Form for Expression of Interest to work as implementing Agency
For
Establish ISO certified Oxygen Generator Plant (OGP) for Hospital
Information of organization
1 | Name of the Vender | |
2 | Date of establishment | |
3 | Place of registration/Registration No. | |
4 | Contact Person: Name, Number & designation | |
5 | Detail Address | |
6 | Existing Total Technical staff: (Name, Position, Education, Experience Year & contact ) | |
7 | Facilities/equipment (specify numbers): - Building (own/rented) -Transportation (vehicle, motorbike, etc.) -Computing (desktop/laptop) -Printing (printer) -Communication (phone line, fax, email, internet etc.) - Other, if any | |
8 | Annual turnover of last Three Fiscal Year years: (NPR) | |
9 | Total number of projects undertaken by the organization since its establishment | |
10 | Total number of Oxygen Generator plant related projects undertaken by the organization since its establishment | |
11 | Details of Established ISO certified Oxygen Generator plant projects, if any Name of Project, Location, Total Budget, Capacity, Brand, Funding Agencies, Contact Duration, Duration of Operation Period, Contact name & number of funding agencies:- (Please list down each projects, which your organisation have done) |
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12 | Details of Medical supply related project, if any (Name of Project, Location, Total Budget, Funding Agencies, Contact Duration, Duration of Operation Period, Contact name & Number of Funding Agencies) | |
13 | Experience of the geographical region | |
14 | Including Documents (Company Registration/Renewal, Affiliation, PAN/VAT certificate, Tax Clearance Certificate of FY-2077-078 or Time extension Letter, Woking Experience Letter) | |
15 | Additional remarks, if any |
I declare that the information provided above is true and accurate to the best of my knowledge. I also declare to take all liabilities to be accountable and responsible for any consequences what so ever hereafter in case of nonconformity.
Signature: | Date: | Stamp: |