MLA

Agency Detailing & Check List Form

Bhavnagar Municipal Corporation

Roads Department

IFB No / Tender Notice No :-

1 Name of Agency/Organization/Company/Tenderer (Attach photo in form at bottom and sign over it) :-

2 Full Address of Agency/ Organization/ Company/ Tenderer :-

3 Is Tenderer Individual ? Or Company ? Or Organization ? :-

4 Name of Responsible Person :-

5 Full Address of Responsible Person :-

6 Landline number of Agency/ Organization/ Company/Tenderer :-

7 Mobile number of Responsible Person from Agency/ Organization/Company/Tenderer :-

8 E-mail Address of Agency/Organization/Company/Tenderer :-

9 GST Registration Number :-

10 PAN Card Number :-

11 EPF / ESI Number :-

12 Class of Registration as a Contractor :-

13 Registration Validity Date as a Contractor :-

14 Detalis of Department which Issued the Registration :-

15 Validity Date of Bank Solvency :-

16 Special Class of Registration :-

17 Validity Date of Special Class Registration :-

18 Bank Name of Demand Draft for Tender Fee :-

19 Demand Draft Number for Tender Fee :-

20 Date of Demand Draft for Tender Fee :-

21 EMD Bank Name :-

22 EMD Number :-

23 EMD issue Date :-

24 EMD Maturity Date :-

25 EMD Maturity Period :-

26 Does EMD Valid for such Days as instruced in tender? :-

27 Stamp & Signature are done behind EMD? :-

28 Does hard copy of Specifications with Signature and Stamp submitted? :-

29 Copies are certified? :-

30 Income Tax documets are submitted? :-

31 Original Affidavite is Submitted? :-

32 Receipt of Paid Professional Tax is Submitted? :-

33 Hard copy of Corrigendum with Stamp and Signature is Submitted? :-

34 All Documents are uploaded with Online Tender? :-

35 Hard copy of Detailing Form with Stamp and Signature is submitted? :-

36 Signed and Stamped Detailing form is uplaoded with Online Tender? :-

37 Name of Work, Tender ID, Tender Notice/IFC number, Last date of submitting documents are mentioned on cover of Tender Document :-

38 Contracter Name - Address - Mobile Number is written over the Tender Document Cover? :-

Tenderer has to fill up all details in prescribed format (Means M.S. Excel format) and upload soft copy online. All details and Numerics has to be written in English ( if possible use Time New Roman fonts) Take a print of this form, Sign on it, send it with other documents and Upload Scaned copy with online document Write "Not Applicable" wherever required (Do not keep any line / column blank)

Name of Agency/Organization/Company/Tenderer

Signature & Date

Name of Responsible Person

Designation of signing person Agency/Organization/Company/Tenderer

Take Print Up to Here