(Refers to para 15 (e) of Instructions)
I, …………………………………………………S/O ……………………………….
do hereby declare that:-
1. I, __________________________________hereby certify that:-
(a) I have not been dismissed from the service at any stage.
(b) I have not been empanelled for a Security Agency earlier at DGR.
(c) I have not applied for CNG Station/Coal Transport/Training Institute or
running any self –employment ventures by DGR.
(d) I will ensure that my agency is not sublet to any other security agency
offices, or any civilian. I will not give Power of Attorney to another person to
run my agency.
(e) I will represent my agency in person to Principal Employer and DGR as
and when required.
(f) All the official correspondence will be signed by me as the director of
(g) At any stage, in case the above statement is found incorrect, I will forfeit
my empanelment. Any sponsorship, if allotted to me may be cancelled and my
security agency be de-empanelled.
2. I shall ensure that all ESM guards are paid wages as per the DGR structure,
will make the contribution to EPF & ESI and all other statutory components regularly
and the guards will be provided proof of deposit of the above for their information.
(a) I am the sole and only proprietor of the Security agency applicable.
(b) I will not include any additional member/make changes in the
(c) My security agency has ….employees. (In case security agency is
already in operation.
(d) I am unemployed. (not working with any concern i.e.
(e) I shall inform the DGR in case above agency indulges in any other
business activities or acquires any other security contracts.
(f) I will follow all directives issued by DGR from time to time.
(g) I shall follow all laws of the land pertaining to security agencies and
follow the rules and regulations pertaining to payment etc. of the employees.
(3) I undertake to employ at least 90% ESM security guards.
(4) I undertake not to use the name of DGR, Ministry of Defence in any
correspondence negotiations in any form with any third party for furtherance of
(5) I or my representative will not submit the tenders to any company or security
agency if any DGR sponsored security agency is already functioning there.
(6) I agree that in case of any dispute between the security agency and the
contracting organisation of the employees or the employees of the security
agency, the DGR shall have the right to arbitrate and the ruling of the DGR
shall be final and binding on me.
(7 I agree to the DGR or any monitoring agency authorised by the DGR having
the right to inspect any document or accounts of my security agency.
(8) I undertake not to use uniform for the security guards which are akin to those
used by Army, Navy, Air Force, Para Military Forces and other Police Forces.
(9) I shall not approach and/or participate directly at CPSU tendering process
unless sponsored/permitted by DGR in writing.
(10) The names of the agency proposed by me have been registered/not registered in
my exclusive name as per Shops and Commercial Establishment Act/ the
concerned Act in the State of my choice. I am also not aware of any other name
proposed by me to have been registered by any other individual
(11) I agree that there will be no sponsorship for my agency on attainment of 60
years of age or my quota is complete which ever is earlier. I agree that my
agency will be disempanelled from the list of DGR empanelled Security
Agencies four years after commencement of first contract or on my attaining
62 years of age or on completion of authorised quota of guards which ever is
(12) I agree that my agency will be disempanelled in case I violate any of the
instructions contained in DGR “Instructions for Functioning of the Security
Agency” issued by DGR.
Signature of Director/Officer
Note: (To be notarised on Rs 10/- Stamp paper)