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Customer Credit Application Form

Contact Details

Company Name *

Name of Company / Firm / Proprietorship *

Domestic/MNC *

Landline/Mobile Number *

Website

Email id *

Name of Owner/Partners/Sole/Proprietor/ Director *

Complete Registered Office Address *

Complete Corresponding Office Address *

Company Details

GST Registration Certificate Number *

Place of Billing *

Place of Supply/Site Address *

SEZ Approval Letter (If Applicable)

If Yes, Letter of Declaration

Total Turnover (P.A in Lacs)

Financial Year 2016-17 *

Financial Year 2017-18 *

Financial Year 2018-19 *

Nature of Company/Firm/Proprietorship *

Nature of Business

Other (Specify)

Details of Sister Concern (If Any)

Name of Project

Project Details

Name of Principle Contractors in Case of Subcontractors

Contact and Address Details of Principle Contractors

SSI Number (If Applicable)

Number (If Yes)

Office Type

Credit Rating (If Available)

Rating (if yes)

Documentation

Upload GST Certificate *

( max. file size 500KB. File Type: Png. Pdf. Jpg. Jpeg...)

Upload PAN Card *

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Upload Aadhar Card *

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Upload Certificate of Registration

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Upload Balance Sheet (Last 2 Years)

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Upload GST 3B Return (Last 3 Months)

( max. file size 500KB. File Type: Png. Pdf. Jpg. Jpeg...)

Upload Bank Statement (Last 3 Months)

( max. file size 500KB. File Type: Png. Pdf. Jpg. Jpeg...)

Upload Verification of Address Document, If any (Visit Report)

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Upload Purchase Order/Work Order

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1. Type of Structure (Please share drawings if available)

supported file type (.doc , .png , .jpeg , .jpg )

2. Position of Ground Water Table ...m

3. Type of Soil Strata (Please share detailed Soil Investigation Report)

supported file type (.doc , .png , .jpeg , .jpg )

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Loadings:

4. Compression...kN.

5. Tension / Uplift...kN.

6. Lateral / Horizontal...kN.

7. Overturning Moment...kNm.

8. Expected design life of the structure...years

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General

Road type:

Paved

Unpaved

Project Length:

[km]

Fill in the traffic distribution in following table:

No.	Type	Axle Load[kN]	Count[Passes/day]
1	Single axle, single wheels
2	Single axle, dual wheels
3	Tandem axle, single wheels
4	Tandem axle, dual wheels

Conventional Pavement Structure

No.	Layer Description	Strength [MPa]	Thickness[mm]	Cost[$/m3]

1
2
3
4
5

Add +

Additional Available Material

No.	Layer Description	Strength[MPa]	Thickness [mm]	Cost[$/m3]

1
2
3
4
5

Add +

Additional Files Submitted

(supported file type (.doc , .png , .jpeg , .jpg )

Project general report (original) supported file type (.doc , .png , .jpeg , .jpg )

Project summary (English) supported file type (.doc , .png , .jpeg , .jpg )

Layout of geometry plan supported file type (.doc , .png , .jpeg , .jpg )

General area map of site supported file type (.doc , .png , .jpeg , .jpg )

Geotechnical report supported file type (.doc , .png , .jpeg , .jpg )

Conventional Design supported file type (.doc , .png , .jpeg , .jpg )

Photos supported file type (.doc , .png , .jpeg , .jpg )

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