Supply of Tubewell Materials under Dakshingram GP (Activity ID No 109402286)

BIDDER INFORMATION FORM

1 Name of the bidder

2 Bid submitted for (NIT No)

5 BIDDERS DETAILS

(a) Address for communication

(b) Contact No. (Mobile)

(C) e-mail Address

(d) Professional tax registration No.

(e) Professional Tax Clear Upto

(i) Income tax return submitted Upto

(a) Name of drawee bank

7 Credential for similar nature of work. (To be supported with work order & completion report / Payment Certificate)

(a) Name of Work executed

(b) name of Department where executed

(c) Amount put to tender

(d) amount of final Bill

(e) Work order No.

(f) Date of Completion

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Tender Inviting Authority: PRODHAN , Dakshingram Gram Panchayat

Name of Work: " Supply of Tubewell Materials under Dakshingram GP (Activity ID No - 109402286) "

Contract No: 8918803087 email : [email protected]

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 BASIC RATE In Figures To be entered by the Bidder Rs. P Excise Duty VAT Freight Charges ( Unloading & Stacking) Any Other Taxes/Duties/Levies Other Taxes 2 IIIrd Party i.e DGS&D / RITES etc Inspection Charges @0.34%+Service Tax Less for Cenvat Credit,if any respect of Supplies Under full Excise Duty Category

" Supply of Tubewell Materials under Dakshingram GP (Activity ID No - 109402286) " BI01010001010000000000000515BI0100001113 Nos Excess(+) Full Conversion INR

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