Empanelment and Appointment of Load Port Inspection Agencies for Inspection of Urea fertilizer on GoI account at Overseas Load ports

APPLICATION FOR PRE‐QUALIFICATION OF INSPECTION AGENCY / SURVEYOR (Completely filled, Signed and stamped copy also to be submitted on letter head along with documents mentioned) NOTE- DO NOT CHANGE ANY OF THE CONTENT OR FORMAT OF THIS SHEET.

TO GENERAL MANAGER (MKTG.) NATIONAL FERTILIZERS LIMITED, CORPORATE OFFICE, A‐11, SECTOR‐24, NOIDA ‐ 201 301 DIST. GAUTAM BUDDHA NAGAR (UP), India SUBJECT ‐ Submission of Bid against NIT Ref. no. NFL/IMP/LPIA/UREA/2026-27/01 Dear Sir, We here by provide our details along with the documents against your subject Notice Ref. no. for your consideration: ‐

Sr Details To be filled by Tenderer

1 Name of Tenderer/ Firm (M/s) and Office address

2 Contact person Name, email Id, Contact Number

3 Status of Tenderer / Firm (Proprietary/Partnership/Company) {Enclose Proprietor PAN/Partnership deed/ Memorandum & Article of Association}

4 Name of the Proprietor/Partners/Director

5 Name (M/s) and address of the company participating in e-bidding for carrying out Inspection i.e. the company who shall be issuing invoice

6 Country from where invoicing to be done by bidder

a) Details required for the Pre-Qualification process: ‐

1. Details of countries where laboratories/offices are present along with name of load ports , details of laboratories, their accreditation status & equipment available for each port for which services are being offered (please enclose supporting documents)

S. No. Name of Country Name of load ports in the respective country Name & address of Office in the respective country along with Contact person Name Name & address of Laboratory in the respective country along with Contact person Name Status of Laboratory (Own/ sub- contract) Names of accreditation associations/ bodies and the countries from whom accreditation certificates for laboratories have been obtained Equipment available for each port for which services are being offered

2. Details of draft survey, quantity and quality inspection activities carried out for UREA at various load‐ ports of various major exporting countries of UREA during last 3 years (please enclose supporting documents):

Total quantity of urea inspected during last 3 years (in MT)

3. Details of corporate clients for whom inspection services are being carried out on regular basis (please enclose supporting documents):

b) Details of Attached documents: ‐

S. No. Particulars Yes / No

1. Copy of valid TIC membership enclosed

2. Copy of documentary proof of remittance of Rs. 1,00,000/‐ or USD 1200 towards Bid Security/EMD as per Clause 7 of Part B enclosed

3. Audited annual accounts and balance sheets for last three years enclosed

4. Duly filled format regarding experience as per Annexure-IA Sr. No. 4 along with requisite documents enclosed

5. Copy of Tax Residential Certificate (TRCs) enclosed

6. Copy of Indian PAN (if any) enclosed

7. Consent Letter per Annexure‐III enclosed

8. Undertaking as per Annexure‐V enclosed

9. Certificate 1 & 2 in compliance of Order (Public Procurement No.4)/OM dated 23.02.2023 issued by Ministry of Finance as per Annexure-VI enclosed

10. Integrity Pact as per Annexure-VII enclosed

11. Acceptance to the terms and conditions of NFL’s Notice for empanelment (each page duly signed and stamped) enclosed

12. Deviations from NIT’s Terms & Conditions. If Yes, then submit the clause-wise deviations in the prescribed format as per Sr. No. c below. (Applications with deviations are liable to be rejected at sole discretion of NFL)

c) Deviations from NIT’s Terms & Conditions, if any:-

S. No. Clause No. of tender document Deviation