Rate Contract for two (2) Year for procurement of High Performance Nucleating Agent (HPNA) for Panipat Naphtha Cracker and Paradip Refinery PP Unit.

Instruction to fill the format below-

Bidders to fill the format below( white cells) and submit with their offer . Please note that submission of this declaration is mandatory,otherwise offer shall be liable for rejection.

COMPLIANCE TO REQUIREMENT OF TENDER DOCUMENTS

[To be submitted by the bidder as a sheet of "Bid_Documents" in the Un-Priced Bid (Technical Bid) , otherwise the Offer shall be liable for rejection]

It is hereby declared that we have read and understood the entire tender documents available on IOCL e-tender portal https://iocletenders.nic.in under-

Tender Reference Number RHQMM25420

We hereby agree to fully comply with, abide by and accept without variation, deviation or reservation all technical, commercial and other condition whatsoever of the Bidding Documents including all Addenda / Corrigenda / Clarifications issued. We further, confirm that we have quoted the rates in the tender considering Inter-alia the 1. Tender Document(s) 2. Additional Document(s) (if any) 3. BOQ Document (Price Bid Format) 4. Corrigendum (if any) 5. Pre Bid Meeting Minutes (if any) We

Any and all deviations, variations, objections or reservations whatsoever hereto set out, given or indicated in our offer, clarifications, correspondence, communications, or otherwise stands null and void. hereby certify that we have fully read and thoroughly understood the tender requirements and accept all terms and conditions of the tender including all corrigendum/addendum issued, if any. Our offer is in confirmation to all the terms and conditions of the tender including all corrigendum/addendum, if any and minutes of the pre-bid meeting. In the event our offer is found acceptable and Order is placed /Contract is awarded to us, the complete tender document shall be considered for constitution of Order / Contract Agreement.

We further, confirm that we have quoted the rates in the tender considering Inter-alia the 1. Tender Document(s) 2. Additional Document(s) (if any) 3. BOQ Document (Price Bid Format) 4. Corrigendum (if any) 5. Pre Bid Meeting Minutes (if any) We hereby certify that we have fully read and thoroughly understood the tender requirements and accept all terms and conditions of the tender including all corrigendum/addendum issued, if any. Our offer is in confirmation to all the terms and conditions of the tender including all corrigendum/addendum, if any and minutes of the pre-bid meeting. In the event our offer is found acceptable and Order is placed /Contract is awarded to us, the complete tender document shall be considered for constitution of Order / Contract Agreement.

Offer Reference No. with date.

Authorised Person's Name (s):

Move to next Work Sheet ------>

Annexure -2(a) - ATC (INDIGENOUS)

THIS DOCUMENT IS APPLICABLE FOR INDIAN BIDDERS ONLY & QUOTATIONS IN INDIAN CURRENCY

Instructions to Fill ATC ( Below) and Annexures ( Deviations, Declaration on acceptance , etc. ) at different work sheets of this XLS file.

1. This workbook is protected, except for cells where comments/confirmation is to be given by bidder. 2. Bidder is advised not to unprotect/tamper the sheet/ alter the terms mentioned in the sheet. 3. Any alteration to terms mentioned by IOCL will be considered as tampering and bidder's offer shall be liable for rejection. 4. Bidders are advised to only fill the unprotected cells ( white cells) by dropdown or writing the comments as applicable as their confirmation . Failure on the part of bidder in not returning this duly filled-up questionnaire with all the sets of unpriced quotation and/or submitting incomplete replies may lead to rejection of bidder’s quotation. 5. All the commercial terms and conditions shall be indicated by vendor in this format only and nowhere else in his quotation. However, in case the space for vendor’s reply is not sufficient against a particular question, the vendor shall furnish same by way of separate annexure/sheet attached to this questionnaire, indicating cross-reference of respective clauses.

AGREED TERMS & CONDITIONS(ATC)-INDIGENOUS

EACH POINT MUST BE CONFIRMED / COMMENTED UPON AND MUST BE SUBMITTED ALONG WITH THE BID

Tender No. RHQMM25420

Offer Reference No.

Sl. No. Vendor’s confirmation/ acceptance/comments

DEVIATIONS' IF ANY Please note:- Any technical / commercial deviations to be mentioned in the Annexure captioned "Deviation Statement (Technical/Commercial)". Any deviations/notes/ comments/etc. given elsewhere in the Offer other than the Annexure "Deviation Statement (Technical/Commercial)" shall be null & void.

1 (a) Confirm that no technical deviation has been taken in your Offer from IOCL tender requirements. No Deviation

1(b) Confirm that sample as required is submitted & submission proof of Tender Sample as per requirement in Technical section is attached. SELECT FROM DROP DOWN

1 c) Confirm that no commercial deviation has been taken in your Offer from IOCL tender requirements. No Deviation

2 (a) Quoted Prices are on FOT Dispatch Point basis CONFIRMED

2 b) Indicate Dispatch point. ( Place from where the material shall be despatched)

2(c) Confirm that the Price Variation Formula mentioned in the tender is acceptable. Not Applicable

2(d) In case of Variable Prices, please specify price variation formula with an upper ceiling and base indices.Unless otherwise specified in the tender, ceiling shall be loaded for evaluation purpose & offer received without any ceiling shall be liable for rejection unless all the bidders have asked for the same Price Variation formula without ceiling. Not Applicable

COMMERCIAL TERMS:- Please Note if bidder does not mention anything against the below commercial terms, the same shall be considered as “nil” and no further confirmation from vendor shall be sought. Evaluation and ordering shall be done considering commercial terms (charges) as Nil.

3(a) PACKING & FORWARDING CHARGES:- The Offer is inclusive of Packing and Forwarding (P&F) charges. CONFIRMED

3(b)1 FREIGHT i. Freight charge (if any) shall be obtained from the bidders in Annexure-1 and RA. ii. Vendor to despatch the materials only through reputed and bank approved transporters having office / godown at or nearby the Refinery Site. In case the material is despatched through any other transporter, the same shall be “door delivery, consignee copy attached” basis and payment shall be released only after receipt of materials at IOCL Stores irrespective of payment terms mentioned in any other clause. CONFIRMED

3(b)2 iii. If a supplier/bidder does not quote freight charges and indicates that the freight is on to pay basis or “extra at actual” then his ex-works price shall be loaded with the maximum freight charges quoted by other bidders or pro-rated (with respect to approximate distance) on maximum freight charges quoted by other bidders. After loading, if the same Bidder becomes L1 (lowest) then the order will be placed based on Freight Charges payable extra at actual subject to maximum freight charges by which the prices of the L1 bidder has been loaded. CONFIRMED

3(b)3 iv.When a bidder does not mention anything about the freight component, the same shall be considered as “nil” and no further confirmation from vendor shall be sought. Evaluation and ordering shall be done considering freight charges as Nil. If bidder has mentioned freight as “quoted” in the unpriced bid / Annexure to Agreed terms & Conditions (ATC) but has not mentioned freight charges in priced bid / stated the Percentage Freight in Annexure to ATC, as asked to quote in the tender (bidder may be asked to quote freight charges in the priced bid or the bidder may be asked to quote freight charges in percentage of basic price in Annexure to ATC), then the basic price quoted shall be considered as inclusive of freight charges and no further confirmation from vendor shall be sought. Evaluation and ordering shall be done considering freight charges as Nil. v. In case of ODC/OWC bidders shall have to mandatorily quote for freight upto Project site / Refinery Stores. In case the bidder does not quote the freight charges, their offer shall be liable for rejection. CONFIRMED

APPLICABLE TAXES:- Please Note, In case bidder does not mention Taxes & Duties, the same shall be considered as “Borne by vendor” and included in quoted price.

4 (a) Type of Vendor:- If Vendor is GST Composition Scheme vendor , Please submit the copy of the declaration i.e., FORM GST –CMP 01 or FORM GST CMP 02 alongwith the offer. SELECT FROM DROPDOWN

4 (b) HSN & SAC CODE:- Please confirm that HSN (Harmonized System of Nomenclature) code of goods or SAC (Service Accounting Code) of services /PWCAMC/PWAMC if any are given below ( at the end of this sheet ). In case there are different HSN/SAC for different items, same may be indicated in the Unpriced BOQ. SELECT FROM DROPDOWN

4 (c) GOODS & SERVICE TAX (GST) RATES:- Please indicate whether quoted rate(s) of GST on the supplies (including spares) as well on Inspection & Freight Charges is Extra OR Inclusive in your quoted prices. The GST amount shall be released only on receipt of GST Invoice. Bidder to provide all-inclusive price (i.e. including P&F, Freight, GST etc.) in the BOQ

4(d) Only statutory variations, if any, in the present rate of GST, shall be reimbursed as under: 1. Any statutory increase in the GST or any new or additional taxes or duties imposed within the Contractual delivery Date or extended Contractual Delivery Date shall be to IOCL’s account whereas if it is after contractual delivery it shall be to BIDDER’S account. Any corresponding decrease on account of above shall be passed on to IOCL 2. Any variation in GST at the time of supplies for any reasons, other than statutory, including variations due to turnover, shall be borne by bidder. 3. In case GST or any taxes or duties is not applicable at present but becomes applicable at the time of contractual delivery period due to any reasons other than statutory, the same shall be borne by bidder. CONFIRMED

4(e) As You were not eligible for input tax credit of Central & State Taxes in pre-GST period but under GST you are entitled to full credit of GST paid and you shall have benefit of incremental input tax credit under the GST regime as above. As such you need to pass on the benefit of your incremental input tax credit to IOCL. Accordingly, Please quote your best basic prices (In Priced BoQ ) CONFIRMED

COMMERCIAL LOADING :- Please note if bidder does not confirm acceptance for following terms as per tender then loading shall be done against following serial numbers as per ITB & this ATC read together or Offer may be rejected .

5 PAYMENT TERM:- Please confirm acceptance to payment terms as per SPC Confirmed

Please Note:- If bidder quotes any other payment terms, if acceptable to IOCL, loading for Simple Interest implication as per ITB. This loading shall be done for differential payment terms & time period.

6 PERFORMANCE BANK GUARANTEE (PBG):- Performance Bank Guarantee (PBG) - Confirm that you will furnish Performance Bank Guarantee in the prescribed format as specified in annexure to GPC as per SPC Confirmed

Please Note:- In case of non acceptance of the PBG, FOT dispatch point price shall be loaded as per ITB.

7 PRICE REDUCTION SCHEDULE DUE TO DELAY IN DELIVERY :- Confirm acceptance to Cl. No. 12 (Respect for Delivery dates & Price Discount) of IOCL’s GPC & Amendment to GPC. Bidder shall submit credit note / adjustment in GST Invoice for PRS, if applicable, on account of delay in delivery. This is with respect to cases wherein Bidder has not considered the applicable PRS in GST Invoice. Confirmed

Please Note:- In case the vendor does not accept Cl. No. 12 of GPC (Discount by way of Price Adjustment due to delayed delivery), their FOR/FOT despatch point prices shall be loaded as per ITB.

8 DELIVERY PERIOD AND TIME PERIOD:- Please confirm acceptance to delivery period as stipulated in the SPC CONFIRMED

9 Confirm that the goods shall be guaranteed as per Clause 1 d i or 1 d ii of IOCL GPC ( Applicability of 1 d i or 1 d ii shall be as per Clause 16 of Salient Points of ITB) , unless otherwise specifically mentioned in the Tender Documents. SELECT FROM DROP DOWN

10 (a) Part Order: i. Acceptance of Part Order as per GPC Clause No. 33 without any value / quantity limitation ii. Any charges quoted extra as lumpsum (like IBR, Testing, freight, etc.) shall be applicable prorata on value basis in the event of part order / part quantities / split order. SELECT FROM DROP DOWN

10 (b) Confirm acceptance of Repeat Purchase order(s) as per IOCL's requirement as stated in GPC & ITB read together, with the same rate and terms & conditions within 6 months from the date of original Purchase Order. Note: Acceptance of Repeat Order does not guarantee Repeat Ordering and is not a part of evaluation. SELECT FROM DROP DOWN

11 (a) Validity of Rate Contract: Rate Contract shall be valid for Two Years from the date of award of Rate Contract/Letter of Acceptance (LOA). Confirmed

11 (b) Confirm the Rate contract can be extended further for a period of one year on the same terms and conditions on mutual consent basis. SELECT FROM DROP DOWN

EARNEST MONEY DEPOSIT (EMD):-

12 Please confirm having submitted Earnest Money Deposit (EMD) / Exemption Documents as per NIT. SELECT FROM DROPDOWN

GOVT OF INDIA POLICIES :-

Public Procurement Policy for Micro & Small Enterprises (MSEs) Order, 2012

13(a) Confirm whether the bidder is an MSE bidder or not SELECT FROM DROPDOWN

13(b) Confirm that you have attached the copy of certificate of registration with any one of the agencies stated in the tender document and specified by Ministry of MSME along with your bid to avail the benefits/preference to MSEs SELECT FROM DROPDOWN

13(c) In case the bidder is an MSE bidder; please further confirm whether it is an SC/ST owned MSE SELECT FROM DROPDOWN

13(d) Confirm that you have attached the copy of SC/ST certificate issued by District Authority. SELECT FROM DROPDOWN

13(e) UDYOG AADHAR MEMORANDUM (UAM) Number

13(f) Confirm that you are a Trader of the Quoted Items. In case being Trader, you shall not be eligible for Purchase Preference. SELECT FROM DROPDOWN

Public Procurement Policy-Make In India

14(a) PLEASE CONFIRM THE PERCENTAGE OF LOCAL CONTENT IN BID AS PER PPP-MII POLICY ( PLEASE REFER PPP-MII POLICY ATTACHED IN TENDER DOCUMENTS)

14(b) ON THE BASIS OF PERCENTAGE OF LOCAL CONTENT, PLEASE CONFIRM WHETHER YOU ARE CLASS-I LOCAL SUPPLIER OR CLASS-II LOCAL SUPPLIER.

14(c) IF YOU ARE ELIGIBLE FOR PRICE PREFERENCE UNDER BOTH THE PUBLIC PROCUREMENT POLICY FOR MSE AS WELL AS PPP-MII POLICY, PLEASE CONFIRM YOUR PREFERENCE UNDER WHICH YOU ARE OPTING FOR TAKING PURCHASE PREFERENCE BENEFIT.

14(d) Please confirm that you have submitted "Undertaking" from Authorized signatory of Supplier or Statutory Auditor / Chartered Accountant of the bidder ( as the case may be ) as per PPP-MII POLICY.

DOMESTICALLY MANUFACTURED IRON & STEEL PRODUCTS (DMI&SP)

15(a) Confirm whether you are eligible as per Policy related to Domestically Manufactured Iron & Steel Products (DMI&SP) . For details please refer ITB Not Applicable

15(b) If so please confirm that you have submitted "Authorization Certificate" as per ITB Not Applicable

15(c) If so please confirm that you have submitted "Affidavit of Self-Certification" (Form -1) as per ITB Not Applicable

15(d) If so please confirm that you have submitted "Other Requisite Documents " as per ITB Not Applicable

VALIDITY OF OFFER:-

16(a) Validity: Confirm that the quoted prices are valid for acceptance up to 120 days from the scheduled bid opening date on e-tender portal or any extension thereafter. CONFIRMED

16(b) On account of exigencies, if the bidder is requested to extend the validity of their offer, the same should be extended without any deviation including change in price. Otherwise, in such an event the offer will be rejected. CONFIRMED

IN CASE OF CHEMICALS:

17 Certificate of Analysis (COA) will be sent along with consignment MSDS will be sent along with consignment Bidder to confirm that MSDS accompanies the consignment for incoming chemical material to Refinery / Project Site. Please confirm MSDS for return of empty cylinders will be same as that of incoming material

18 Confirm whether the product offered is based on IOC formulation and have valid agreement to pay the royalty to IOCL on the basis of sale of such products .

19 If yes to above, give the extent of royalty inflow net of prevailing taxes/surcharge.

VENDOR DETAIL:-

20(a) Vendor who is registered with IOCL:- Please mention your active IOCL Vendor code against which all details are updated at IOCL and you have recently received the online payment from IOCL.

20(b) Vendor who is not registered with IOCL for online payments / not having IOCL vendor code/existing vendor desiring to change the bank details, may submit requisite details as sought in "9-Bank_Mandate" Sheet of this document CONFIRMED

21 Please confirm that the Shelf Life as sought in Technical Specification is complied with CONFIRMED

22 If no Shelf Life Clause is stated in Technical Specification, please indicate the same

23 Please note that the best prices are given strictly as per Price BOQ CONFIRMED

24 Please note that you will dispatch the materials on “Freight paid basis” by IOCL / Bank approved Transporter having delivery office at Refinery location. Pl. note & confirm. CONFIRMED

25 Transit risk insurance shall be covered by the Owner against their MCE (Marine cum Erection) Policy and the same shall not be included in the quoted prices. CONFIRMED

26 Please note that unless otherwise specified, part dispatches will not be allowed and vendor has to supply materials in one lot. CONFIRMED

27 Please note that all relevant Third Party Inspection Release Notes, IBR Certificate, Test Certificates etc. (as applicable) shall be submitted along-with the dispatch documents & supplied materials. CONFIRMED

28 Please confirm acceptance of the following in toto. Bidder is not required to submit soft/ hard copy of them. a) NIT b) General Purchase Conditions c) Instructions to Bidder ( ITB ) d) Terms & Conditions for supervision of Erection, Testing & Commissioning for Indigenous Bidders ( if applicable ) e) Terms & Conditions for Site Work / HSE ( if applicable ) f) Integrity Pact ( if applicable ) g) Special Purchase Conditions ( if applicable ) CONFIRMED

29 DECLARATION:- Whether any of the Directors of BIDDER is a relative of any Director of Owner or the BIDDER is a firm in which any Director of Owner or his relative is a Partner or the BIDDER is a private company in which any director of Owner is a member or Director. List of Indian Oil Directors may be taken from www.iocl.com NO RELATIONSHIP

30 Please confirm you have not been banned or de listed by Indian Oil Corporation Limited or its Administrative Ministry (i.e. Ministry of Petroleum & Natural Gas, Government of India). If you have been banned, then this fact must be clearly stated. Confirm that the Proforma Of Declaration Of Black Listing / Holiday Listing has been attached CONFIRMED

31 Bidder confirms that they are not under liquidation, insolvency, court receivership or similar proceedings. CONFIRMED

32 Deviations to Terms & Conditions shall lead to loading of prices as per Commercial Terms of TENDER or rejection of offer. Please confirm acceptance. CONFIRMED

33 Any claim arising out of order shall be sent to IOCL in writing within 3 months from the date of last Dispatch. In case the claim is received after 3 months, the same shall not be entertained by IOCL. CONFIRMED

34 Please confirm submission of details, documents self-certifications and declarations for meeting Net Worth condition as per ITB ( if applicable ) CONFIRMED

35 Bidder to confirm that they are not from such a country which shares land border with India and they are eligible to be considered for this tender. ( in line with OM no 6/18/2019-PPD PUBLIC PROCUREMENT 1 &2 DTD 23.07.2020 AND 24.07.2020 FROM MINISTRY OF FINANCE, GOVT OF INDIA) SELECT FROM DROPDOWN

36 Please confirm submission of certificate/undertaking for bidders from a country which shares land border with India. Kindly refer ITB for details. SELECT FROM DROPDOWN

37 Kindly confirm Fall Clause as per SPC without any deviation. CONFIRMED

BIDDER INPUTS :-

A SPECIFY DESPATCH POINT

B GSTIN NO. OF DESPATCH POINT

C SPECIFY INVOICING PLACE

D GSTIN NO. OF INVOICING PLACE

E Transportation of materials will be in the scope of vendor and shall be arranged by them up to respective Refinery units. Freight charge (If any) shall be obtained from the bidders in SPC-Annexure-1 and RA. Freight charges quoted by the bidder shall be paid against delivery of materials without any documentary evidence. To be provided in price breakup as per fomat given in Annexure-1 of SPC after RA

F HSN CODE OF GOODS

G GST APPLICABLE ON QUOTED FOT DESPATCH POINT PRICES To be provided in price breakup as per fomat given in Annexure-1 of SPC after RA

H GST RATE APPLICABLE ON FREIGHT be considered same as GST applicable on Materials/Supply. CONFIRMED

I SAC CODE FOR SITE SUPERVISION / SITE WORK / TRAINING CHARGES/ PWCAMC/PWAMC Not Applicable

J GST APPLICABLE EXTRA ON QUOTED SITE SUPERVISION / SITE WORK / TRAINING CHARGES/ PWCAMC/PWAMC Not Applicable

K CURRENCY OF QUOTE INR

L INDICATE ANY OTHER GOVERNMENT TAX/LEVY APPLICABLE AND ITS RATES.

In case of any conflict in the terms mentioned in this Agreed Terms and Conditions (ATC) and elsewhere in the Offer, the terms indicated in ATC shall supersede.However, in case any heirarchy is defined elsewhere in the tender documents then the heirarchy shall prevail in case of any conflict in terms and conditions. Printed terms and conditions, if any, appearing in quotation, shall not be applicable in the event of order. In case of contradiction between the confirmations given above and terms & conditions mentioned elsewhere in the offer, the confirmation given above in this ATC shall prevail.

1 We confirm that we have filled ATC indigenous as per sheet "ATC(ind) " of this XL file.

2 We confirm that we have filled Deviations (If any) as per sheet "DEVIATIONS STATEMENT- TECHNICAL" & "DEVIATIONS STATEMENT- COMMERCIAL"of this XL File.

3 We confirm that we have filled Proforma for PQC as per sheet - “PQC Doc- details” of this XL file.(If Applicable)

4 We confirm that we have filled unpriced BOQ as per sheet "Unpriced-BOQ" of this XL file.

5 We confirm that we have filled Holiday List Declaration as per sheet "Holiday-List-Declaration" of this XL file.

6 We confirm that we have filled Non Tampering Declaration as per sheet "NON-TAMPERING_DECLARATION" of this XL file.

7 We confirm that we have filled Contact Details as per sheet "Contact Details" of this XL file.

Offer Reference No. with date.

Authorised Person's Name (s):

Move to next Work Sheet ------>

Annexure -2(b)-ATC (Import)

THIS DOCUMENT IS APPLICABLE FOR FOREIGN BIDDERS ONLY & QUOTATIONS IN NON INDIAN CURRENCY

Instructions to Fill ATC ( Below) and Annexures ( Deviations, Declaration on acceptance , etc. ) at different work sheets of this XL file.

1. This workbook is protected, except for cells where comments/confirmation is to be given by bidder. 2. Bidder is advised not to unprotect/tamper the sheet/ alter the terms mentioned in the sheet. 3. Any alteration to terms mentioned by IOCL will be considered as tampering and bidder's offer shall be liable for rejection. 4. Bidders are advised to only fill the unprotected cells ( white cells) by dropdown or writing the comments as applicable as their confirmation . Failure on the part of bidder in not returning this duly filled-up questionnaire with all the sets of unpriced quotation and/or submitting incomplete replies may lead to rejection of bidder’s quotation. 5. All the commercial terms and conditions shall be indicated by vendor in this format only and nowhere else in his quotation. However, in case the space for vendor’s reply is not sufficient against a particular question, the vendor shall furnish same by way of separate annexure/sheet attached to this questionnaire, indicating cross-reference of respective clauses.

AGREED TERMS & CONDITIONS(ATC)-IMPORT

EACH POINT MUST BE CONFIRMED / COMMENTED UPON AND MUST BE SUBMITTED ALONG WITH THE BID

Tender No. RHQMM25420

Offer Reference No.

Sl. No. Vendor’s confirmation/ acceptance/comments

DEVIATIONS' IF ANY Please note:- Any technical / commercial deviations to be mentioned in the Annexure captioned "Deviation Statement (Technical/Commercial)". Any deviations/notes/ comments/etc. given elsewhere in the Offer other than the Annexure "Deviation Statement (Technical/Commercial)" shall be null & void.

1(a) Confirm that no technical deviation has been taken in your Offer from IOCL tender requirements. SELECT FROM DROP DOWN

1(b) Confirm that sample as required is submitted & submission proof of Tender Sample as per requirement in Technical section is attached. SELECT FROM DROP DOWN

1(c) Confirm that no commercial deviation has been taken in your Offer from IOCL tender requirements. SELECT FROM DROP DOWN

INCOTERM All charges like P&F, inland transit up to FOB/FCA International port of exit, FOB/FCA charges etc., should be included by bidder in their prices.

2(a) Indicate the Currency of quoted prices.Change in currency once quoted will not be allowed. Bidder shall quote in USD / EUR / JPY SELECT FROM DROP DOWN

2(b) Confirm that the Quoted Unit Prices are on FOB Major International Gateway Seaport of Exit basis.Owner reserves the option to place order on FOB or on CFR basis. Confirm acceptance. CONFIRMED

2(c) Confirm unconditional acceptance of Price Variation Formula as per Tender requirement. SELECT FROM DROP DOWN

2(d) In case of variable prices, please specify price variation formula with an upper ceiling and base indices.Unless otherwise specified in the tender, ceiling shall be loaded for evaluation purpose & offer received without any ceiling shall be liable for rejection unless all the bidders have asked for the same Price Variation formula without ceiling.

COMMERCIAL TERMS:- Please Note if bidder does not mention anything against the below commercial terms, the same shall be considered as “nil” and no further confirmation from vendor shall be sought. Evaluation and ordering shall be done considering commercial terms (charges) as Nil.

3 FREIGHT CHARGES:- Confirm quote of firm ocean freight charges up to Port of entry in India (Kolkata Sea Port / Nhava Sheva – for Sea) (Valid till entire duration of Order). CONFIRMED

HSN & SAC CODE:-

4 HSN & SAC CODE:- Please confirm that HSN (Harmonized System of Nomenclature) code of goods or SAC (Service Accounting Code) of services /PWCAMC/PWAMC if any are given below ( at the end of this sheet ). In case there are different HSN/SAC for different items, same may be indicated in the Unpriced BOQ. SELECT FROM DROPDOWN

COMMERCIAL LOADING :- Please note if bidder does not confirm acceptance for following terms as per tender then loading shall be done against following serial numbers as per ITB & this ATC read together or Offer may be rejected .

5 PAYMENT TERM:- Please confirm acceptance to payment terms as per SPC. 100% payment by cash against documents (CAD) or 100% through irrevocable LC at sight. Payments shall be released by Barauni Refinery Unit. Payment for the last shipment shall be released only after receipt and acceptance of material at site after R&D test result instead of CAD. SELECT FROM DROP DOWN

6(a) Payment Mode:- Wherever, Letter of Credit is stated as the payment mode, IOCL prefers the mode of “Cash Against Documents” . In case bidder wants to obtain payment via “Cash Against Documents” , same to be indicated. SELECT FROM DROPDOWN

6(b) a) Letter of Credit shall be opened by IOCL after submission of the following documents by vendor to IOCL: (i) Performance bank guarantee (PBG) as per ITB (ii) Unconditional acceptance of IOCL’s Fax of Acceptance/ Purchase Order . (iii) in line with details as per Annexure I of ITB b) Letter of Credit shall be opened through a Govt. of India Nationalised/ Scheduled Bank and hence need not be confirmed. Confirm acceptance. CONFIRMED

6(c) However, if you still insist for confirmed L/C, confirmation charges shall be borne by you. Confirm SELECT FROM DROPDOWN

Please Note:- If bidder quotes any other payment terms, if acceptable to IOCL, loading for Simple Interest implication as per ITB. This loading shall be done for differential payment terms & time period.

7 PERFORMANCE BANK GUARANTEE (PBG):- Please confirm that you will furnish Performance Bank Guarantee as per SPC The PBG should be sent to us directly by your Banker and the bank should confirm regarding issue of BG on enquiry by IOCL. SELECT FROM DROPDOWN

Please Note:- In case of non acceptance of the PBG, FOB Port of Exit basis price shall be loaded as per ITB.

8 PRICE REDUCTION SCHEDULE DUE TO DELAY IN DELIVERY :- Confirm acceptance to Cl. No. 12 (Respect for Delivery dates & Price Discount) of IOCL’s GPC & Amendment to GPC. Bidder shall submit adjustment in Invoice for PRS, if applicable, on account of delay in delivery. SELECT FROM DROP DOWN

Please Note:- In case the vendor does not accept Cl. No. 12 of GPC (Discount by way of Price Adjustment due to delayed delivery), their , FOB Port of Exit basis price shall be loaded as per ITB.

9 DELIVERY PERIOD AND TIME PERIOD FOR SITE WORK:- Please confirm acceptance to delivery period as stipulated in the SPC . This delivery period shall be reckoned from the date of Letter of Acceptance (if issued) else from date of Purchase Order. CONFIRMED

10 Part Order: i. Acceptance of Part Order as per GPC Clause No. 33 without any value / quantity limitation ii. Any charges quoted extra as lumpsum (like IBR, Testing, freight, etc.) shall be applicable prorata on value basis in the event of part order / part quantities / split order. Not Applicable being Evaluation on Overall basis

11 Confirm acceptance of Repeat Purchase order(s) as per IOCL's requirement as stated in GPC & ITB read together, with the same rate and terms & conditions within 6 months from the date of original Purchase Order. Note: Acceptance of Repeat Order does not guarantee Repeat Ordering and is not a part of evaluation. SELECT FROM DROP DOWN

EARNEST MONEY DEPOSIT (EMD):-

12 Please confirm having submitted Earnest Money Deposit (EMD) / Exemption Document as per NIT. SELECT FROM DROPDOWN

GOVT OF INDIA POLICIES :-

Purchase Preference linked with Local Content

13(a) PLEASE CONFIRM THE PERCENTAGE OF LOCAL CONTENT IN BID AS PER PP-LC / PPP-MII POLICY ( PLEASE REFER PP-LC POLICY ATTACHED IN TENDER DOCUMENTS)

13(b) ON THE BASIS OF PERCENTAGE OF LOCAL CONTENT, PLEASE CONFIRM WHETHER YOU ARE CLASS-I LOCAL SUPPLIER OR CLASS-II LOCAL SUPPLIER. AS PER PP-LC CLAUSE NO. 4.4 (B) AND ( C) , ONLY CLASS -I AND CLASS -II LOCAL SUPPLIER SHALL BE ELIGIBLE TO BID.

13(c) IF YOU ARE ELIGIBLE FOR PRICE PREFERENCE UNDER BOTH THE PUBLIC PROCUREMENT POLICY FOR MSE AS WELL AS PURCHASE PREFERENCE LINKED WITH LOCAL CONTENT, PLEASE CONFIRM YOUR PREFERENCE UNDER WHICH YOU ARE OPTING FOR TAKING PURCHASE PREFERENCE BENEFIT.

13(d) Please confirm that you have submitted "Undertaking" from Authorized signatory of Supplier or Statutory Auditor / Chartered Accountant of the bidder ( as the case may be ) as per PP-LC POLICY.

DIMENSIONS, WEIGHT & VOLUME OF PACKAGES:- Shipper will ensure that the goods are properly packed to withstand the sea / air and Road Journey and the markings for gross weight, net weight, material description, IOCL material code, safety precautions are boldly and legibly put on at least two sides of the packages.

14 DECLARATION OF CARGO AS ODC / NON ODC:- Packing of the individual boxes should be done in such a way that the onsignment does not become an ODC (Over Dimensional Consignment) for Air Transport. When the size of the package exceeds the standard pallet (PIP) dimensions (for Air Transport) which are given below, they will be treated as ODC. Length 121 inches Width 84 inches Height 60 inches Maximum Gross Weight 4626 Kg Maximum Net Weight 4508 Kg Floor Load Limitations 90.7 Kg /Sq Ft In such case, Vendor to take IOCL’s confirmation before handing over the goods to the overseas forwarding agents. SELECT FROM DROPDOWN

VALIDITY OF OFFER:-

15(a) Validity: Confirm that the quoted prices are valid for acceptance up to 120 days from the scheduled bid opening date on e-tender portal or any extension thereafter. CONFIRMED

15(b) On account of exigencies, if the bidder is requested to extend the validity of their offer, the same should be extended without any deviation including change in price. Otherwise, in such an event the offer will be rejected. CONFIRMED

NAME & ADDRESSES OF MANUFACTURER, BANKER & INDIAN AGENT, IF ANY

16 Manufacturer’s Name & Address , contact person details like Name, Telephone no., Fax no. and E-mail Bidder to indicate the complete name and address, contact mail ID, telephone nos. etc on which order to be placed by IOCL (in the event of an order) Vendor may indicate IOCL vendor code, if available with the vendor

17 Name and address , of your banker and other details ( like Bank account No. , SWIFT code etc.) required for Opening of Letter of Credit.

18 Please indicate the name of the Indian Agent, with his full address and percentage of commission included in your offer.

19 Please note that Indian Agent Commission will be paid directly by Owner to Indian Agent in equivalent Indian Rupees (at the TT buying rate of exchange ruling on the date of placement of order) after the order. Pl. Confirm. CONFIRMED

IN CASE OF CHEMICALS:-

20 Certificate of Analysis (COA) will be sent along with consignment MSDS will be sent along with consignment Bidder to confirm that MSDS accompanies the consignment for incoming chemical material to Refinery / Project Site. Please confirm MSDS for return of empty cylinders will be same as that of incoming material CONFIRMED

21 Confirm whether the product offered is based on IOC formulation and have valid agreement to pay the royalty to IOCL on the basis of sale of such products . SELECT FROM DROPDOWN

22 If yes to above, give the extent of royalty inflow net of prevailing taxes/surcharge.

23 Please confirm that the Shelf Life as sought in Technical Specification is complied with CONFIRMED

24 If no Shelf Life Clause is stated in Technical Specification, please indicate the same

25 Please note that the best prices are given strictly as per Price BOQ CONFIRMED

26 Please note that you shall submit “Phytosanitary Certificate”/ IPPC certificate as per ISPM 15, whichever is applicable for the wooden packing material, without any extra cost to IOCL. CONFIRMED

27 Please note that you will furnish three copies of certificate of origin from Chamber of commerce along with shipping document without any extra cost to IOCL. CONFIRMED

28 Bidder to indicate Permanent Account Number (PAN) to avoid any additional Tax deduction at source for any Services ( if any under Tender scope) as per the prevailing Indian Income Tax Acts/ Rule. CONFIRMED

29 Transit Insurance: Prices quoted must exclude transit insurance charges from FOB International Sea Port of Exit as the same shall be arranged by the Purchaser. However, all transit insurance charges for inland transit up to FOB International Sea Port of Exit must be included by you in your quoted price. Export permit/licence if required shall be Bidder's responsibility & any expenditure towards same will be borne by you. CONFIRMED

30 Please confirm acceptance the following in toto. Bidder is not required to submit soft/ hard copy of them. a) NIT b) General Purchase Conditions c) Instructions to Bidder ( ITB ) d) Terms & Conditions for supervision of Erection, Testing & Commissioning for Indigenous Bidders ( if applicable ) e) Terms & Conditions for Site Work / HSE ( if applicable ) f) Integrity Pact ( if applicable ) CONFIRMED

31 Confirm documentation charges as per IOCL’s technical specifications and tender requirements are included in your quoted prices. CONFIRMED

32 Please note that, all bank charges and stamp duties payable outside India in connection with payment to be made under the Purchase Order shall be borne by the seller. All bank charges and stamp duties payable in India shall be borne by the Buyer. CONFIRMED

33 Dangerous Goods Clause Please note that, The Shipper has to arrange shipment / air freighting of the dangerous and normal consignment separately in two different air way bills instead of air freighting both the consignment on a single air way bill. The necessary shipping documents like invoice etc. must be prepared separately by the shipper (Not to exceed PO Order Value) and handed over to the overseas freight forwarding agents of IOCL. The Shipper has to ensure that the DGR and normal cargo are air freighted by overseas freight forwarding agents of IOCL under two separate HAWB / MAWB. CONFIRMED

34 Please note that, all the correspondence must be in English language only CONFIRMED

35 Please confirm you have not been banned or de listed by Indian Oil Corporation Limited or its Administrative Ministry (i.e. Ministry of Petroleum & Natural Gas, Government of India). If you have been banned, then this fact must be clearly stated. Confirm that the Proforma Of Declaration Of Black Listing / Holiday Listing has been attached CONFIRMED

36 Bidder shall confirm that they are not under liquidation, insolvency, court receivership or similar proceedings CONFIRMED

37 Deviations to Terms & Conditions shall lead to loading of prices as per Commercial Terms of TENDER or rejection of offer. Please confirm acceptance. CONFIRMED

38 Any claim arising out of order shall be sent to IOCL in writing within 3 months from the date of last Dispatch. In case the claim is received after 3 months, the same shall not be entertained by IOCL. CONFIRMED

39 DECLARATION:- Whether any of the Directors of BIDDER is a relative of any Director of Owner or the BIDDER is a firm in which any Director of Owner or his relative is a Partner or the BIDDER is a private company in which any director of Owner is a member or Director. List of Indian Oil Directors may be taken from www.iocl.com NO RELATIONSHIP

40 In the event of receipt of a purchase order, the vendor shall have to give 30 days’ advance notice for ocean shipping arrangements (45 days for break bulk cargo) and 10 days for air shipment to enable IOCL’s nominated freight forwarder for arranging suitable vessel/carrier. The shipper should give intimation for insurance within three days of effecting the shipment. CONFIRMED

41 Please confirm submission of details, documents self-certifications and declarations for meeting Net Worth condition as per ITB ( if applicable ) CONFIRMED

42 Bidder to confirm that they are not from such a country which shares land border with India and they are eligible to be considered for this tender. ( in line with OM no 6/18/2019-PPD PUBLIC PROCUREMENT 1 &2 DTD 23.07.2020 AND 24.07.2020 FROM MINISTRY OF FINANCE, GOVT OF INDIA) SELECT FROM DROPDOWN

43 Please confirm submission of certificate/undertaking for bidders from a country which shares land border with India. Kindly refer ITB for details. SELECT FROM DROPDOWN

44 Please mention Platinum procurement charges(procurement fee),in case IOCL authorizes bidder to purchase Platinum and Rhenium on behalf of IOCL. NOT APPLICABLE

45 Please mention ABG/SBLC charge for securing advance,,in case IOCL authorizes bidder to purchase Platinum on behalf of IOCL. NOT APPLICABLE

46 (a) Kindly confirm whether any components of your quoted items are eligible for exemption under the prevailing Indian Customs Laws [including any benefit available under any trade agreement which India has with any other nation or block of nations viz. Comprehensive Economic Partnership Agreement (CEPA), Free Trade Agreements (FTA) etc.] as on the date of Bid.

46 (b) If yes, kindly mention the Chapter or Heading or subheading or tariff of such items

46 (c) Kindly confirm that you will be submitting all the required documentary proof such as Certificate of Origin (original), Form-I & Declaration on vendor’s letter head in given format for the same at the time of dispatch of goods and in any case not later than the date on which Bill of Entry is required to be filed in India enabling Indian Oil, as importer, to avail the exemption as quoted by the Bidder. CONFIRMED

46 (d) In the event of non- submission of the requisite documents by the successful bidder as per the conditions for availing the exemption/ preferential duty benefit, then any additional outflow suffered by Indian Oil on account of those taxes and duties (including interest, if any) shall be recovered from the bidder either from any payment due to the successful bidder or separately. It shall be obligatory on the part of the bidder to acquaint itself with the provisions of Indian Customs Act, 1962 and other related regulations under which said exemption is quoted by the bidder. CONFIRMED

47 Kindly confirm Fall Clause as per SPC without any deviation. CONFIRMED

BIDDER INPUTS :-

A Indicate Major International Gateway Seaport of Exit

B Extra Ocean Freight Cost from FOB Major International Gateway Seaport Of Exit To Sea Port Of Entry - Nhava Sheva Port in India on % of FOB price. Freight charges must be quoted considering 21 free container days.

C Extra Ocean Freight Cost from FOB Major International Gateway Seaport Of Exit To Sea Port Of Entry - Kolkata Port in India on % of FOB price. Freight charges must be quoted considering 21 free container days.

D Indicate Indian Permanent Account Number (PAN)

E Manufacturer's name & address

F Country of Origin from where the goods have been offered

G Indicate Shipping Net Weight & Gross Weight of the quoted material(s).

H Indicate Shipping Dimensions & Volume of the quoted material(s).

I Indicate name, address of your Bankers for L/C opening, telephone/E-mail address, SWIFT Code and Account Number

J Indicate Customs Duty Tariff / HS Tariff Code, Number and classification.

K Indicate Tax Reference Number in your country of registration

In case of any conflict in the terms mentioned in this Agreed Terms and Conditions (ATC) and elsewhere in the Offer, the terms indicated in ATC shall supersede.However, in case any heirarchy is defined elsewhere in the tender documents then the heirarchy shall prevail in case of any conflict in terms and conditions. Printed terms and conditions, if any, appearing in quotation, shall not be applicable in the event of order. In case of contradiction between the confirmations given above and terms & conditions mentioned elsewhere in the offer, the confirmation given above in this ATC shall prevail.

1 We confirm that we have filled ATC indigenous as per sheet "ATC(ind) " of this XL file.

2 We confirm that we have filled Deviations (If any) as per sheet "DEVIATIONS STATEMENT- TECHNICAL" & "DEVIATIONS STATEMENT- COMMERCIAL"of this XL File.

3 We confirm that we have filled Proforma for PQC as per sheet - “PQC Doc- details” of this XL file.(If Applicable)

4 We confirm that we have filled unpriced BOQ as per sheet "Unpriced-BOQ" of this XL file.

5 We confirm that we have filled Holiday List Declaration as per sheet "Holiday-List-Declaration" of this XL file.

6 We confirm that we have filled Non Tampering Declaration as per sheet "NON-TAMPERING_DECLARATION" of this XL file.

7 We confirm that we have filled Contact Details as per sheet "Contact Details" of this XL file.

Offer Reference No. with date.

Authorised Person's Name (s): RHQMM25420

Move to next Work Sheet ------>

DEVIATIONS STATEMENT- TECHNICAL

Tender No. RHQMM25420

The bidder confirms that: Following are the only deviations to the technical terms and conditions if considered unavoidable . Bidder also confirms that any deviation taken anywhere else in the offer shall be considered as invalid.

Sl. No. Referred document name/ Tender document page no. Clause No. Description of Clause Deviation proposed by bidder

Bidder should note that this Annexure has been included in the Tender Document solely for the convenience of the Bidder so as to facilitate them to list out the "TECHNICAL"deviation(s)/exception(s) from/to the Tender Documents. IOCL will not consider any "TECHNICAL"deviation(s)/exception(s) which is not listed in this Annexure, for evaluation of bidder's offer. Please note that bidders are, normally, not allowed to take deviations and any deviation listed above may make the Bid liable for rejection.

Authorised Person's Name (s):

Move to next Work Sheet ------>

DEVIATIONS STATEMENT-COMMERCIAL

Tender No. RHQMM25420

The bidder confirms that: Deviations taken in Agreed Terms & Conditions, if any, and the below are the only deviations to the commercial terms and conditions, if considered unavoidable. Bidder also confirms that any deviation taken anywhere else in the offer shall be considered as invalid.

Sl. No. Referred document name/ Tender document page no. Clause No. Description of Clause Deviation proposed by bidder

Bidder should note that this Annexure has been included in the Tender Document solely for the convenience of the Bidder so as to facilitate them to list out the "COMMERCIAL"deviation(s)/exception(s) from/to the Tender Documents. IOCL will not consider any "COMMERCIAL"deviation(s)/exception(s) which is not listed in this Annexure, for evaluation of bidder's offer. Please note that bidders are, normally, not allowed to take deviations and any deviation listed above may make the Bid liable for rejection.

Authorised Person's Name (s):

Move to next Work Sheet ------>

(This Annexure is applicable for tenders having Pre-qualification criteria)

Important Instruction-

IOCL Reserves the right to complete the evaluation w.r.t. "Pre Qualification Criteria", based on the documents mentioned below only without taking cognizance of any other documents submitted towards "PQC", which is not mentioned below. In case required details are not mentioned in the relevant cells and merely enclosed/attached etc. is mentioned, IOCL may not take cognizance of such documents during evaluation. Please submit details of only those complete documents for relevant orders etc., which you consider are meeting IOCL tender PQC requirements in toto.

Details of documents submitted against Tender "Pre Qualification Criteria"

Tender No. RHQMM25420

S.N. Clause Sl no. Documents submitted to support compliance Remarks Full address of the client and contact person (Name & Details i.e. Mail ID, Mobile No. etc) if applicable

In addition to above bidder to ensure submission of compliance statement with all necessary documents for meeting any other Technical PQC of IOCL tender document ( as applicable)

PQC Commercial -Experience

Note:- Order (s) which are executed as per tender PQC compliance of Bidder's offer. Accordingly, please submit details of only those complete documents for relevant orders etc., which you consider are meeting IOCL tender PQC requirements in toto.

Meeting through 01(One) executed order:

S.N. Required exceuted order value as per NIT (INR/USD) Executed order value ( Landed Cost inclusive of P&F, TPI Charges, Freight, Taxes if any) as per bidder (INR/USD) Purchase order no. and date Purchase Order issued by (Client name) M/s Item description as per PO Documents submitted against completion/execution proof as specified in tender Full address of the client and contact person (Name & Details i.e. Mail ID, Mobile No. etc)

Meeting through 02(Two) executed orders:

S.N. Required exceuted order value as per NIT (INR/USD) Executed order value ( Landed Cost inclusive of P&F, TPI Charges, Freight, Taxes if any) as per bidder (INR/USD) Purchase order no. and date Purchase Order issued by (Client name) M/s Item description as per PO Documents submitted against completion/execution proof as specified in tender Full address of the client and contact person (Name & Details i.e. Mail ID, Mobile No. etc)

Meeting through 03(Three) executed orders:

S.N. Required exceuted order value as per NIT (INR/USD) Executed order value ( Landed Cost inclusive of P&F, TPI Charges, Freight, Taxes if any) as per bidder (INR/USD) Purchase order no. and date Purchase Order issued by (Client name) M/s Item description as per PO Documents submitted against completion/execution proof as specified in tender Full address of the client and contact person (Name & Details i.e. Mail ID, Mobile No. etc)

PQC Commercial-Financial ( Turnover )

S.N. Financial Year Annual Turnover required as per NIT (INR/USD) Annual turnover of your company (INR/USD) Details of Documentary evidence ( i.e. audited balance sheet/ profit and loss statement of audited balance sheet / published anual report / balance sheet in public domain etc.) Remarks if any.

Move to next Work Sheet ------>

PROFORMA OF DECLARATION OF BLACK LISTING / HOLIDAY LISTING

In the case of Proprietary concern:

I hereby declare that neither I in my personal name or in the name of my Proprietary concern

M/s which is submitting the acccompanying

Bid/Tender nor any other concern in which I am proprietor nor any partnership firm in which I am involved

as a Partner, are presently or have during the past three years, been placed on any black list or holiday list

declared by Indian Oil Corporation Limited or by any department of any Government ( State, Provincial,

Federal or Central ) or by any Public Sector Organization in India or in any other country nor is there pending

any inquiry by Indian Oil corporation Ltd. Or any Department of the Government or by any Public sector

organization in India or in any other country, in respect of any corrupt or fraudulent practice(s) against me

or any other of my proprietorship concern(s) or against any partnership firm(s) in which I am or was at the

relevant time involved as a partner, except as indicated below:

(Here give particulars of black listing or holiday listing and/or inquiry and inabsence thereof state "NIL")

In the case of a Partnership Firm:

We, hereby declare that neither We, M/s.

submitting the acccompanying Bid/Tender nor any partner involved in the said firm either

in his individual capacity or as proprietor or partner of any other firm or concern presently are or within the

past three years have been or has been placed on any blacklist or holiday list declared by Indian Oil

Corporation Ltd. Or by any department of Government (State, Provincial, Federal or Central) or by any public

Sector Organization in India or in any other country nor there is any pending inquiry by Indian oil Corporation

Ltd. Or by any Department of any Government ( State, Provincial, Federal or Central) or by any Public Sector

Organization in India or in any other country, in respect of corrupt or fraudulence practice(s) against us or any

partner or any partner or any other concern or firm of which he is proprietor or partner, except as indicated below:

(Here give particulars of black listing or holiday listing and/or inquiry and in the absence thereof state "NIL")

In the case of Company:

We, M/s hereby declare that neither we or a parent, subsidiary or

other company under direct or indirect common parent ( associate company) are presently nor have within

the past three years been placed on any holiday list or black list declared by Indian Oil Corporation Ltd. Or by

any Department of any Government ( State,Provincial, Federal or Central) or by any Public Sector Organization

in India or in any other country; and that there is no pending inquiry by Indian Oil Corporation Ltd. Or by any

Department of any Government ( state, Provincial, Federal or Central) or any Public Sector Organization in any

country against us or a parent or subsidiary or associate company as aforesaid in India or in any other country,

in respect of corrupt or fraudulent practice(s), except as indicated below:

(Here give particulars of black listing or holiday listing and/or inquiry and in the absence thereof state "NIL")

It is understood that if this declaration is found to be false in any particular, Indian Oil Corporation Limited shall have right to reject my/our bid, and if the bid has resulted in a contract, the contract is liable to be terminated without prejudice to any other right or remedy ( including black listing or holiday listing) available to Indian Oil Corporation Ltd.

Offer Reference No. with date.

Authorised Person's Name (s):

UNPRICED SCHEDULE

NAME OF THE BIDDER:

Sl No. Material Description UoM Qty Quoted Currency in Please select Quoted / Not Quoted

10 8808543904 High Performance Nucleating Agent (HPNA) AS PER TECHNICAL SPECIFICATIONS Metric Tonne (MT) 140.3 INR

[See sub-rule (1) of rule 21AB]

Information to be provided under sub-section (5) of section 90 or sub-section (5) of section 90A of the Income-tax Act, 1961

I *son/daughter of Shri

in the capacity of (designation) do provide the

following information, relevant to the previous year

*in my case/in the case of for the purposes of sub-section (5) of *

section 90/section 90A:-

Sl.No. Nature of information : Details#

(i) Status (individual; company, firm etc.) of the assessee :

(ii) Permanent Account Number (PAN) of the assessee if allotted :

(iii) Nationality (in the case of an individual) or Country or specified territory of incorporation or registration (in the case of others) :

(iv) Assessee’s tax identification number in the country or specified territory of residence and if there is no such number, then, a unique number on the basis of which the person is identified by the Government of the country or the specified territory of which the assessee claims to be a resident :

(v) Period for which the residential status as mentioned in the certificate referred to in sub-section (4) of section 90 or sub-section (4) of section 90A is applicable :

(vi) Address of the assessee in the country or territory outside India during the period for which the certificate, mentioned in (v) above, is applicable :

2. I have obtained a certificate to in sub-section (4) of section 90 of sub-section (4) of section 90A from

the Government of (name of country or

specified territory outside India)

Permanent Account Number:

I do hereby declare that to the best of my knowledge

and belief what is stated above is correct complete and is truly stated.

Verified today the day of

1. *Delete whichever is not applicable.

2. #Write N.A. if the relevant information forms part of the certificate referred to in sub-section (4) of section 90 or sub-section (4) of section 90A.

Authorised Person's Name (s):

VENDOR BANK DETAILS

To Indian Oil Corporation Ltd. (Refineries Divn) Scope Complex, Core- 2 Lodhi Road New Delhi – 110 003

Dear Sir, With reference to the P.O. / W.O / Contract if awarded to us by IOCL against this tender, we hereby give our consent to accept the related payments of our claims/ bills on IOCL through Cheques or Internet based online E-payments system at the sole discretion of IOCL. Our Bank account details for the said purpose is as under:

Sl.No. Particulars : Details

i Name and address of the Beneficiary :

ii Account Number of Beneficiary :

iii Account Classification (CA/ CC -11 or 29) & SB- 10 as per Cheque leaf. :

iv Name and address of the Bank Branch (where payments are to be sent by IOCL) :

v Branch Name / Code :

vi The 9 Digit MICR code of the Branch (as appearing on the MICR cheque) :

vii IFSC Code of the Bank Branch for RTGS mode. :

viii IFSC Code of the Bank Branch for NEFT mode :

ix E-mail ID of Beneficiary :

x Any other Particulars (to be advised by Beneficiary for the E-payments purpose). :

xi Vendor Code (to be filled by IOC’s Deptt. Only) :

xii PERMANENT ACCOUNT NUMBER :

xiii MOBILE NUMBER (FOR SMS ALERTS) :

xiv CIN No. Of Company (If Any) :

A blank copy of a cancelled cheque / photocopy of the cancelled cheque relating to the above account

number for verifying the accuracy of the bank account details is enclosed.

A copy of PAN Card duly attested by authorized signatory for verifying the accuracy of the PAN is enclosed.

I/We hereby declare that the particulars given above are correct and complete.

Encl.: (1) One cheque / photocopy of cheque duly cancelled (2) copy of PAN Card (3)Certificate of Incorporation with CIN details (4)Telephone or Electricity Bill for address proof

1. Verification from your bank on the above bank details required only in case : (a) Vendors not providing a cancelled cheque leaf or if vendors name is not printed / appearing on the cancelled cheque leaf submitted to IOCL Office. (b) Change in existing bank details.

Authorised Person's Name (s):

Declaration by the bidders regarding non-tampering of tender documents

Tender No. RHQMM25420

We hereby declare that none of the tender documents have been tampered with. In case of tampering of tender documents, the bid shall be rejected outright and EMD forfeited without prejudice to any other rights or remedies available to IOCL.

Authorised Person's Name (s):

Contact Details of Vendor

Tender No. RHQMM25420

Please fill up the details below:

Designation Name Telephone Nos. Mobile nos. E mail ids

Country Manager

Marketing Manager

Contact Person(s) for this Tender

Contact Person at Delhi, if any

Note: 1. Designations are indicative only. Actual designations may please be mentioned. 2. All the concerned persons in the hierarchy must appear in the above list. 3. In case of multiple phone nos., mobile nos., e-mail IDs, the same may also please be given

ACKNOWLEDGEMENT OF TENDER

( ONLY IN CASE OF LIMITED TENDERS)

The Supplier is requested to mail the following statement within 2 working days of receipt of the enclosed Tender.

Proforma for Acknowledgement Letter to Tender

Email: IOCL e mail ids provided in Notice Inviting Tender

Vendor’s Ref. No.:

To : M/s Indian Oil Corporation Ltd., Refineries Division, New Delhi/ …………. Refinery

Attention: Tender inviting authority

Subject : Response against your “Tender” No.: __________for ___________ (specify item) for

______________ PROJECT

Dear Sir, We acknowledge receipt of your above referred TENDER and confirm that ( CHOOSE THE APPLICABLE OPTION):

i) We will be submitting offer so as to reach you within the due date. Yes

ii) We regret to quote as: No

Yours faithfully

(Authorized Signatory)

Company name, address and Seal:

PEROFORMA FOR DECLARATION ON NCLT / NCLAT /DRT /DRAT/ COURT RECEIVERSHIP/ LIQUIDATION

Tender No. RHQMM25420

I/ We hereby declare that I/We /M/s declare that :

(i) I / We am/are not undergoing insolvency resolution process or liquidation or bankruptcy proceeding as on date. Yes

(ii) I / We am/are undergoing insolvency resolution process or liquidation or bankruptcy proceeding as on date as per details mentioned below. (Attached detail with technical bid) No

Note:- Select the appropriate choice against sl no i. Option against Sl no ii is conditional to chosen Option against Sl No i

It is understood that if this declaration is found to be false, Indian Oil Corporation Ltd. shall have the right to reject my/our bid, and forfeit the EMD. If the bid has resulted in a contract, the contract will be liable for termination without prejudice to any other right or remedy (including black listing or holiday listing) available to Indian Oil Corporation Ltd.

Name of Signatory :

CERTIFICATE FOR DECLARATION OF RESTRICTION FOR BIDDERS FROM COUNTRIES WHICH SHARE LAND BORDER WITH INDIA

Proforma for certification to Tender

Email: IOCL e mail ids provided in Notice Inviting Tender

Vendor’s Ref. No.:

To : M/s Indian Oil Corporation Ltd., Refineries Division, New Delhi/ …………. Refinery

Attention: Tender inviting authority

Subject : Response against your “Tender” No.: __________for ___________ (specify item)

Dear Sir, I have read the clause regarding restrictions on procurement from a bidder of a country which shares a land border with India. I certify that this bidder is not from such a country or, if from such a country, has been registered with the competant authority. I hereby certify that this bidder fulfills all requirements in this regards and is eligible to be considered. [Where applicable, evidence of valid registration by the Competent Authority shall be attached.]"

Yours faithfully

(Authorized Signatory)

Company name, address and Seal:

Select, Excess (+), Less (-)

Tender Inviting Authority:

Name of Work: Rate Contract for two (2) Year for procurement of High Performance Nucleating Agent (HPNA) for Panipat Naphtha Cracker and Paradip Refinery PP Unit.

Contract No: RHQMM25420

Name of the Bidder/ Bidding Firm / Company :

Sl. No. Item Description Item Code / Make Quantity Units Estimated Rate in Rs. P Addition / Deduction Addition / Deduction Values Currency Convertion against each Item Quoted Currency in INR / Other Currency Bidder will quote the Total Prices for 140.30 MT ( All Inclusive including GST) i.e. as per evaluation methodology given in evaluation criteria of SPC Rs. P GST (If applicable in Percentage) GST Amount in Rs. P HSN / SAC Code

1 High Performance Nucleating Agent (HPNA)

1.01 Total all inclusive price of High Performance Nucleating Agent (HPNA) AS PER TENDER TECHNICAL SPECIFICATIONS ( i.e. inclusive of all P&F, Freight, GST etc.) CALULATED as per SPC for Total Quantity 140.30 MT. Item code - 8808543904 Nos Excess(+) Full Conversion INR

Total in Figures

Quoted Rate in Figures Select %

Please Enable Macros to View BoQ information