PACKED TPTN AT DBP

TENDER NO. SRO/PT/015/KASO/26-27-EOI-III – TENDER ID – 2026_KASO_189713_1

STATEMENT OF CREDENTIALS

Tenderer should fill in below mentioned details along with the Technical bid. (NON- COMPLIANCE OF ANY DETAILS WILL MEAN INCOMPLETE TENDER). Please state "NOT APPLICABLE" in case you have no positive answer. For example, if you are not a proprietary firm, then please state "NIL" or “NOT APPLICABLE’ against item No. (B) 1 below instead of keeping the same blank.

S. No Particulars Vendor's response

1 Name and address of the Bidder:

2 Telephone Nos.:

3 Fax & E-Mail, if any:

4 Name of Contact Person:

6 Nature of the firm ( state whether Limited Co. Partnership, Co-operative Society or Sole Proprietor)

7 Year of Establishment

8 Registration No. Of Company or Firm

9 Sole Proprietorship?

If yes, Give name of the Proprietor

10 Partnership firm?

If yes, Give names of the Partners

11 Private or Public Limited Company?

If yes, Give list of Directors.

12 State whether the bidder is Haulage Contractor at the supply locations covered in this tender. Choose `Yes' or `No' from the drop down list provided.

TENDER NO. SRO/PT/015/KASO/26-27-EOI-III – TENDER ID – 2026_KASO_189713_1

SL. NO NAME OF THE BIDDER ADDRESS CONTACT NUMBER DSC HOLDER NAME PAN CARD NUMBER GST REGISTRATION CERTIFICATE NO. MAIL ID EMD PAYMENT ONLINE OR EXEMPTION NATURE OF FIRM FIRM REGISTRATION CERTIFICATE FROM REGISTRAR OF FIRM ENCLOSING ALL ANNEXURES WITH ALL THE PARTNERS NAME OR CERTIFICATE OF INCORPORATION POWER OF ATTORNEY FOR DSC HOLDER AND SIGNING AUTHORITY (ANNEXURE-IX) CATEGORY DECLARATION FOR THE BID (ANNEXURE-IV) CONFIRMATION LETTER FROM SCHEDULED COMMERCIAL BANKS FOR EXTENDING LOAN UNDER GOVT. OF INDIA'S STAND UP INDIA SCHEME (SUIS) SC / ST CERTIFICATE NUMBER MSME DECLARATION (ANNEXURE-X) MSME CERTIFICTAE NUMBER / UDYOG AADHAAR NUMBER MSME SELF - DECLARATION (ANNEXURE-XV) UNDERTAKING - TO BE SUBMITTED ALONGWITH TECHNICAL BID (ANNEXURE-III) UNDERTAKING FOR TRUCKS OFFERED (ANNEXURE-VI) DECLARATION A, B, C, D (ANNEXURE-VII) DECLARATION OF HOLIDAY / BLACKLISTING (ANNEXURE-XIII) INTEGRITY PACT (ANNEXURE-XIII) BANK DETAILS (ANNEXURE-XIV) DISCHARGE OF GST PERCENTAGE ON FCM 12% OR RCM 5% (ANNEXURE-XVI) RTO REGISTRATION NO. OR TEMPORARY REGISTRATION NO. OR SUIS (TYPE OF TRUCK OFFERED) READY TRUCK OR TEMPORARY REGISTRATION TRUCK OR SUIS - PROPOSED TRUCK ADDRESS OF REGISTERING RTO BODY TYPE ENGINE NO. CHASSIS NO. GLW ULW RLW NAME OF REGISTERED OWNER AS PER RC BOOK RELATIONSHIP WITH THE BIDDER OWNED / ATTACHED AFFIDAVIT FOR ATTACHED TRUCK (ANNEXURE-V) NOC FOR OPERATING TRUCKS QUOTED TRUCKS IS OFFERED ONLY TO THIS PARTICULAR TENDER AND NOT OFFERED TO ANY OIL COMPANY INCLUDIN GANY OTHER UNITS OF INDIAN OIL CORPORATION DATE, MONTH & YEAR OF ORIGINAL MANUFACTURING DATE OF TRUCK AS PER RC BOOK / INVOICE (ALL QUOTED & ELIGIBLE TRUCKS (MONTH / DATE / YEAR)

FORM-C FORM-A DATE MONTH YEAR

TENDER NO. SRO/PT/015/KASO/26-27-EOI-III – TENDER ID – 2026_KASO_189713_1

SL. NO NAME OF THE BIDDER ADDRESS CONTACT NUMBER DSC HOLDER NAME PAN CARD NUMBER GST REGISTRATION CERTIFICATE NO. MAIL ID EMD PAYMENT ONLINE OR EXEMPTION NATURE OF FIRM FIRM REGISTRATION CERTIFICATE FROM REGISTRAR OF FIRM ENCLOSING ALL ANNEXURES WITH ALL THE PARTNERS NAME OR CERTIFICATE OF INCORPORATION POWER OF ATTORNEY FOR DSC HOLDER AND SIGNING AUTHORITY (ANNEXURE-IX) CATEGORY DECLARATION FOR THE BID (ANNEXURE-IV) CONFIRMATION LETTER FROM SCHEDULED COMMERCIAL BANKS FOR EXTENDING LOAN UNDER GOVT. OF INDIA'S STAND UP INDIA SCHEME (SUIS) SC / ST CERTIFICATE NUMBER MSME DECLARATION (ANNEXURE-X) MSME CERTIFICTAE NUMBER / UDYOG AADHAAR NUMBER MSME SELF - DECLARATION (ANNEXURE-XV) UNDERTAKING - TO BE SUBMITTED ALONGWITH TECHNICAL BID (ANNEXURE-III) UNDERTAKING FOR TRUCKS OFFERED (ANNEXURE-VI) DECLARATION A, B, C, D (ANNEXURE-VII) DECLARATION OF HOLIDAY / BLACKLISTING (ANNEXURE-XIII) INTEGRITY PACT (ANNEXURE-XIII) BANK DETAILS (ANNEXURE-XIV) DISCHARGE OF GST PERCENTAGE ON FCM 12% OR RCM 5% (ANNEXURE-XVI) RTO REGISTRATION NO. OR TEMPORARY REGISTRATION NO. OR SUIS (TYPE OF TRUCK OFFERED) READY TRUCK OR TEMPORARY REGISTRATION TRUCK OR SUIS - PROPOSED TRUCK ADDRESS OF REGISTERING RTO BODY TYPE ENGINE NO. CHASSIS NO. GLW ULW RLW NAME OF REGISTERED OWNER AS PER RC BOOK RELATIONSHIP WITH THE BIDDER OWNED / ATTACHED AFFIDAVIT FOR ATTACHED TRUCK (ANNEXURE-V) NOC FOR OPERATING TRUCKS QUOTED TRUCKS IS OFFERED ONLY TO THIS PARTICULAR TENDER AND NOT OFFERED TO ANY OIL COMPANY INCLUDIN GANY OTHER UNITS OF INDIAN OIL CORPORATION DATE, MONTH & YEAR OF ORIGINAL MANUFACTURING DATE OF TRUCK AS PER RC BOOK / INVOICE (ALL QUOTED & ELIGIBLE TRUCKS (MONTH / DATE / YEAR)

FORM-C FORM-A DATE MONTH YEAR