VENDOR REGISTRATION DETAILS

NAME PADHI TRAVELS

ADDRESS NEW BUS STAND

House No
House Name BUS STAND MAIN ROAD
Street
City BHADRAK
District BHADRAK
Pin 756100

Name of Proprietor HEMANTA KUMAR PADHI

CONTACT DETAILS:
Contact Person HEMANTA KUMAR PADHI
Mobile No. 9437173392
Telephone No.
Mail ID: Padhi.travels@gmail.com
Fax No.

PAN CARD DETAILS ALNPP9506A

GST NO 21ALNPP9506A12B

STATE SALES SALES TAX REGD NO.

CENTRAL SALES TAX REGD NO.

REGISTERED UNDER MSMED ACT 2006

IF YES (COPY OF REGD. CERTIFICATE) NO
BANK DETAILS
Name of bank IDBI Bank
Baranch Name Bhadrak
Address Mohan Plaza
Rajghat Chhak, Mathasahi

BANK ACCOUNT NO. 0402102000002462

IFSC CODE IBKL0000402
“I/We give our explicit and absolute consent to UltraTech Cement Limited for using the above said data to
enable UltraTech Cement Limited to register me/us as a Vendor of UltraTech Cement Limited. We agree
and confirm that this consent has been given us in accordance with the provision of Rule 5 of Information
Technology (Reasonable security practice and procedures and sensitive data or information)Rules. 2011’’

Seal & Signature of vender

(Please attach all required documents)

 PADHI TRAVELS New Bus Stand, Mathasahi, Bhadrak

To

UltraTech Cement Ltd.

22,Camac Street,
Block-D, 4th Floor,
Kolkata-700016,
West Bengal

Subject: Declaration of relation with any Employee/Director of UltraTech Cement Limited

I/We hereby confirm that our organization/ Company/ Firm/proprietor/ Partner have/Do not Thave any
relation with any Employee/Directors of UltraTech Cement Ltd. (Pl cancel whichever is not applicable)

I/We also undertake to inform the company in case any relationship is created in future between our
organization/ Company/ Firm/ proprietor/ partner and any Employee/ Director of UltraTech.

We hereby declare that above mentioned information is provided by us and is true and correct.

Place: BHADRAK Vendor Firm

Date: Signature and seal

Contact Nos- 9437173392 PAN No-ALNPP9506A

To

Dear Sir,

We are in process of making payments through ECS/NEFT/RTGS/Electronic fund transfer, Please provide
the details:

Sr No Particulars
1 Name of the Vendor PADHI TRAVELS
Fill Address New bus stand, Mathasahi, Bhadrak

3 Telephone No
4 Mobile 9437173392
5 PAN No
6 Name of the Bank IDBI Bank
7
8 Address of the Bank Mohan Plaza, Rajghat Chhak, Mathasahi
9 Branch Code IBKL0000402
10 Payee (payment in Hemanta Kumar Padhi
name of)
11 RTGS/NEFT IFSC IBKL0000y02
12 Nature of Account Current Account
13 Account No

Thanking you,

Yours Faithfully,