Page 1 of 2 APPLICATION FORM B S N by MikeCallan

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									APPLICATION FORM                                                                                              BSNL

                  APPLICATION FORM FOR SEEKING TENDER DOCUMENTS
                                  BSNL USOF PROJECT DIVISION- DEHRADUN
To,
        The Executive Engineer
        BSNL USOF PROJECT DIVISION,
        3, Tyagi Road
        Dehradun – 248001.

Sub:-   Submission of application for the work of ……………………………………………………………..…
        …...………………………………………………………...……..
        ---------------------------------------------------------------------------------------------------
        ( Kindly use separate application form for each work)

        NIT No. ……………………………………………………………

        Ref:-    …………………………………………………………………………….
Sir,
1.      .I am/ We are registered with BSNL Civil Wing/DOT for building works as Class.……..…… Contractor(s)
        and our registration number is …………………………………………………….. and as on date the said
        registration is valid up to ………………...(copy enclosed)

2.      I am/ We are also registered contractor(s) with the other departments and the particulars of the authority
        and class and the limit of amount up to which I am/ we are eligible to tender are furnished below (proof
        attached)

          S.                Authority                Class      Tendering Limit      Registration Valid Up
          No.                                                                                  to



3.      It is certified that this/ these registration (s) is/ are valid as on date and I/ we shall inform the department
        myself /our self as soon as my/our registration expires or is cancelled/ revoked.

4.      The particulars of work done are enclosed and the following 3(three) nos. of work completion certificates are
        submitted with respect to this N.I.T in order to establish my/our eligibility for participation in tender.

         S.              Name of work              Amount of        Date of          Issuing authority
         No.                                       work done      completion




                                                                                                             Page 1 of 2
APPLICATION FORM                                                                                              BSNL

5.       The list of works in hand (in progress) with me/ us in the format is given below (use separate sheet if
         required):

          Sl.               Name of work                   Name &         Tendered    Position    Remarks
          No                                             particulars of    Amount      of work
                                                        division where     as per         in
                                                        work is being       award     progress
                                                           executed         letter




6.       The attested copy of the partnership deed is enclosed herewith.
7.       “I,________________________________             s/o Shri    _______________________________________
         __Resident of _______________________________hereby certify that none of my relative (s) as defined
         above is/are employed in          BSNL Civil Zone Uttranchal. In case at any stage, it is found that the
         information given by me is        false/incorrect, BSNL shall have the absolute right to take any action as
         deemed fit without any prior intimation to         me”.
8.       The declaration is hereby given which will become part of agreement-
9.       I/we …………………………………..                       do hereby solemnly declare that I shall abide by all the
         rules/conditions/provisions of EPF and miscellaneous Provision Act 1952. In case of default by the
         undersigned the sole responsibility shall be mine.
10.      I/ We will produce the original documents of all the self attested copies submitted herewith whenever
         required by the department.
11.      I am/ We are enclosing …………… number of sheets including self attested copies of documents listed
         above along-with my/our application.
12.      I/ We request that permission may be granted to me /us for participation in the tender.

Note :
   1. All the documents attached with the application should be self attested with full name and rubber
       stamp of the firm.

         *Strike out whichever is not applicable.


                                                                                                        Yours faithfully,

Date:……………..
                                                                                                    (CONTRACTOR)
                                                                                           (SIGN WITH STAMP/SEAL)

PHONE NOS.: Landline - ……………………                                    NAME:             ……………..
            Mobile - …………………….

E-MAIL          ……………                                               ADDRESS:         ………………

Enclosures:-
1.)
2.)
3:)




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