Partner Registration Form Company Information Company Name: Year of Establishment: Company Type: OEM/ManufacturerCalibrationService ProviderConsultantProduct DistributorDigitalComponentsSoftwareC&F Registered Address: City: State: PIN: Country: CountrySpainAfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Saint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBritish Virgin IslandsBruneiBulgariaBurkina FasoBurmaBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCook IslandsCosta RicaCroatiaCubaCuracaoCyprusCzechiaDemocratic Republic of the CongoDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFederated States of MicronesiaFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern and Antarctic LandsGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyIvory CoastJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMoldovaMongoliaMontenegroMontserratMoroccoMozambiqueNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestinePanamaPapua New GuineaParaguayPeruPhilippinesPitcairn IslandsPolandPortugalPrincipality of MonacoPuerto RicoQatarRepublic of the CongoReunionRomaniaRussiaRwandaSaint BarthelemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and South Sandwich IslandsSouth KoreaSouth SudanSri LankaSudanSurinameSvalbardSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin IslandsWallis and FutunaWestern SaharaYemenZambiaZimbabwe Website: Contact Details Primary Contact Person: Designation: Mobile Number: Email Address: Alternate Contact Person (if any): Alternate Mobile Number: Business Details Company Type: Pvt LtdPartnershipProprietor Branches Available: PlaceOption 1Option 2Option 3 Busines Details: OEM - Panel BuilderContractorDesign Build ContractorsSystem IntegratorScada solutionAuditingTrainingConsultant - Design/Marketing/other Brief Description of Products / Services Offered: GST Number: PAN Number: MSME Registration Number (if applicable): Any Other Certifications (ISO, etc.): Banking Details (Optional at Registration Stage) Bank Name: Branch: Account Number: IFSC Code: Declaration We hereby declare that the information provided above is true and correct to the best of our knowledge. We agree to abide by CIRBRID’s terms, conditions, and code of conduct for vendors. Authorized Signatory Name: Designation: Signature with Company Seal: Date: Partnership Intrested: Choose OptionI-expertS-ExpertP-ExpertT-ExpertC-Expert Attachment Three yeast Balance Sheet: Top Tend Customer list: GST Certificate: Company Certificate: Company Profile: