M.P. HOUSING BOARD: BHOPAL FORM OF APPLICATION FOR REGISTRATION AS CONTRACTOR IN MP HOUSING BOARD Issued Sl No._________________________________________/G5/200 Date __/__/200 Cost of form Rs. 100.00 (Rupees One Hundred only) received vide M.R. No. Dated __/__/200 and issued to__________________________________________ To, The Add!. Housing Commissioner MP Housing Board, Bhopal 1. Name of Contractor/Firm (In case of firm registration of Firm & Partnership Deed be enclosed also) 2. Name of Power of Attorney holder in case of firm 3. Technical qualification and experience of the proprietor or partners 4. Permanent address of Contractor/Firm 5. Present Address of Contractor/Firm 6. Period for which the Contractor/Firm is staying on present address 7. If the Contractor/Firm is registered with MP Housing Board previously, please state class and copy of such registration be enclosed. 8. If the Contractor/Firm is registered with other departments, please state class and copy of such registration be enclosed. 9. Category in which the registration/renewal desired presently 10. Name of relatives and their present post if any in MP Housing Board (Not below the rank of Divisional Accountant) 11. Name of Technical persons and qualifications under employment of Contractor/Firm (in proforma - I) 12. Consent of Contractor/Firm for depositing desired security deposit and registration fee as per norms fixed from time to time. 13. Details of annual turn - over of last 3 year (state year wise) 14. Details of machines, tools and plants held by Contractor/Firm in Proforma - II 15. Area in which the contractor wants to work 16. Period upto which Income Tax clearance Certificate is obtained (Attested Photo Copy of Income Tax Clearance Certificate with full details to be attached) 17. Has the applicant or his partners or shareholders been black listed/removed in the past in any Government Deptt. or any other Govt. body (Public undertakings) 18. Details of work if any abandoned by the contractor previously in any Govt. Deptt. or any other Semi Govt. Body. 19. Consent for making payment any arrears if demanded by Govt./Housing Board as per demand 20. If the Contractor is interested in electrical works. He should submit copy of desired licence issued by MPEB in his favour & State Class of Registration desired 21. Name of the nominee in case of death of the Contractor for refund of Security. Dep0sit if due (As per proforma No. III attached) Certificates (1) I/We hereby certify that I/We am/are not partner in the firm(s) black -listed etc. or connected with the firm black-listed etc. in any Govt./Semi Government Department. (2) Desired information's in proforma 1 to 7 are enclosed (3) I/we hereby certify that the informations given above are true and if at any item found misleading/ Incorrect, then MP Housing Board in free to cancel the registration done at any time. Place Date Signature (Name & Designation & Full address of the Signatory with Date) Proforma - 1 M.P. HOUSING BOARD: BHOPAL Details of Technical Persons S.N. Name Qualification Status Experience in years Form which date appointed in the firm in case of employee 1 2 3 4 5 6 (Signature of Applicant) Proforma -2 M.P. HOUSING BOARD: BHOPAL List of Tools, Plants and Machineries S.No. Name of Articles Quantity Approximate Value Location 1 2 3 4 5 Certificate Certified that the above articles are in my physical possession. (Signature of Applicant) Proforma-3 Bsdsnkjh uketnxh QkeZ eS---------------------------------------------------------iq=@iq=h@ifRu------------------------------------------------------------------fuoklh--------------------------------tks fd e/;izns'k x`g fuekZ.k e.My esa Js.kh-------------------------------Bsdsnkj ds :Ik esa iathd`r gwWaSA blds }kjk Jh@Jherh@dqekjh-----------------------------------------------------------------iq=@iq=h@ifRu---------------------------------------------mez-------------------o"kZ-------------------------dks ejh e`R;q gks tkus ij Bsdsnkjh ds iath;u ds :Ik esa e.My esa tek lqj{kk fuf/k@/kjksgjjkf'k dks izkIr djus ds fy, uketn djrk gWW@djrs gSA Hkonh; rkjh[k lfgr Bsdsnkj ds gLrk{kj rkjh[k lfgr lkf{k;ksa ds gLrk{kj 1-uke irk 2-uke irk Proforma - 4 M.P. HOUSING BoARD: BHOPAL Details of works executed in various Dapartments other than M. P. Housing Board (At least for last five years) S. No. Name of Division/ Department and Place Name of work Amount of work put to tender Whether contract awarded Date of Award of Contract Target Date of completion of works as per Contracatand date of completion if completed Reasons for delay if any Remarks 1 2 3 4 5 6 7 8 9 (Signature of the Applicant) Proforma - 5 M.P. HOUSING BOARD: BHOPAL Details of works in progress in various Department other than M. P. Housing Board Statement of works which are in hand and works tendered -for and works awarded in various Divisions (Statement Dn. Wise} S. No. Name of Division/ Department and Place Name of work Amount of work put to tender Whether contract awarded Date of Award of Contract Target Date of completion of works as per Contract and likely date of completion Reasons for delay if any Remarks 1 2 3 4 5 6 7 8 9 Signature of Contractor/Firm Signature of Executive Engineer Proforma - 6 (For Completed works) M.P. HOUSING BOARD: BHOPAL Name of Contractor : List of works which completed during last five years or more with M. P. Housing Board in Various Divisions S.No. Name of Work Division & Place Agreement No. & Date Amount of works as per agreement Actual cost of work as per final bill Period Allotted Actual Time Taken to complete the work Any Arbitration case in the work Penalty imposed if any for delay 1. 2. 3 4 5 6. 7. 8. 9. Signature of Contractor Note: In Support of proof execution of works and quality performance certificate of concerning EE be attached or statement can be signed. Proforma - 7 M.P. HOUSING BOARD: BHOPAL (For works in progress) Name of Contractor :_______________________________________________________________________________ List of works which are in progress in M. P. Housing Board (Statement Division wise) S. No. Name of Work & Division Agreement No.& Date Amount of work as per agreement Actual cost of work done till application Period allotted as per agreement Probable time to be taken to complete the work Liquidated damages Imposed for delay if any Financial Progress achieved in% Remarks in-respect of qualit) 1 2 3 4 5 6 7 8 9 10 1. State whether the details as above given by the contractor is correct if not state the correct Information (By Executive Engineer) 2. State whether the contractor is executing the work in progress satisfactorily as per satisfaction If not give the correct position of the work 3. Any other remarks Signature of Contractor/Firm Signature of Executive Engineer (with Seal) izi=&8 fuekZ.k dk;ksZ dh xq.koRrk dk izek.k&i= esjs }kjk Bsdsnkj Jh@esllZ-----------------------------------------------------------------------------------------------------------------------------------------us iwoZ esa tks fuekZ.k dk;Z lEikfnr fd;s gS o tks fuekZ.k dk;Z orZeku esa lEikfnr fd;s tk jgs gS] ftudk mYys[k uhps gS] mu dk;ksZ dks fnukad ----------------------------------dks HkkSfrd :Ik ls ns[kk x;k o dk;ksZa dh xq.koRrk ckcr~ tks esjh Vhi gS] mls izR;sd dk;Z ds lkeus vafdr fd;k tk jgk gSA esjs }kjk Bsdsnkj ds fu"ikfnr dk;ksZaa ds voyksdu mijkUr budk iath;u-------------------------------oxZ esa djus dh vuq'kalk dh tkrh gSA dk;Zikyu ;a=h ,e-ih-gkmflax cksMZ laHkkx ¼lhy½ izi=&9 izek.k&i= eS izekf.kr djrk gWw] fd eS ;k esjh QeZ dk dksbZ Hkkxhnkj vkt rd dHkh Hkh fdlh Hkh vijkf/kd dk;Zdykiksa esa layXu ugh jgk gSA eq>s ;k esjh QeZ ds fdlh Hkkxhnkj ds fo:) fdlh Hkh U;k;ky; ls nf.Mr ugha fd;k x;k gSA vkSj esjs ;k esjh QeZ ds fdlh Hkkxhnkj ds fo:) fdlh Hkh U;k;ky; esa dksbZ vijkf/kd izdj.k fopkjk/khu ugha gSA Bsdsnkj@QeZ dk uke irk% izi=&10 izek.k&i= eS izekf.kr djrk gWw] fd eSus@esjh QeZ us fiNys ikap o"kksZ esa fuEukafdr laLFkkvksa esa fuekZ.k dk;Z fu"ikfnr fd;s gS%& Øekad laLFkk dk uke fuekZ.k dk;Z dk uke fuekZ.k ykxr eS ;g Hkh izekf.kr djrk gWw fd eSus@esjh QeZ us mijksDr laLFkkvksa ds ljy Øekad----------------------------ij vafdr fuekZ.k dk;ksZa ds laca/k esa vf/kdj.k ,oa U;k;ky;ksa esa izdj.k izLrqr fd;s gS@ugh fd;s x;s gSA Bsdsnkj@QeZ dk uke irk%
