Estimated money
date to be completed
Document Upload
National Identity Card Number *:
Upload BR:
National Identity Card Number *:
Upload Slip:
National Identity Card Number *:
Upload License: