Payment Information

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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?

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Post:

Business Information

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Business Name *:

Address *:

Line 2:

Line 3:

BR Number *:

BR Date *:

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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 :

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Name of the Owner/Directors/Partners:

Special Certificate:

Item Selection

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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

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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

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National Identity Card Number *:

Upload BR:

National Identity Card Number *:

Upload Slip:

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National Identity Card Number *:

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