NTPC Limited

(A Government of India Enterprise)

RAMAGUNDAM SUPER THERMAL POWER PROJECT

P.O. Jyothinagar, Dist. Karim Nagar-505 215, Telangana State.

RSTPS/09/C&M-CS/2016-17/VENDOR Enlistment NIT- 01

APPLICATION FOR ENLISTMENT OF AGENCY/CONTRACTOR

Description of Work/Service for which Enlistment is sought:

Package No.

Description of Work (as mentioned in Annexure-A)

Category

(A or B or Both)

(mention A or B or both as the case may be)

Name of the Organization / Agency / Contractor

Full Address:

Telephone, Fax, email etc.

i) Registered Office

ii) Regional Offices

iii) Works

______________________________________

Whether Registered with any other Department/Organization Govt./Quasi Govt. Organization:

(Attested copies of documentary proof to be attached). Please give details of Name of Deptt./ Organisation Govt./ Quasi Govt. Organization, Regn. No. and nature of Service(s)

(a) In case of Companies, copies of Certificate of Incorporation, Memorandum and Articles of Association to be furnished.

Enclosed

Yes / No

(b) In case of partnership firm, the copy of Partnership Deed duly registered to be furnished (Original partnership deed to be produced for verification on demand).

Yes / No

(d) Whether the firm is ISO/Equivalent certified if so furnish copy of certificates.

Yes / No

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Copies of following documents to be

Enclosed

(i) PAN Number

Yes / No

(ii) Sales Tax Registration No.

Yes / No

(iii) Service Tax Registration No.

Yes / No

(iv) VAT Registration No.

Yes / No

(v) ESI Registration No.

Yes / No

(vi) PF Registration No.

Yes / No

(vii) NSIC Certificate.

Yes / No

(viii) SSI Certificate.

Yes / No

Details of relatives employed in NTPC (giving full particulars i.e. name, designation and the deptt./ unit in which working)

1. _____________________

2. _____________________

3. _____________________

Any other particulars (give details of similar services done earlier, their year of service, commissioning

and feedback on Performance)

If already enlisted (either as individual or partnership) with any NTPC Power Stations/Regions/Units

Give details & enclose copy of Enlistment Certificate

Name of Project/Station

Work/Services enlisted for

Year of enlistment

If already enlisted with any PSU/Govt. Deptt. Give details

Name of PSU/Govt. Deptt

Year of Enlistment

Items/Services enlisted for

Page-3 of 9

10.

If already executed Works/Services in Ramagundam NTPC of similar nature; give details of 3 or 4 major works done similar to type under consideration.

LOA NO.& Date/

SAP PO No. & Date

Description of work/services

Awarded Value

(Rs. Lakhs)

Actual Executed Value (Rs. Lakhs)

12.

No. of workers employed.

Skilled Workers :__________ Semi- Skilled Workers __________ Unskilled Workers :_________________

NTPC shall invite all the tenders through e-tendering. To participate in such tenders,

you require Class-III digital certificate and P.C. with internet connection. Please confirm that you will

continue to participate in our tender, if invited through on-line electronic mode.

14.

Mention any other relevant details.

I certify that all the information and data furnished by me in this application form are true and complete to the best of my knowledge and all required Certificates as per list at Note below have been enclosed.

Signature of the Applicant/Authorized Person

(Seal)

List of Enclosures :

Documents to be enclosed with the Application:

Service Tax Registration Number

- Yes / No

VAT Registration Number

- Yes / No

Performance Certificates from important customers

- Yes / No

List of Important Customers

- Yes / No

Sales Tax Registration Certificate

- Yes / No

Copies of dealership certificate, if any

- Yes / No

NSIC/SSI Registration /Factory License No., if any

- Yes / No

ESI Registration Number

- Yes / No

Independent PF Code Number

Please refer CHECK-LIST Annexure –D for more details of documents to be furnished.

- Yes / No

Page 4 of 9

Note:

FOR EACH PACKAGE (WORK) SEPARATE APPLICATION WITH SEPARETE ENLISTMENT FEE OF RS. 450/- PER VENDOR IS TO BE ENCLOSED.

APPLICATION FOR EACH PACKAGE (WORK) SHOULD FURNISHED IN SEPARTE ENVELOP.

No correspondence on the subject from Agency/Contractor will be entertained.

They will be informed, in due course, as soon as enlistment is finalized.

All applications shall be super scribed as “Application for Agency Enlistment” and the ‘Package number’ on the envelope.

NTPC reserves the right to accept, reject any or all the applications without assigning any reasons and to seek extra information, if required

Completed forms in all respects along with necessary documents to be submitted by the date indicated in the forms.

***Please submit the relevant documents only***.

Page 5 of 9

INFORMATION ABOUT THE AGENCY

ESI Registration No.
PF’s Code No.
Service Tax’s Registration No.
PAN No.
WCT Registration No.
TIN No.

Signature along with Seal of Company

…..………………………………………

(Duly authorized to sign the tender on behalf of the Bidder)

Name	: ……………………………………………
Designation	: ……………………………………………
Name of Co. And postal address	: ……………………………………………
	……………………………………………
	……………………………………………
	……………………………………………
Website	: ……………………………………………
Tel. No./ Fax No.	: ……………………………………………
e-mail	: ……………………………………………

page 6 of 9

ANNEXURE-C

Qualifying Requirements FORMAT/CHECKLIST

Ref: RSTPS/09/C&M-CS/2016-17/VENDOR Enlistment NIT- 01 Dated:04.05.2016

(Details of documents to be furnished by the bidders with reference Qualifying Requirements. PLEASE MENTION ONLY THREE MAJOR WORKS REQUIRED AS PER THE LIST)

Sl. No	Description of QR Condition	Brief data/values, reflecting the supporting document, towards meeting the respective QR-condition	Details of supporting documents attached
1.	Annual Turnover during FY2013-14	Rs.
	Annual Turnover during FY2014-15	Rs.
	Annual Turnover during FY2015-16	Rs.
2.	Major Work Order (of highest Value) as mentioned in the Qualifying Requirements (Govt. departments/ organizations or Semi Govt. departments/ organizations or PSUs or companies or firms as proof of having executed the above works.)
	Major Work Order (of 2^nd highest Value) as mentioned in the Qualifying Requirements (Govt. departments/ organizations or Semi Govt. departments/ organizations or PSUs or companies or firms as proof of having executed the above works.)
	Major Work Order (of 3rd highest Value) as mentioned in the Qualifying Requirements (Govt. departments/ organizations or Semi Govt. departments/ organizations or PSUs or companies or firms as proof of having executed the above works.)
3.	Individual Provident Fund Account No.

NOTE :

1. Proof of Annual Turnover should be Balance Sheet Copy/ Profit & Loss Sheet/ Turnover Certificate duly certified by Charted Accountant only.

2. Enclose a copy of Work completion / Executed copies of works actually executed by you in last 07 years.

I /We here by confirm that the details furnished above are true to the best of our knowledge. I / We further confirm that original documents will be produced for the verification of NTPC, as and when called for.

(Signature of the authorized representative):__________________________

Name of the Contact Person: ______________________________________________________

Name of the Agency/Agency: M/s____________________________________________________

Page 7 of 9

ANNEXURE –D

CHECK LIST (LIST OF DOCUMENTS TO BE ENCLOSED)

Sl. No.	Enclosed Document Detail	Enclosed? Yes/ No
1.	Enlistment fee
2.	Agency Registration Forms duly filled in
3.	Proof of Turnover
4.	Balance Sheet copies of last three financial years (Certified by C.A.)
5.	P&L sheet copies of last three financial years (certified by C.A.)
6.	Certified copy of Turn over from Charted Accountant.
7.	Work Order copies of three (3) major works done in similar work (Package) during last Seven (7) years (Self attested) NOTE : Copy of Work order/LOAs should clearly indicate the following: Award/Order value, Date of order Specifications of item ordered, Quantity ordered with rates. Detailed Scope of the work
8.	Proof of execution / work completion indicating final values for above orders
9.	Partnership Deed/Articles of Association/Memorandum of Association etc. (Self attested) or Certificate of Incorporation/ Registration of Company /firm /Industry as applicable (Self attested)/ Registration with NSIC / SSI.
10.	Service Tax / Works Contract Tax Registration Certificate (Self attested)
11.	Photostat coy of Latest Income Tax Clearance Certificate / PAN Number (Self attested).
12.	Relevant Licenses from appropriate licensing authority to undertake works as “LICENCED CONTRACTOR”, in respect of works for which registration is sought.
13.	Bank reference certificate from Nationalised Bank certifying financial soundness of your firm. (Original)
14.	Certificate from P.F. Authorities. (Self attested)
15.	particulars of manpower with their qualifications / experience and qualifying trade / skill certificates for skilled personnel in relevant trades.
16.	Copies of the list of Machinery / Tools/ Equipment to be deployed
17.	Copies of Agency Registration with Govt. / PSU organizations (Self attested).
18.	Experience if any – Furnish your client list and copies of orders executed by you (Self attested) during the Past Seven (07) Years together with related invoice (Self attested) copies to be furnished in support of your experience.
19.	Agency registration form duly filled in. All pages to be signed.

Page 8 of 9

ATTACHMENT

EFT (Electronic Fund Transfer) FORM

NTPC Limited,

Ramagundam Super Thermal Power Station,

PO Jyothinagar – 505 215.

Karimnagar (Dist) T.S

Dear Sir,

Ref: Authorization of all our payments through Electronic Transfer System.

We here by authorize the employer to make all our payment through Electronic Fund transfer system. The details for facilitating the payment are given below:

(TO BE FILLED IN CAPITAL LETTERS)

1. NAME OF THE BENEFICIARY

2. ADDRESS :

PIN CODE

3. TELEPHONE NO.( WITH STD CODE)

4. BANK PARTICULARS

A) BANK NAME

B) BANK TELEPHONE NO.( WITH STD CODE)

C) BRANCH ADDRESS:

PIN CODE

D) BANK FAX NO. (WITH STD CODES)

E) BRANCH CODE

Page 9 of 9

F) 9 DIGIT MICR CODE OF THE BANK BRANCH (ENCLOSE COPY OF A CANCELLED CHEQUE)

G) BANK ACCOUNT NUMBER

H) BANK ACCOUNT TYPE (TICK ONLY)

SAVING

CURRENT

LOAN

CASH

CREDIT

OTHER

IF OTHER 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 affected at all for reasons of incomplete or incorrect information, I/We would not hold the Employer responsible.

SIGNATURE

DATE: (AUTHORISED SIGNATORY)

NAME:

OFFICIAL STAMP

BANK CERTIFICATION:

It is certified that above mentioned beneficiary holds bank account no…………………………………............

with our branch and the bank particulars mentioned above are correct.

SIGNATURE

DATE: (AUTHORISED SIGNATORY)

Authorization no. …………………………………..

NAME

OFFICIAL STAMP

Annexure No I

Request for Login ID on NTPC e-Tender

If you are not a supplier of NTPC, and interested in participating in E-tenders of NTPC, please fill in the following form:

Form A

Name: __________________________________________________________

Address: ________________________________________________________

________________________________________________________

State:___________________________ City:_______________________ Country:____________________ Pin:_________________

Telephone No: ____________________ Extn: ________________

Fax Number:______________________

Email ID: ___________________________________________________

Company’s Bank Name: _________________________________

Account Number:____________________________________ Branch:_____________________________________________

Address: ____________________________________________

___________________________________________________

PAN Number: ______________________________________

CST Number: ______________________________________

Excise Regn. Number: _________________________________________

SSI Number: ________________________________________________

Contact Person’s Name: ________________________________________

Designation: _________________________________________________

Annexure No II

Request for Login ID on NTPC e-Tender

If you are already a supplier 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: _____________________________________________

Address and other detail (Only in case of change)

Name: ___________________________________________________ Address:___________________________________________________

________________________________________________________________________

State: _____________________________________ City:_______________________________ Country: ____________________________________ Pin:_________________

Telephone No: ____________________ Extn: ________________

Fax Number:______________________

Email ID: ___________________________________________________

Company’s Bank Name: _________________________________

Account Number:____________________________________ Branch:_____________________________________________

Address: ____________________________________________

_______________________________________________________________