Annexure I

National Thermal Power Corporation Ltd.,

(A Government of India Enterprise)

Eastern Region II Head Quarters

Adderss:

Phone :06742500906

Contracts & Matrerials department

Fax : 06742500906

OLIC Building, 3rd & 4th Floor

 

N 17/2 Nayapalli Bhubaneswar 751012

 

APPLICATION FOR SHORTLISTING OF VENDORS

NIA NO : NTPC/ERIIHQ/2014/01

1,0 GENERAL :

1.1Name of the Organisation

1.2Full Address : Telephone & Fax No. etc.

i)Registered Office

ii)Regional Offices

1.3Organisational set up of the company with details

1.4(a) In case of companies, date

Enclosed

Yes/No

 

place of registration and certified

 

Name of Directors / Partners

Status

copies of Memorandum of Association

1.

 

 

and Articles of Association

 

2.

 

 

to be furnished.

 

3.

 

 

Names, Addresses and particulars

 

4.

 

 

of all the Directors should be furnished.

5.

 

 

(b)In case of partnership firm the names of all the partners and their addresses are to be

Annexure I

furnished. Attested copies of partnership deed to be attached.

(Original partnership deed to be produced for verification on demand).

c) In case of individual/proprietary concern , his full name, address,

place and nature of business are to be furnished along with notarized affidavit.

1.5PF registration details ( copy to be enclosed)

1.6Details of PAN, Sales tax/ VAT Registration, Service Tax (copy to be enclosed)

1.7

Details of relatives employed

1.

 

in NTPC (giving full particulars i.e.

2.

 

name, designation and the department

3.

/ unit in which working).

1.8Annual Turnover for last three years (Copies of balance sheet , profit & loss account ,

supporting documents showing average annual turnover during last three financial years, to be submitted)

Financial year (FY)

Turnover in Rs lakhs

2013-2014

A

2012-2013

B

2011-2012

C

Annual average Tornover(ATO)

(A+B+C)/ 3

Annexure I

1.10NSIC/ SSI registration, if any (copy to be enclosed)

1.11Any other particulars / merits in favour.

2.0TECHNICAL

2.1If already worked as a

Contractor of NTPC

(Give the following Details along with documentary evidence like order copy, completion certificate,work execution documents etc)

Name of the Power

Name of

Value

Year

Station/project

work& order no

 

 

2.2Work execution details ( Technical) in support of QR.

(Give the following Details along with documentary evidence like order copy, completion certificate,work execution documents etc)

Name of the Power

Name of

Value

Year

Station/project

work & Order no

 

 

______________________________________________________________________________

2.3Attach details for participation in E-tendering ( i.e as per Ann-1 or Ann-2)

2.4 Attach NTPC fraud police declaration duly signed

Annexure I

2.5Mention any other relevant Detail

Note: a) Separate sheet (s) may be attached to any column wherever necessary.

a) All the submitted documents are to be self attested.

I certify that all the information and data furnished by me/us in this application from are true and complete to the best of my knowledge.

Signature of the Applicant/

Authorised Person

(Seal)