DOCUMENT REF NO: F01(UTCL-P- 02) REV-4 DTD: 20.12.

2022

UltraTech Cement Limited

Registered Address: Ahura Centre, 2nd Floor, 'A' Wing, Mahakali Caves Road,
Andheri (E), Mumbai – 400 093, India

VENDOR REGISTRATION FORM

1 : - VENDOR NAME *:
Name*
Contact No.*
Proprietor/Partner/MD/CEO
Email Id*
Qualification
Scale of Industry Nature of Entity* Material Supply*

Macro Proprietor Manufacturer Channel Partner

Small Partnership OEM Any Other, Please Specify

GENERAL DETAILS:
Please select (Yes / No / N.A. ) as applicable in Private / Public Ltd.
the suitable box Mini Authorized Dealer
Company

Medium PSU Trader

Large NGO Importer, Stockist

Promoters Holding (%)

Whether Listed / Not Listed in If Authorized Dealer/Stockist/Channel Partner please specify name of the Product
BSE / NSE? & Principal Company
Supporting Certificate to
Partnership Deeds be attached* Collaboration Details if any (Foreign / Local)
Establishment Year* Others, please specify
2 : - REGISTERED OFFICE ADDRESS: * (Do not write the firm/company name here)
Address :

City : Pin Code: State : Country:

Contact Person Phone No. (O) Fax No. Mobile No. Email

Ordering Adress can only be one. Please confirm whether above mentioned address will be the ordering address?
Dealing Office / Local Office Address : (Do not write the firm/company name here)
Address :

City : Pin Code: State : Country:

Contact Person Phone No. (O) Fax No. Mobile No. Email

Ordering Adress can only be one. Please confirm whether above mentioned address will be the ordering address?

Factory Address (Attach sheet if more than 1) : (Do not write the firm/company name here)
Address :

City : Pin Code: State : Country:

Contact Person Phone No. (O) Fax No. Mobile No. Email

Ordering Adress can only be one. Please confirm whether above mentioned address will be the ordering address?

Stockist / Distributor / Dealer (Name) :

Address :

City : Pin Code: State : Country:

Contact Person Phone No. (O) Fax No. Mobile No. Email

Please furnish other address (if any) in a separate sheet

3. REGISTRATION NO.: CIN NO.

HSN Code

PAN NO. *

GST Registration Number for

PF Number (PF Reg. No.)*
all locations: *

MSME Registration Details: Labour License No. & Date

SIGNATURE :

VENDOR's AUTHORIZED SIGNATORY ALONG WITH SEAL

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 HAVE OFFICIALS OF ULTRATECH CEMENT VISITED AT YOUR PREMISES / WORKS / OFFICE? (SELECT YES / NO)

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 4 :- PRODUCT DETAILS: *
Sr. No. Product Manufactured / Stocked Services Rendered

1 Products Manufactured along with the year of commencement of Production

Product Name, Size Range, Models, Grades, Standards etc.

2
(Please attache product catalogues, leaflets, literatures etc. as supporting documents)

3 Production Capacity

4 Details of Raw Material used & its Sources

5 Does your company sell its products directly to end customer ? (Select Yes/No/N.A.)
6 Do you have after Sales Services ? (Select Yes / No / N.A.)
Note: Separate Catalouges/Pamphlets/Brouchers may be attached.
5 :- TECHNICAL DETAILS:*

Sr. No. Manufacturing Facilities / Equipments Available (In - House)

1 List of Machineries & Production Equipments installed with Size, Capacity, Range etc.

Details of Sub-Contract Jobs viz. Type of Job being sub-contracted, name to whom job is sub-contracted, address,
2
your quality check on it etc.
3 Standards & Codes followed by you for manufacturing
Details of Laboratory Facilities available with you & accreditations
4
(If any then please attach photocopy)
5 Any Specific manufacturing facilities of Interest
Note: Separate Catalouges/Pamphlets/Brouchers may be attached.
6 :- INSPECTION & TESTING FACLITIES / ASPECTS

1 Testing Equipments & Facilities in your company along with details about various test conducted inhouse

Testing facilities availed from outside agencies (such as chemical testing, Radiography, other NDT methods) along
2
with the Name & Address of outside Agencies from whom testing facilities are availed.

3 Codes & Standards folllowed for Testing.

Whether Independent Quality Control & Inspection Section is established in your company? (Select Yes / No /
4
N.A.)
5 Inspection & Quality Control and Record Procedure for :
i) Raw Material
ii) Various stages of Production
iii) Final Product
6 Third Party Inspection Agencies Name & Address, if Any
Note: Separate Catalouges/Pamphlets/Brouchers may be attached.
7 : - QUALITY MANAGEMENT SYSTEM :*

Social Accountability
Certification ISO 9001 ISO 14001 OHSAS 18001 TPM TQM
SA 8000

Certification No

Certified By

Under Process / Not Certified

(a) Do you have Quality Manual? (If yes, please attach copy of same)
(b) Do you have Quality Assurance Plan ? (If yes, please attach copy of same)
(c ) Do you have Material Test Certification? If Yes, Please accordingly such as Self Certification, Third Party
Certification, Not Applicable)
(d ) Do you have Product Certification like ISI, BIS etc ? (If any please attach photocopy of Certificate)

(e) Whether Quality Complaints Handling Systems is in your place? (If yes, please attach copy of same)

(f) Quality awards / Appreciation by customer / Merit rating by customers (If yes, please attach copy of same)

(g) Other Quality Certification :

8: - ORGANIZATIONAL DETAILS : *
(a) No. of Staff: (b) No. of Engineers : ( c) No. of Supervisors
(d) No. of Workers : Trained: Skilled: Unskilled:
Please attach sheet giving technical/professional skills & qualifications of key persons.
(e) Do you have Design & Drawing Facilities? If yes, then furnish complete details

(f) Do you have R&D Setup? If yes, then furnish complete details

(g) Do you have customer service & technical support setup? If yes, give details

(h) Do you have any other sister concerns?

If yes, please give the details:

Name of the Items they Are they already dealing / supplying to

Sr. Name of sister concern Vendor Code, if registered at UTCL
Deal/Manufacture M/s UTCL (Yes / No )

Financial Year Turnover Net Profit Networth

Financial Details for last 3 years (Rs.Lacs)*

(Attached Audited Balance Sheet)

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 9: - BANK DETAILS: -* (Remittance of payment by electonics mode - RTGS / NEFT
Banker's Name : MICR Code No.:
Branch Name & Address : IFSC Code:
Account No.: Account type :
Working Capital Limit Original Cancelled Cheque
Certified that the Bank details furnished above are corect as per our records.

SIGNATURE :

VENDOR's AUTHORIZED SIGNATORY ALONG WITH SEAL

10: OTHER INFORMATION: *

Do you engage Child Labour less than 15 yrs?

Does your company take deposit money from the employee for employment?

Does your company follow all the statutory government compliances such as Minimum wages, PF, Gratuity & insurance as per Law?

Have your company undertaken any Corporate Social Responsibility (CSR). Please attached details, if any.
Does your company have any Enterprise Resources Planning (ERP) Software?
Do you Publish Sustainability Reports? If yes, then attached one copy of the same.

11: SAFETY ASPECTS: *

a) Do you have Health & Safety Policy of your Company? If so, provide a copy.

b) Do you have a set of Safety & Health related Rules & Regulations followed in your Company. If yes, give a copy of it.

c) Are your engineers/supervisors/workmen trained for various safety aspects such as safety, safety procedures, use
of Personal Protective Equipments. Are you Providing Personal Protective Equipments to your workman? If yes, Please give details.

Details of PPE:
d) Do you periodically get your electrical appliances/powered tools tested for their proper functioning ? Do you keep the record of such
testing?

e) Do you periodically get your lifting tools & tackles, mobile cranes tested through a competent person and maintain record in a prescribed
format under the factories act & rules ?

f) Do you deploy a Qualified Electrical Supervisor to look after all Electrical aspects at Work Place?

g) Do you deploy a Qualified Safety Supervisor to look after safety requirements and safety of the personal at work place ?

Please furnish the record of accidents during working in past for the last three years as per format given below :

Sr. No Date of Accident Name of Work No. of major injury No. of deaths Reason of Accident

12:- ENVIRONMENTAL, SOCIAL AND GOVERNANCE: *

12.1 Environment Particulars -

i. Does your company have valid documents/ certifications/licenses/ consent/permits for the following: Consent to Operate issued by Pollution Control
Board; Storage and use of hazardous substance; Factory License; Fire safety license

ii. Has your company received any fines, prosecution, or warnings by regulators in previous years ? If yes, please mention.

iii. Does your company have internal mechanism to monitor, track and report the following: Air Emissions, i.e., Nox, Sox, and Particulate Matter (PM);
Hazardous Waste Generated; GHG Emissions; Water Consumption

iv. Does your company organise key programmes and initiatives for employees/workers on relevant environmental and health particulats, as indicated
below-Air Emissions; Waste Management; Occupational Health & Safety; Water Management; Any Other

12.2 Social Particulars -

i. Does your company have formal internal guidelines to regulations concerning to the following: Payroll Documents; Working Hours; Minimum Wages &
Incentives; Prevention of Sexual Harassment at workplace

ii. Does your company have procedures in place to ensure appropriate Personal Protection Equipment (PPE) is provided to employees?

iii. Does your company have a written emergency response plan and fire evacuation procedure?

iv. Has the emergency response plan and fire evacuation procedure been communicated to all parties that could be affected by the emergency in local or
appropriate languages?

v. Does your company monitor and track incidents and fatalities? If yes, provide the below details: Accidents reported within 12 months period; Number of
fatalities within last 12 months.

vi. Does your company qualify for the mandatory CSR? (for Indian companies only, as per Companies Act 2013)
If yes, please provide the details of CSR expenditure (mandatory/voluntary) by your company for last 3 financial years:

12.3 Governance Particulars -

i. Does your company have formal coporate structure to monitor performance? If yes kindly provide the name and designation of governing body
responsible for monitoring performance.

ii. Does Your company publish the following reports, as a part of public disclosure: Business Responsibility Report (BRR); Sustainability Report / Integrated
Report; Any Other disclosure on purbic forum

iii. Does the company have following policies? Human Rights Policy; Child Labour Policy; Fair Competition and Ethical Trade Policy; Human Rights Policy;
Environment, Health and Safety Policy

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 13:- MAJOR CUSTOMERS*
Please give list of your Customers giving Repeated Business for last 3 years and attach latest PO Copies executed for them.

If your company is already registered with any units of Aditya Birla Group (ABG), then give unit Name and attach latest order copies.

Aditya Birla Group Units / Other Cement Performance Certificate Months &
S. No. Industries / Other Customers Contact Person Contact Detail Materials Supply (YES/NO/N.A.) Year of order

Please furnish details of other client (if any) in a separate sheet.

Do you have annual rate contract with any reputed Company for your product, preferably Cement Company
(If Yes, please attach rate contract copies)
Appreciation letters / certificates from customer (if yes, please attach copy of same)
Any other information you want to give, about your Business
Any other Remarks
14:- GENERAL:
Would you like to give more information about your organisation like -
(a) Standards or certification achieved in any field like Quality, Social, Environmental, Inspection, Testing, Service etc.

(b) Steps initiated by your organization towards “Sustainability” (Social/environmental – like reduction in consumption of paper, energy carbon etc,)

( c) Whether your organization is involved in any litigation with any of your customer? if yes, nature of litigation.

(d) Whether your organization is de-listed by any of your customers? if yes, details thereof.

(e) Any other information, which you feel relevant

15 :- DECLARATION:
I /We hereby undertake that at no stage of business, our company will resort to adopt any unethical means in lieu of getting
On behalf of M/s …………………………………………………………….……………….
business. Also if any of your employees / representatives makes a demand
which is unethical in nature, our Company would not succumb to such pressure and M/s UltraTech Cement Ltd reserves the right to suspend or terminate the registration and recover the dues (if any) from
the vendor.

Terms & Conditions :

1. The form must be complete in all respects, failing which the form will not be considered

2. This Vendor Registration Form does not guarantee the receipt of notification for all applicable solicitations or invitation to offer or placing of any Purchase Order or participation in bid or floating of
Request of Quotation.
3. The Vendor is solely responsible a) for providing all material information, whether required by this form or not and b) for the information provided in / with this form c) for providing additional information
as and when required by UTCL
4. Changes, if any, shall be informed to UTCL by the Vendor well in advance and if not possible, within 7 days of happening of the change.

5. UTCL reserves the rights to assess the vendor periodically and to decide the continuation / discontinuation of business with the vendor based on assessment report.

6. Representative of UTCL or their nominated agency has the right to visit vendor's premises for the verification of information with a prior initmation to the Vendor.

7. At later date if it is found that the information furnished is untrue, inaccurate or is incomplete, M/s UTCL reserves the right to suspend or terminate the registration and recover the dues (if any) from the
vendor.
All the information furnished above and the documents attached herewith are true and correct.

Remarks, if any :

All the above Terms and Conditioned mentioned above are accepted
Name Signature
Designation Date
Mobile No. Seal
Email ID

ABOVE TO BE ENDORSED BY : CHIEF EXECUTIVE / PROPRIETOR / PARTNER / UNIT HEAD

Note :
A) Annexure 1: Checklist of the required documents as applicable.
B) Annexure 2: Additional Details required (Only to be filled by Packing Bags Vendors)
C) * Mandatory Fields
D) For details not related to you, Please mention as N.A.
E) If the space provided is insufficient, then vendor can attached seperate annexure.

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 FOR INTERNAL USE (NOT TO BE FILLED BY VENDOR)

IS THE VENDOR WHICH IS TO BE REGISTERED, A RELATED PARTY OF THE COMPANY IN TERMS

( YES / NO )
OF THE PROVISIONS OF THE COMPANY ACT, 2013 ?

a. Vendor already registered at group units under different Vendor Name/Code ?

b. Any of the Directors/Promoters in the supplier entity, an ex-employee of ABG ?

c. Any of the Directors/Promoters in the supplier entity a Near Relation/ Blood Relation with any employee at Aditya Birla Group ?

IF YES, THEN PRIOR APPROVAL OF THE AUDIT COMMITTEE IS MANDATORY BEFORE

REGISTERING

VENDOR ASSESSMENT (Assessment Grades :- Excellent : 5 | Very Good : 4 | Good : 3 | Average : 2 | Poor : 1)

S. No. Evaluation Criteria Assessment Weightage Net Score

(Input Field)

1 Manufacturing / Serviceability Strength 25% 0

2 Quality Management System 25% 0

3 Financial Strength 25% 0

4 ESG Compliance 10% 0

5 Market Reputation 5% 0

6 Logistics & Delivery 5% 0

7 General Administration 5% 0

Final Score 0

RECOMMENDATION FOR REGISTRATION : (YES/NO)

PREPARED/INITIATED BY RECOMMENDED BY APPROVING AUTHORITY

VENDOR CODE NUMBER DATE OF REGISTRATION

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 ANNEXURE 1 - CHECKLIST* (TO BE FILLED BY THE VENDOR)

Please ensure that the following documents are attached, as applicable and select (Yes/No/N.A.) whichever is attached.

1 Vendor Registration Form of UTCL duly filled and signed on each page by the vendor.

2 Any of the following as applicable :

a Partnership Deed
b Memorandum of Association
c Articles of Association
3 Attested copies of following (whichever is applicable):

a IEC registration certificate (for importing house)

b PAN card

c MSMED Certificate

d GST Registration Certificate

f Manufacturing Certificate issued by Government of India (for manufacturers)

g Quality Control Certificate (eg. ISO)

h PF registration (Mandatory for service providers working at any of the UTCL sites)

4 List of the following :

a Branch office with contact details

b Existing major customers /clients

c All equipments (mandatory for service providers)

d Product (Catalogue)

5 In case of dealer, authorization certificate from the OEM / Manufacturers.

6 Audited Balance Sheet and Profit & Loss A/C for the last 3 Financial Years.

Copy of few Purchase Orders executed during laste 2 years alongwih Vendor Satisfaction Certificate issued by those clients
7
(preferably big companies / Corporate houses)

8 Details of sister concern and parent concerns (if not applicable give declaration)

The Vendor Registration Form shall be signed by the vendor on each page. It shall also have address and contact details of
9
the proprietor / CEO / MD of the Organisation

10 Bankers Details along with cancelled cheque and banker's certificate, if available

11 Credit rating, if available

12 Please attach documents which can support your credentials, if any

All the documents attached should be self attested also.

Please give written confirmation with reason for those which are not applicable, if any

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 ANNEXURE 2 - ADDITIONAL DETAILS REQUIRED (ONLY FOR PACKING BAG VENDORS)

PRODUCTION FACILITIES (MANUFACTURER)

1 Production Capacity Per Annum (Rs. Lacs)

Type of Bag Manufactured for
a) Cement
b) Fertiliser
c) Others

2 Brief Details of Machineries Available

a) Tape Section
i) No. of Extruders & Make
ii) Extruder Capacity (Kg./Hr.)
iii) Process Blown / T Die
b) Fabric Section
i) No. of Looms & Make
ii) Type of Loom – Circular / Flat

3 No. of Stitching Machines & Make

4 No. of Printing Machines & Make

5 Testing Machine
i) Make of Fabric Strength Testing Machine
ii) Make of Tape Strength Testing Machine

6 Laboratory Standards / Approval / Certifications in Place

7 Raw Material Sourced from

i) PP:
ii) Filler:
iii) Ink:
iv) Master Batch:

8 Power Sources
i) Own DG sets
ii) Grid

9 Transporter Details

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