e-N.I.T. NO-13, 2025-2026/DHFWS

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) P-Tax Enrollment No.

(e) Professional Tax Clear Upto

(f) GST Registration No.

(g) GST return submitted upto

(i) Income tax return submitted Upto

(a) Name of drawee bank

(c) NEFT/RTGS / Net banking Ref No

7 Credential for similar nature of work. (To be supported with work order & completion 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

Select, At Par, Excess (+), Less (-) IOCL Select Excess (+) Less (-) Excess (+) Less (-)

Tender Inviting Authority: THE CHIEF MEDICAL OFFICER OF HEALTH, BIRBHUM

Name of Work: Additional civil and electrical works for IPHS-2022 Compliance at Goruijora HWC, PM-ABHIM, Birbhum District.

Contract No: e-N.I.T. NO-13, 2025-2026/DHFWS, SL NO-04

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

1 Civil & Electrical Works BI01010001010000000000000515BI0100001112

1.01 Additional civil and electrical works for IPHS-2022 Compliance at Goruijora HWC, PM-ABHIM, Birbhum District. BI01010001010000000000000515BI0100001113 Nos Excess(+) Full Conversion INR

Total in Figures

Quoted Rate in Figures Select

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