DOC NO.
LARSEN & TOUBRO LIMITED [SCA]
SCM REGISTRATION - APPLICATION FORM
QUALITY MANAGEMENT
(**Mandatory Data - to be filled in and supporting documents enclosed ) Application Sl. No.
Date of Application:
S.NO FIELD DESCRIPTION SIZE INPUT
. ( letters )
1 Name of the Organization** 100
(Please do not start with M/s, Dr , Mr,
etc... )
2 Regd. Office Address** 150
3 Contact Person 50
4 Telephone Number 25
5 Zip/ Pincode** 15
6 E-Mail** 25
7 Valid PAN Number / GIR No. ** 10
Give number if applicable (Enclose if available) **
Applied For ------
--------
N.A. (Not Applicable)
8 IT clearance certificate ** 15 (Enclose if available) **
9 CST (if available) (Enclose)
10 LST (if available) (Enclose)
11 Excise Registration ( if available) (Enclose)
12 Excise Control Code (if available) (Enclose)
13 SSI (if available) (Enclose)
14 SSI Validity Period From (Enclose)
( if SSI available)
15 SSI Validity Period Up to (Enclose)
( if SSI available)
16 Service Tax Registration No. 50 (Enclose)
17 Organization type ** (Enclose)**
(Partnership, Private, Proprietary, PSU,
Public, Govt., Associate, Foreign Company,
Joint Venture, Subsidiary, OTHERS)
18 Payment in favour of** 50
19 Bank Name** 50
20 Bank Address** 50
21 MICR / Bank Branch Code** 9
22 Account No. ** 15
23 Preferred Login Name** 15
24 Regional office of ECC where you
HQ-Chennai Ahmedabad
will submit the hard copies of
your application for registration Bangalore Chennai Delhi
** Hyderabad Kolkata Mumbai
(Head Office to be registered first.
Branch Offices to be entered under Pithampur Pondy Kanchipuram
Branch Details.)
DOC NO.
LARSEN & TOUBRO LIMITED [SCA]
SCM REGISTRATION - APPLICATION FORM
QUALITY MANAGEMENT
(**Mandatory Data - to be filled in and supporting documents enclosed ) Application Sl. No.
Date of Application:
Sub-contractor Category
Labour contractors (Labour supply)
Labour contractors (PRW)
Sub-contractor with labour, materials and / or
equipment
Sub-Contractor for P&M maintenance
Sub-Contractor for Hiring out equipment
Sub-Contractor for transport of materials, P&M and
Personnel
P.F. Registration Number 25 (Enclose if available)
Workmen's Compensation Policy No. 25 (Enclose if available)
Bank solvency Enclose if available
Banker’s Credit Limit Enclose if available
Reference No. of application document hard copy
Registration with any other body Enclose , if available
ISO Certification (if available) (Enclose)
Quality Assurance/Quality Plan of the organization (Enclose if available)
_________________________________________________ (Enclose if available)
Safety procedure manual/Plans of the organization
BUSINESS AREA (As per Business Codes attached)
DISCIPLINE (As Per Discipline Code attached)
SKILL GROUP (As Per Skill Group Code attached)
SUB SKILL (As Per Sub Skill Code attached)
ANNUAL TURNOVER OF PAST FIVE (5) YEARS (Attach copy of annual reports / Certificates of turnover)
S.No Financial Year Ending Turnover (Rs. In Lakhs) Remarks)
1
2
3
4
5
DOC NO.
LARSEN & TOUBRO LIMITED [SCA]
SCM REGISTRATION - APPLICATION FORM
QUALITY MANAGEMENT
(**Mandatory Data - to be filled in and supporting documents enclosed ) Application Sl. No.
Date of Application:
PREVIOUS EXPERIENCE IN INDIA/ OVERSEAS OF PAST FIVE (5) YEARS (Attach copy of WO and Completion
Certificates / Final Certified copy of Invoice
Sl. Project/ Coun State, if in Client/ Disc Group Sub WO Duration Job Code if
No. Job try India Lead iplin skill skill Value of Job in ECC work
Site (50) Contrac e (Rs. months (15)
(50) tor(50) Lakhs)
1
8
DOC NO.
LARSEN & TOUBRO LIMITED [SCA]
SCM REGISTRATION - APPLICATION FORM
QUALITY MANAGEMENT
(**Mandatory Data - to be filled in and supporting documents enclosed ) Application Sl. No.
Date of Application:
JOBS IN HAND (Attach copy of WO)
Sl. Project/ Coun State, if in Client/ Disc Group Sub WO Duration Job Code if
No. Job try India Lead iplin skill skill Value of Job in ECC work
Site (50) Contrac e (Rs. months (15)
(50) tor(50) Lakhs)
1
8
DOC NO.
LARSEN & TOUBRO LIMITED [SCA]
SCM REGISTRATION - APPLICATION FORM
QUALITY MANAGEMENT
(**Mandatory Data - to be filled in and supporting documents enclosed ) Application Sl. No.
Date of Application:
LABOUR MOBILISATION CAPACITY
Sl. No Workmen category Peak Mobilization Source country Source State
Capacity (50)
numbers
1 Highly Skilled
2 Skilled
3 Semi Skilled
4 Unskilled
EQUIPMENT OWNED AS ON DATE
Sl.No Equipment ( Category / Class ) Capacity / Make (50) Nos. Owned
1
6
DOC NO.
LARSEN & TOUBRO LIMITED [SCA]
SCM REGISTRATION - APPLICATION FORM
QUALITY MANAGEMENT
(**Mandatory Data - to be filled in and supporting documents enclosed ) Application Sl. No.
Date of Application:
DETAILS OF KEY PERSONNEL ON ROLL
Sl.No Name(s)of the person(50) Position Qualification(50) Experience (Years)
1 Owner/ Proprietor
2 Partner(s)
3 Director(s)
4 Chief Executive
Sl.No Positions Number of persons
< 5 Years of 5 to 10 years > 10 years of Total no. of
experience experience experience persons
1 Engineering Managers (with
Engineering Graduation &
above)
2 Engineers (with Engineering
Diploma)
3 Other technical staff (ITI or
other certifications)
Any court cases / Arbitration cases pending YES / NO
(If yes, please furnish details in Hard copies)
Any incidence of suspension / abandonment of work (in last 5 years) YES / NO
(If yes, please furnish details in Hard copies)
Are you or any of your Partners / Directors already registered with us in other individual name /
organisation name YES / NO
(If yes, please furnish details in Hard copies)
Any other relevant data (Furnish in Hard Copy)
REFERRED BY (If any)
(Name, Designation, Address, Telephone No.) YES / NO
(If yes, please furnish details)
DECLARATION
We hereby declare that the above mentioned statements are true and in case of any false statements
and / or misrepresentation on our behalf, our registration will be liable to be withdrawn by Larsen &
Toubro Ltd – ECC Division.
We also accept that the registration is not a promise, in any form, by Larsen & Toubro Limited - ECC
Division for award of any job. We also agree to submit this form duly filled in, sealed and signed in
hard copy with all enclosures as aforesaid to the Section Head, Resource Department at the Regional
Office of ECC Division as indicated above.
This Portal is governed by the Terms & Conditions laid in the IT Act, 2000 & the Copyright Act,1957,
The Indian Contract Act, 1872 and/or other applicable laws of India and users are automatically
agreeing to abide by all Terms & Conditions of the act. Any unauthorized usage of this portal is a
legal offence.
Date Authorized Signature & Name of Sub-Contractor with Seal
