GOVERNMENT OF MEGHALAYA

PUBLIC WORKS DEPARTMENT

Service Specific Details

Type of Application *

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New Registration

Renewal

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Purpose of Application *

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Roads

Building

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Choose the Class of Contractor registering for *

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Class I

Class II

Class III

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Name of Applicant *

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Type of Applicant *

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Individual

Firm

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Application Submission Details

Directorate *

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Circle *

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Division *

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Basic Applicant's Details

Father's Name *

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Mother's Name *

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Date of Birth/Date of Incorporation *

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Name of Power of Attorney *

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Permanent Address [in Full] *

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Communication Address [in Full] *

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Nationality *

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State of Domicile *

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Mobile Number *

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Social Category *

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E-Mail *

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Applicant's Photograph[250 kb max] *

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Basic Details as Contractor

Name of Bank *

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Turn Over (in Rs. Lakhs) *

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Total Value of Works in last 3 financial years (in Rs. Lakhs) *

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Date from which working as contractor *

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Previous Registration Number

DECLARATION

This I do hereby declare that the statements made above are true to the best of my knowledge and belief. In case, the statements are found incorrect, my application is liable to be summarily rejected.

I Agree *