DETAILED  INVITATION  FOR  BIDS

 

NTPC Ltd.

(A Govt. of India Enterprise)

 

(EASTERN REGION (II) , HEAD QUARTERS (ERHQ-II))

INVITATION FOR BIDS (DCB)

FOR

 

Construction of Toilets in schools of different locations

 

                                                                                       AROUND  GSTPP

 

 DISTRICT DHENKANAL , STATE OF ODISHA, INDIA  

(Domestic  Competitive  Bidding)

NIT No.:  BI No.40032503                                                                           Date: 12/01/2015

 

1.0        NTPC Ltd  invites Online Bids on Single Stage Two Part bidding basis (Part – I : Techno-Commercial Bid & Part – II : Price Bid) from eligible bidders for  Construction of 30 nos of toilet blocks at different schools of Dhenkanal Sadar block of Dhenkanal District (Area-2/Package-2).as per the Scope of Work mentioned hereinafter.

 

2.0        Brief  Scope  of  Work

 

The scope of work comprises of construction of   toilets as per BOQ  ( Bill of Quantity )  at diff. locations inclusive of all required materials , labour , T&P etc. all inclusive. The work shall be carried out as per the drawing as attached.

 

 

 

 

 

GAJAMARA SUPER THERMAL POWER PROJECT  (2X800  MW) 

BI NO. 40032503

CONSTRUCTION OF TOILETS

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DETAILED  INVITATION  FOR  BIDS

 

     

 

3.0       Detailed specification, scope of work and terms & conditions are given in the bidding documents which are available for examination and sale at the address given below as per the following schedule:

 

------------------------------------------------------------------------------------------------------------------------------------ BI No.                                                      :     40032503

 

Documents Sale Dates & Timings       :  13.01.2015 to 23.01.2015

(from 1000 hrs to 1730 hrs. (IST))

 

Last Date for receipt of queries for        :     27.01.2015 clarification from prospective Bidders

 

 

Bid Receipt Date & Time for                 :     Upto  30.01.2015 by 1530 hrs (IST) Techno-Commercial Bid and

Price  Bid

 

Bid Opening Date & Time                         :     30.01.2015  at 1600 hrs (IST)

for Techno-Commercial Bid

 

Bid Opening Date & Time                       :     Shal b intimate separatel by for Price Bid                                                 NTPC.

 

Cost of Bidding Document:                    :     Rs.900/- (Rupees Nine   hundred only)

EMD Amount                      :  Rs 67,000.00                

------------------------------------------------------------------------------------------------------------------------------------

 

 

4.0  A complete set of Bidding Documents may be downloaded by any interested Bidder on payment (non-refundable) of the cost of the documents as mentioned above in the form of a crossed account Payee demand draft in favour of NTPC Ltd., Payable at BHUBANESWAR or directly through the payment gateway at our SRM Site (https://etender.ntpclakshya.co.in/sap/bc/gui/sap/its/bbpstart). For logging on to the SRM Site, the bidder would require vendor code and SRM user id and password which can be obtained by submitting a questionnaire available at our SRM site as well as at NTPC tender site (www.ntpctender.com). First time users not allotted any vendor code are required to approach NTPC at least three working days prior to Document Sale Close date along with duly filled in questionnaire for issue of vendor code and SRM user id/password.

 

 

           

 

GAJAMARA SUPER THERMAL POWER PROJECT  (2X800  MW) 

BI NO. 40032503

CONSTRUCTIONOF TOILETS

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DETAILED  INVITATION  FOR  BIDS

 

 

 

5.0           Qualifying  Requirements  for  Bidder

 

 

In addition to satisfactory fulfillment of the Qualifying requirements stipulated in section  ITB ( instruction to bidders) of bid documents, the bidder should also meet the qualifying requirements stipulated hereunder:

 

a)    . The bidder should have successfully executed the work of Civil construction /Civil Maintenance at any organization. The bidder should submit documentary evidence in support of the work carried out by them.

b)    The Bidder should have executed similar works during last seven (07) years reckoned as on the date of bid opening with either of the following:-

 

i.    Value of  26.51 Lac in case of a single similar order.

                    

                      Or

               ii.    Value of ` 16.57 Lac each in case of two similar orders.

                      Or

          iii.   Value of ` 13.25 Lac each in case of three similar orders.

6.0     Financial Criteria:

Average Annual Turnover:

The average annual turnover of the bidder in the preceding three (3) financial years as on the date of bid opening shall not be less than ` 79.53 Lac (Rupees  Seventy Nine  Lac Fifty Three  Thousand Only).

 

 

 

 

GAJAMARA SUPER THERMAL POWER PROJECT  (2X800  MW) 

BI NO. 40032503

CONSTRUCTIONOF TOILETS

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Note:

a)    Similar Works would mean Bidder should have executed the work of Civil construction /Civil Maintenance at any organization

 

b)    The word ‘executed’ means that the bidder should have achieved the specified QR at para 5  even if the total contract is not completed/closed

 

c)    Other income shall not be considered for arriving at annual turnover as specified in the QR Para 6.0.

d)    In case where audited results for the last preceding financial year are not available, certification of financial statements from a practicing Chartered Accountant shall also be considered acceptable.

e)    Notwithstanding anything stated above , the employer reserve the right to assess the capability and capacity of the bidder/ his collaborators/ associates/ subsidiaries/ group companies to perform the   contract,     should the circumstances warrant such assessment in the overall interest of the Employer.

 

 

 

 

 

 

 

 

 

 

07.0    GUIDELINE   for Participation in SRM/ E- tender:

Access To Tender Document:

 

This is an e- tender case. Tender document can be accessed / downloaded from NTPC website  after paying the stipulated tender fee of Rs.900.00 .Please ensure that you have the vendor code, user ID and password to log on to our e-tender portal.  In case you do not have  either vendor code or user ID and Password, please contact NTPC well in time  as mentioned hereunder:

 

Initial steps for participating in our E-tender is as per the table mentioned below:

 

 

 

 

 

                                                                                                                                                                                                                          

 

 

 

 

GAJAMARA SUPER THERMAL POWER PROJECT  (2X800  MW) 

BI NO. 40032503

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                                           DETAILED  INVITATION  FOR  BIDS

Type of Vendor

Required Document for viewing our tender document

Vendors already having E-tender User Id and Password

Before download/ viewing the tender document, bidder has to pay requisite tender fee either through payment gate way by clicking on “pay tender fee” after loging in our SRM site or send crossed Demand draft / Pay order/Bankers cheque in favour of NTPC Limited payble at Bhubaneswar, directly to us , which should reach us at least seven working days prior to Last Date of Tender Fee Payment.

Vendors already having NTPC Vendor Code, but not having E-tender User Id and Password

1.     Duly filled Annexure-1 (format available in Guidelines to Bidders on the e-tender website given below) should reach us at least five working days prior to Last Date of Tender Fee Payment.

 

2.     Before download/ viewing the tender document, bidder has to pay requisite tender fee either through payment gate way by clicking on “pay tender fee” after login in our SRM site or send crossed Demand draft / Pay order/Bankers cheque in favour of NTPC Limited payble at Bhubaneswar directly to us , which should reach us at least seven working days prior to Last Date of Tender Fee Payment.

New Vendor neither having any NTPC vendor code nor

any E-tender User Id and Password

1.     Duly filled Annexure-2 (format available in Guidelines to Bidders on the e-tender website given below) and PAN card scanned / photo copy (Self Attested) along with the detailed address should reach us at least seven working days prior to Last Date of Tender Fee Payment.

 

2.     Before download/ viewing the tender document, bidder has to pay requisite tender fee either through payment gate way by clicking on “pay tender fee” after login in our SRM site or send crossed Demand draft / Pay order/Bankers cheque in favour of NTPC Limited payble at Bhubaneswar directly to us, which should reach us at least seven working days prior to Last Date of Tender Fee Payment.

Note:

1.     The agency can login e-tender site (SRM login site) for participation in our tendering after complying to above. The agency can reach our e-tender site SRM login site) directly through below mentioned address.

https://etender.ntpclakshya.co.in/sap/bc/gui/sap/its/bbpstart

 

They can also reach our e-tender site (SRM login site) through www.ntpctender.com and clicking on Login (e-Tender).

 

2.     Digital Certificate (Class III) is a must for vendors desiring to participate in this tender. For further details regarding this please visit the link “GUIDELINES TO BIDDERS” in NTPC E-Tender Website. NTPC won’t be responsible for any vendor not having a suitable valid digital certificate.

 

GAJAMARA SUPER THERMAL POWER PROJECT  (2X800  MW) 

BI NO. 40032503

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A)    Document to be submitted to Project –in-Charge (AGM-C&M-ERIIHQ) in sealed envelope ( offline)  is  as under:

 

Envelope  must contain Earnest Money Deposit (EMD)    and be superscribed “EMD/ Original bid security for the work of “Construction of 30 nos of toilet blocks at different schools of Dhenkanal Sadar block of Dhenkanal District (Area-2/Package-2). ”, NIT No 40032503  due on date: 30/01/2015  from ____________________________________________ (Name and Address of bidder).

NOTE: The  EMD  must be submiited/received by us  prior to technical bid opening date , otherwise their technical bid shall not be opened.

B) TECHNICAL BID (Online submission): Technical (un-priced) Bid comprising of required documents  as mentioned in Attachment -A of bid document  along with required  supporting documents shall be strictly uploaded online in C-folder as per instructions provided in “Instruction to Bidder-E-procurement” and Bidder’s Manual /Guidelines available on NTPC E-tender website.

Sequence of operations in brief  for uploading in "C"  folder:

Login           Process bid           bid no          change            General Data

unpriced bid             collaboration button         Attach in 'C' folder

Bidder should submit all the relevant documents in support of Qualifying Requirements and other conditions stipulated in the tender documents and technical details. No offline submissions of above mentioned documents are acceptable.

Original documents for verifications shall be produced as and when called for.

C ) PRICE BID (Online submission): The PRICE bid shall be submitted online by quoting prices of all the items as per  instructions provided in Instruction to Bidder-E-procurement” and Bidders Manual /Guidelines available on NTPC E-tender website. Prices submitted / uploaded elsewhere shall not be considered for evaluation.Following procedure must be followed while submitting price bid online.

 

 

Rate  shall only be filled in " item data -  condition"  as same  are to be considered for evaluation bid .

 

 

 

     

GAJAMARA SUPER THERMAL POWER PROJECT  (2X800  MW) 

BI NO. 40032503

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Sequence of operations in brief for filling of Amount in " item data  condition"

 

Login            Process bid            bid no            change            Item Data

 

Click on item no.           click on condition botton             Fill the rate & save (i.e  hold button)

 

The online bidding system will not allow bid submission after the respective specified expiry date and time. Bidders are advised to make sure that the bid submission is completed well in advance before the stipulated time for bid submission

D.TENDER OPENING

Tenders shall be opened online as follows:

a)      First Part of Opening:

       EMD (received offline) will be opened  as and when received before the technical opening date.

       Technical Bid (QR documents / Technical offer as per attachments mentioned in Attachment -A ) shall be opened online on the scheduled day only of the bidders whose EMD  are found in line with our requirements as mentioned in the tender documents.

                Note:

                       i.       All the supporting documents should have at least certified / attested by the bidder.

                      ii.       After opening of Technical-bids, the documents submitted by the bidders against QR conditions will be scrutinized. NTPC reserves the right to seek clarifications / confirmations on Technical Bid during the evaluation of same (i.e. before opening the Price Bid) and the bidders shall furnish the details within a short period of time.

The bidders shall produce the original documents for verification of NTPC, as & when called for.

                     iii.       In case the bidder fails to submit the documents in support of meeting the qualifying  requirement (QR), the offer shall be liable for rejection. Offer of the bidder not fulfilling the QR shall be rejected and the bid security shall be returned.

b)      Second Part of Opening:

       The price bids of only those parties shall be opened who are found qualified after evaluation of the first part bid, for which separate intimation will be sent to such qualified bidders.

 

GAJAMARA SUPER THERMAL POWER PROJECT  (2X800  MW) 

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c)          OTHER CONDITIONS

1.       Earnest money deposit (EMD):

(A)   The EMD offered shall, at bidders option, be in the form of (i) A Crossed Demand Draft/Pay Order/Bankers Cheque in favour of NTPC Limited payable at, Bhubaneswar or (ii) an unconditional and irrevocable Bank Guarantee (BG) from any of the banks specified in the bidding documents. The format of Bank Guarantee towards bid security shall be in accordance with the ‘Proforma for BG’ included in the bidding documents. EMD for an amount less than or equal to Rs. 50,000.00 shall not be accepted in the form of Bank Guarantee.

(B)   The bid security shall remain valid for a period of forty five (45) days beyond the original bid validity period or beyond any extension in the period of bid validity subsequently requested

(C)   ANY BID NOT ACCOMPANIED BY AN ACCEPTABLE BID SECURITY IN A SEPARATE SEALED ENVELOPE SHALL BE REJECTED BY THE EMPLOYER AS BEING NON-RESPONSIVE AND SHALL NOT BE  OPENED.

(D1)NSIC / SSI units registered with OSID (Odisha)  for the items / services for which such units are registered, shall be exempted from payment of Tender Fee/Bid Security / Earnest Money Deposit. Eligible NSIC/SSI units shall be exempted from paying Security Deposit (SD) up to the monetary limit for which the unit is registered with NSIC/ OSIDC. This shall be subject to submission of a self certified legible copy of valid registration certificate giving details, such as ‘items / services for which registered, validity, monetary limits etc’ in the EMD envelope. This should reach us before stipulated bid opening Date.

D2) Tender document will be issued free of cost to Micro and Small Enterprises. Such Enterprises are not required to submit EMD, however they have to submit copy of Enterprise Memorandum II issued by DIC/Registration Certificate issued by khadi and village Industries Commission/Coir board/NSIC/Directorate of handicrafts and handloom or any other body specified by Ministry of  Micro, Small and Medium Enterprises GOI

           E) Notwithstanding anything stated above, NTPC reserve the right to assess bidder’s capability and capacity to perform the contract, should the circumstance warrant such assessment in overall interest of the owner.

F.    NTPC reserves the right to reject any or all bids or cancel / withdraw the Notice Inviting Tender without assigning any reason whatsoever and in such case no bidder / intending bidder shall have any claim arising out of such action. In such circumstances, EMD only shall be returned without any additional financial liability to NTPC Limited.

G.    Tender documents are not transferable. Issuance of tender documents does not automatically mean that the bidders are considered qualified. NTPC shall evaluate the qualifying requirements of each bidder as per NIT after opening of Technical Bid and the Price bids of the bidder who is not meeting the qualifying requirements shall not be opened.

H.                       If the last date of receiving application and date of bid opening coincides with a holiday, the date will be shifted to the next working day.

 

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             I.Above details are only indicative. Other detailed terms and conditions shall be as per our tender documents. Interested bidders are advised to visit the site and familiarize themselves with the site conditions.

 

     J.Parties blacklisted/ banned by any NTPC Unit/ Corporate Centre as well as other Public Sector/ Govt. agencies are not eligible to participate.     

 

 

Help Desk (problem related with Login ID / C- Folder attachment ):

In case of   any problem related with login ID / password & C- Folder, vendors may pl contact on following nos. Helpdesk Contact Nos. 0120-2952319 or 0120-2597319 or 0120-2410252 or 2410259 or 0120-2410306 or 9650992097 or 9650991941 or 9650996029

Contact details of concerned person  at NTPC ERHQ II , Bhubaneswar :

 

a) P K Samantaray   (AGM/ C&M ), E-mail Id :pksamantray@ntpc.co.in,

     Ph:  9437043529

b)  D P Pradhan (AGM/ C&M ), E-mail Id :dppradhan@ntpc.co.in,

     Ph:  9437043570

 

                ADDRESS FOR COMMUNICATION:

 

ADDITIONAL GEN. MANAGER(C&M) ,  NTPC LTD , EASTERN REGION (II) , HEAD QUARTERS (ERHQ-II) ,PLOT NO. N/17/2 ,  ORISSA LIFT IRRIGATION BHAWAN (OLIC BLDG.) , 3RD   & 4TH  FLOOR ,  PO: NAYAPALLI , BHUBANESWAR – 751012, ORISSA PHONE NO. 0674-2500946, 9437043529 FAX NO: 0674-2500906

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SALIENT TECHNICAL FEATURES

 

Subject:            Construction of 30 nos of toilet blocks at different schools of Dhenkanal Sadar block of Dhenkanal District (Area-2/Package-2).

 

 

 

 

LOCATION DETAILS :  Dhenkanal Town : Around 110 Km from Bhubaneswar Railway Station & 120 Km from Bijupattnaik Airport , Bhubaneswar.

Dhenkanal Municipality is   Dhenkanal Town

Dhenkanal Sadar : A block of Dhenkanal district  , adjoining Dhenkanal town.

 

 

 

 

 

The scope of work comprises of CONSTRUCTION of   toilets as per BOQ  ( Bill of Quantity )  at diff. locations inclusive of all required materials , labour , T&P etc. all inclusive. The work shall be carried out as per the drawing as attached.

 

 

 

 

 

 

Annexure No 1

 

Request for Login ID on NTPC e-Tender.

If you are already a supplier/contractor of NTPC, and interested in participating in e-tenders of NTPC, please fill in the following form.

Form B

For Existing Venders:

 

Existing Vender Code with NTPC: _______________

                                                                                                 

Phone Number:  ____________________            Extn: _________________

Email ID:_______________________________________________________

Contact Person’s Name: ___________________________________________

Designation: _______________________________________________

 

Bid Invitation number interested in: _________

 

DD/BC/Pay Order details as tender fee:  Issuing Bank: _____________________________

No: _____________       Date of Issue: __________

Amount: _________       DD/BC/Pay Order Valid till: __________

Address and other detail (Only in case of change)

Name:   ___________________________________________________

Address:           ___________________________________________________

                       

 

 

                          ___________________________________________________

                        ___________________________________________________

 

State:               _________________                  City: ____________________

Country:            ______________

Pin:                  _________________

Telephone NO: _______________           Extn: ________

Fax Number:    _______________

Email ID:           ___________________________________________________

Your Company’s Bank Name _______________________________________

Account Number: ____________________________________

Branch: _____________________________________________

Address: ____________________________________________

                        _____   ______________________________________

Note: Tender fee payment can be given through DD/BC/Pay Order or payment Gateway. In case the option of DD/BC/Pay Order is opted should be in favor of “NTPC Ltd” payable at the ordering location mentioned in the Bid invitation.

 

Request for Login may be sent through E-mail or manually sent to Package in charge / Contact person as mentioned in the Bid Invitation.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Annexure No 2

 

Request for Login ID on NTPC e-Tender.

If you are not a supplier/Contractor of NTPC, and interested in participating in e-tenders in NTPC, please fill in the following.

 

Form A

New Vender (prospective)

 

Name:                ___________________________________________________

Address:           ___________________________________________________

                        ___________________________________________________

                        ___________________________________________________

State:               _________________      City: _______________________

Country:            ______________

Pin:                  _________________

 

Telephone NO: _______________           Extn: ________

Fax Number:     _______________

Email ID:           ___________________________________________________

Your Company’s Bank Name _______________________________________

Account Number: ____________________________________

Branch: _____________________________________________

Address: _____________________________________________________

            ________________________________________________________

PAN number: ___________________________________________________

CST number: ___________________________________________________

Excise Regn Number: _____________________________________________

SSI Number: ___________________________________________________

Contact Person’s Name: ___________________________________________

Designation:     _____________________________________________

Bid Invitation number interested in: __________________

 

DD/BC/Pay Order details as tender fee:  Issuing Bank: _____________________________

No: _____________       Date of Issue: __________

Amount: _________       DD Valid till:__________

 

Note: Please download, print and fill up this form & Submit it to the Package in charge/ Contact person as mentioned in the Bid Invitation along with the DD/BC/Pay Order of required amount & a cancelled cheque & EFT form duly filled in as attached herewith. DD/BC/Pay Order should be in favor of “NTPC Ltd” payable at the ordering location mentioned in the Bid Invitation.

 

Request for Login may be sent to Package in charge / Contact person as mentioned in the Bid Invitation.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

ANNEXURE-2A                                                   

            E.F.T- Form                                                                 

(TO BE RETURNED TO THE COMPANY)

To,

 

NTPC Limited.

Talcher Super Thermal Power Station

P.O.: - Deepshikha, Dist: Angul, (Orissa)

Pin- 759 147

 

Dear Sir,


Ref:      AUTHORISATION OF ALL OUR PAYMNETS THROUGH ELECTRONIC FUND

TRANSFER SYSTEM.

 

We hereby authorize NTPC Ltd., Scope Complex, Lodi Road, New Delhi to make all our payments through Electronic Fund Transfer system. The details for facilitating the payments are given below:

(TO BE FILLED IN CAPITAL LETTERS)

 

1.         NAME OF THE BENEFICIARY

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

2.         ADDRESS

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

PIN CODE:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

3.         MOBILE NO:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

4.         BANK PARTICULARS

A)         BANK NAME

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

B)    BANK TELEPHONE NO. (WITH STD CODE)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

C)    BRANCH ADDRESS

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

PIN CODE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

D)    BANK FAX NO. (WITH STD CODE)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

E)            BRANCH CODE OF THE BANK

 

 

 

 

 

 

 

 

 

 

 

F)    9 DIGIT MICR CODE OF THE BANK BRANCH                                

            (ENCLOSE COPY OF A CANCELLED CHEQUE)

 

 

 

 

 

 

 

 

 

 

G)   11 DIGIT IFSC CODE  CODE OF THE BANK BRANCH                                

           

 

 

 

 

 

 

 

 

 

 

 

 

 

 

H)    BANK ACCOUNT NUMBER

                                   

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

I)     BANK ACCOUNT TYPE (TICK ONE)

                                   

SAVING

CURRENT

LOAN

CASH CREDIT

OTHERS

 

                        IF OTHERS SPECIFY

 

 

 

 

 

 

 

 

 

 

 

5.         PERMANENT ACCOUNT NUMBER (PAN)

 

 

 

 

 

 

 

 

 

 

 

6.         E-MAIL Address for Intimation regarding release of payments

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

I/ We hereby declare that the particulars given above are correct and complete. If the transaction is delayed or credit is not erected at all for reasons of incomplete or incorrect information, I/ We would not hold the Company responsible.

 

                                                                                                                        SIGNATURE

DATE

 

 

 

 

 

 

 

 

 

                 

 

                                                                                                (AUTHORISED SIGNATORY)

 

Name :

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

                                                                                    OFFICIAL STAMP

 

BANK CERTIFICATION:

 

It is certified that above mentioned beneficiary holds a bank Account No. _________________ with our branch and the Bank Particulars mentioned above are correct.

 

                                                                                                            SIGNATURE

DATE

 

 

 

 

 

 

 

 

 

                 

 

                                                                                                (AUTHORISED SIGNATORY)

 

                                                            Authorization No.: ……………………………………..

Name: