Client Registration & Waste Profile Form

1 CLIENT / COMPANY DETAILS

Company Name *

Registered Address *

City

State

Pin Code

Date of Inc.

GST No.

PAN No.

LLPIN / CIN No.

IEC No.

Industry Type

Organization Type

2 PLANT / FACTORY DETAILS

Plant Name

Plant Address

City

State

Pin Code

Land Area

No. of Employees

3 POLLUTION CONTROL BOARD AUTHORIZATION DETAILS

Authorization No.

Issuing Authority

Date of Issue

Valid Upto

PCB Category

Red Orange Green

HW Authorization

Yes No

CTO No.

CTO Valid Upto

4 CONTACT DETAILS

A. Primary Contact (Communication)

Name *

Designation

Mobile No. *

Email ID

B. Accounts / Billing Contact

Name

Designation

Mobile No.

Email ID

5 NATURE OF BUSINESS / INDUSTRY

6 WASTE DETAILS (INDICATIVE)

Sr.	Waste Description	Physical Form	Approx. Qty	Packing / Storage	Disposal Route
1

7 BILLING INFORMATION

Billing Address

GST Applicable

Yes No

GST Number

Request a Pickup

Request Submitted!