NON-EMPANELLED VENDOR REGISTRATION FORM
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Agency Name
*
PAN Number
*
Agency Address
*
State
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-- Select --
ANDAMAN and NICOBAR ISLANDS
Andhra Pradesh
ARUNACHAL PRADESH
ASSAM
BIHAR
CHANDIGARH
CHHATTISGARH
DADRA and NAGAR HAVELI
DAMAN and DIU
GOA
GUJARAT
HARYANA
HIMACHAL PRADESH
JAMMU and KASHMIR
JHARKHAND
KARNATAKA
KERALA
LAKSHADWEEP
MADHYA PRADESH
MAHARASHTRA
MANIPUR
MEGHALAYA
MIZORAM
NAGALAND
NCT OF DELHI
ORISSA
PUDUCHERRY
PUNJAB
RAJASTHAN
SIKKIM
TAMIL NADU
TELANGANA
TRIPURA
UTTAR PRADESH
UTTARAKHAND
WEST BENGAL
District
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-- Select --
DIMAPUR
KIPHIRE
KOHIMA
LONGLENG
MOKOKCHUNG
MON
PEREN
PHEK
TUENSANG
WOKHA
ZUNHEBOTO
Discom
*
DoPN
Primary Contact Person Details
Name
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Mobile Number
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Email
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[This will be used as Login Id]
Note:
Login Id & Password will be sent to your email account post DISCOM Approval.
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