TENDER FORM FOR PRE-QUALIFICATION HANDLING & TRANSPORTATION CONTRACTORS NATIONAL FERTILIZERS LIMITED (A GOVERNMENT OF INDIA UNDERTAKING)

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1 Tender No. NFL/ZO-Chandigarh/Logs Price Rs. 100/- LAST DATE OF SUBMISSION OF FORM AT 2.30 P.M. AT ZO, CHANDIGARH TENDER FORM FOR PRE-QUALIFICATION OF HANDLING & TRANSPORTATION CONTRACTORS NATIONAL FERTILIZERS LIMITED (A GOVERNMENT OF INDIA UNDERTAKING) ZONAL OFFICE: S.C.O , SECTOR: 17-D, CHANDIGARH PHONE: RAKE POINT APPLIED FOR:...STATE... NAME OF THE H&T CONTRACTOR/PARTY:... D.D. NO... DATE...

2 BANK... AMOUNT...

3 INSTRUCTION FOR APPLICANT FOR PREQUALIFICATION FOR H&T CONTRACTOR RAKE POINT Please submit the application form alongwith all the required documents as mentioned in the Application Form. 2. One application form will be considered for one rake point only. 3. In case of any change in name, style & constitution of the firm/company after submission of application form, please intimate in writing to NFL, Chandigarh. 4. Parties must have Infrastructure at Rake Point/Centre for which application is being submitted. 5. Parties who are finally pre-qualified and come to the stage of award of contract through limited tendering shall have to open account with the branch of a bank having Core banking facility for electronic receipts and payments within fifteen days of award of contract. 6. NFL reserves the right to ask for any Additional information/documents. NFL also reserves the right to visit the Establishment of the party/work site and/or may contact various other Parties/Organizations/Institutions/Departments to verify the documents, information etc as submitted by the party. 7. Pre-qualification does not mean the award of contract. NFL reserves the right to accept/reject any or all applications with assigning any reason thereof. Therefore no damage/claim whatsoever will be payable by NFL and by mere submission of pre-qualification tender/offer, shall not construe that such bidder is considered automatically for award of contract/issue of tender document. 8 In case you are found suitable for Pre-qualification, your participation in every Tender is compulsory, during the tenure of empanelment, failing which your empanelment is liable to be terminated.

4 9 The Firm/company having common Partner/Director/Proprietor/Blood Relatives/Husband/Wife or under the same Management or having some common criteria shall be considered as sister concern/group/associate company. In such a case only one party shall be considered. Application for Prequalification may be sent in the enclosed format alongwith Enclosures/Documents to State Office... latest by... ZONAL MANAGER APPLICATION FORM FOR PREQUALIFICATION FOR H & T CONTRACTOR AT RAKE POINT : 1. DETAILS OF THE FIRM/PARTY (i) (ii) (iii) (iv) Name of the Party/Firm Address of the Firm/Party Phone Number Mobile Number 2. (i) This Application is for Rake Point. (ii) Other Rake Points Applied for 3. In case Application Form is downloaded from NFL Website, submit DD for Rs. 100/- in favour of NFL payable at Chandigarh (i) (ii) (iii) (iv) DD Number. Dated. Amount. Bank. 4. Status of the Firm: Proprietorship/Partnership/Private Limited/Cooperative Society/Union (i) In case of Proprietorship Name of the Proprietor Sh...S/o Sh... (Enclose Latest dated Notarized Sole Proprietorship Affidavit giving therein Name of the Proprietor, Son of, Name of the Firm & Resident of) (ii) In case of Partnership Name of all the Partners 1. Sh...S/o Sh Sh...S/o Sh Sh...S/o Sh... (Enclose dated Notarized copy of Partnership Deed with recent date of Notarization on each page) (Submit Latest dated Notarized Affidavit by Partners that there is no change in the current status of the firm in the format given in Annexure '1')

5 (iii) In case of Private Limited Company Name of the 1. Sh...S/o Sh... Subscribers/Directors 2. Sh...S/o Sh... Name of the Managing 3. Sh...S/o Sh... Director (Enclose copy of MOA/Articles of Association and List of Directors) (iv) In case of Cooperative Society/Union Name of the President 1. Sh...S/o Sh... (Enclose copy of Bye Laws/Resolution, Details of Elected Body) 5. Authorization/Responsible Person for day to day activities. (i) Name of the Responsible Person - Sh... S/o... (Enclose dated Power of Attorney/Notarized Affidavit by Properitor/Partners Authorizing the responsible person of the firm for day to day activities, In case of Limited Company enclose copy of Resolution) 6. Details of Sister Concerns/Group of Firms/Companies having Common Partners/Director/Managing Director with the Applicant as on date. Name of the Firm Common Partners Type of Business Date of Constitution of Firm (Submit dated Notarized Affidavit as per format given in the Annexure '1' regarding Non-Participation of Sister Concerns in the Prequalification/Tender 7. Give details, If you or your Sister concern is dealing : with NFL as:- : - H & T Contractor : - Dealer. : - Private Godown : - Related to any Company Employee : Experience/Details 8. (i) The Firm M/s... is registered with the following Manufacturer/Company/Agency (ii) As on Date, the Firm/Company is executing the following Contracts:- Name of the Company Year Experience as H & T Contractor of Previous and Current From To Fertilizers Other Products (Enclose Original latest Experience Certificate giving therein the Name of the Company Experience and Competence of Applicant/Copy of the current Work Orders etc.) 9. Details of Immovable Properties in the Name of the Properitor/Partner/Directors of the Firm/Company as given below:- Type of the Property Address of Property Ownership Status, Percentage Share Estimated Market Value

6 Land Plot Shop House (Enclose dated Notarized Affidavit as per Format given in Annexure '1' alongwith self attested Valuation Report of the Properties owned) 10. Details of Movable Properties in the name of the Properitor/Partner/Directors of the Firm/Company as given below:- DETAILS OF TRUCKS OWNED HIRED REGISTRATION NUMBER (Enclose Self Attested copies of RC books) 11. Details of Man Power under Disposal of the Firm. Designation of Office Staff Number 12. Details of Bank Account: - (i) Name of the Bank and Branch : (ii) Account Number : (iii) Type of Account (CC/OD/Current/Saving) : (iv) Facilities enjoyed : (v) Status of the Firm as per Bank Records : and Authorized Signatory of Bank Account : (Submit Bank Certificate in Original covering all aspects as given in the format as per Annexure 'B'.) 13. Balance Sheet for the previous three financial years. Year Submitted Yes/No (Enclose Self Attested copies of Balance Sheets for last 3 financial years) 14. Income Tax for the previous three Assessment years. Year Submitted Yes/No (Enclose Self Attested copies of Income Tax Returns/ITCC for last 3 Assessment years) 15. Permanent Account Number of the Firm/Properitor (i) PAN Number of Firm : (ii) PAN Number of Properitor : (Enclose Self Attested Copy of PAN Number)

7 16. Service Tax Registration Number of the Firm : (Enclose Self Attested Copy of Service Tax Registration Number) 17. Detail of Infrastructure/Office at the Rake Point Applied for (Enclose Notarized Affidavit regarding Maintenance of Infrastructure as per the Format given in Annexure '1' ) 18. Details for E Payments/E Receipts Name and address of Bank Branch Code IFSC Code of Bank Bank Account Number (E payment facility is available with SBI only) 19. Following Documents are enclosed: - (i) Sole Proprietor Affidavit/Partnership Deed/MOM/AOA/Copy of Bye Laws (as per Clause 4 of Application Form) (ii) Latest Notarized Affidavit regarding 'No change in status of firm/documents'. (iii) Notarized dated Affidavit with complete details as per Annexure '1' (iv) Original Bank Reference Letter (as per Annexure '2') (v) Original Experience Certificate (vi) Self Attested copies of Balance Sheet alongwith P&L Account from last 3 financial years. (vii) Self Attested copies of I.T.R./Assessment Orders for last 3 Assessment years. (viii) Self Attested copy of PAN Number. (ix) Self Attested copies of Service Tax Registration Certificate. (x) Self Attested copies of RC Books of Trucks owned. (xi) Self Attested copies of Valuation Report of Properties owned. (xii) Demand Draft of Rs. 100/- in case the Application Form is downloaded from Website 19. Any Other Information (Note: In case any of the above documents is not enclosed please give specific reasons. For Prequalified Parties, Participation in every Tender is Compulsory) Certified that the particulars furnished above are true to the best of my/our knowledge and belief. In case any of the above information/documents are found to be incorrect, my application can be rejected without any claim whatsoever. Date: Party) Place: (Signature of the with stamp In case of Proprietorship Firm - The Properitor is to sign the Application form. In case of Partnership Firm - All the partners should sign the Application form. In case of Limited Firm - Managing Director should sign the Application form. In case of Cooperative/Truck Union - President should sign the Application form.

8 ON NON JUDICIAL STAMP PAPER AFFIDAVIT ANNEXURE '1' I,... S/o Shri... aged...years, residing at... (address) working as Proprietor/ Partners/Director of M/s... having its registered Office at... do hereby solemnly affirm and declare on oath as under:- 1. That my/our Firm M/s... is a Proprietorship/Partnership Firm/Company is participating in tender for carrying out Handling & Transporation work at...railhead/centre. 2 (i) That I Sh.... S/o Sh... I am the properitor of the firm M/s... (ii) That we Sh.... S/o Sh... and Sh S/o Sh... and Sh.... S/o Sh... are the partners of the firm M/s... vide partnership deed dated I/we confirm that there is no change in the status of the firm or the documents submitted earlier to NFL. 4. That I, the Properitor Sh.../We the Partners...,... &... Authorize Sh.... S/o... to work with NFL on behalf of M/s That I/We will open and maintain local establishment at... rake point/centre on award of contract within stipulated time given by NFL. 6. That I/We hereby confirm and declare that none of my/our group/sister Concern/Associate Company is participating/submitting this tender. 7. That I/We hereby confirm/declare that my/our firm/company M/s... and my/our firm/group/sister concern/associate company have not being blacklisted/de-listed or put on holiday by any institutional agencies/govt. Deptt./Public Sector Undertaking etc. in the last TWO years. 8. Details of sister concerns as on date is given below:- Name of the firm (Sister Concern) Type of Business Details of Association (i) (ii) 9 Details of Immovable Properties in the Name of the Properitor/Partner/Directors of the Firm/Company as given below:- Type of the Property Address of Property Ownership Status, Percentage Share Land Plot Shop House Estimated Market Value 9. That I/We further undertake that in case any of the facts contained above and in our application is found otherwise or incorrect or false at any stage, my/our firm/company/group/sister concerns/associate companies shall stand debarred from the present and future tenders of the NFL.

9 Seal) (Signature of the Proprietor/Partners/Director with DEPONENT (S) Verified at... on...that the contents of paras 1 to 9 of this Affidavit are true and correct to the best of my knowledge and no party of this is false and nothing has been concealed or falsely stated therein. (Signature of the Proprietor/Partners/Director with Seal) Date: DEPONENT (S) In case of Proprietorship Firm - the Properitor is to submit the Affidavit. In case of Partnership Firm - All the partners should submit the Affidavit In case of Limited Firm - Managing Director should submit the Affidavit. In case of Cooperative/Truck Union - President should submit the Affidavit.

10 ANNEXURE (B) Format for Annexure (B) to be enclosed in prescribed format. BANK REFERENCE LETTER (On Bank's Letter Head) 1. Certified that M/s... at (address... is having an account in our Bank as per following particulars:- (i) Type of Account: Cash-Credit/Current/Saving. (ii) Bank Account No... (iii) Cash-Credit/O.D. Limit (if any) No/Yes for Rs... (iv) Holding Account Since... (v) Financial Standing & Soundness : SOUND/POOR (vi) Dealing & Conduct of the Party : SATISFACTORY/UNSATISFACTORY (vii) Authorized Signatory of Bank Account : (viii) The Status of the Firm as per Bank Records : PROPERITORSHIP/PARTNERSHIP (ix) Any other comments Certified that Bank is Nationalized/Cooperative. In case of Cooperative bank, it is certified that Bank has 51% Government share. That the Certificate is issued on the request of Shri... for submission of N.F.L. Office. Date:... Place... (Sign. of Bank Manager) Stamp

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