APPLICATION FORM FOR ENLISTMENT OF CONTRACTORS FOR CIVILWORK AT NISPPlease type or write in block letters & tick against the correct box.1. Name of the Company 2. Office Address CITY: STATE: COUNTRY: PIN/ZIP: WEBSITE: TELEPHONE: E-MAIL: FAX: CONTACT PERSON: DESIGNATION: RES. TEL . NO.: MOBILE NO:3. Nature of the Company:Pvt. LtdPublic Ltd. CompanyPSUProprietary

PartnershipCo-Op SocietyContractorSmall Scale

Medium ScaleLarge ScaleStockiest/AgentDealer

4. Year of Establishment: 5. PAN Number:6. Commercial Tax Registration Number and its clearance certificate 7. Service Tax Registration No.: 8. Name and Address of your banker and type of account and No. a. Full name of the party as appearing in Bank records:b. Name of the bank and branch to which payment is to be sent:c. Branch Code:d. Account No. of the Party:e. RTGS/IFSC code of the bank:

9. Yearly Turnover for the Last 3 financial years(2010-11,2010-09,2009-08):10. Current Bank Solvency Certificate( at not earliest than 3 months):11. Working Capital:12. Maximum amount of work executedi. Name of the workii. W.O. No. & Dateiii. Amount13. List of works executed during the last 3 years along with work order copies and completion certificate as per enclosed Annexure-IA.14. Details of equipment and list of manpower as per enclosed Annexure 1B & 1C15. Registration with PWD/MES/BRO, State Govt. or PSU, etc.16. Do you have any of your relatives working in NMDC/NISP:i. If so, please furnish the details.17. Any other information you would like to mention.Note: Documentary evidence in photo copies for Sl No: 3 to 20 to be furnished duly attested by Gazetted officer /Notary along with the application proforma otherwise the application is liable for rejection without assigning any reason thereof.

Place: SIGNATURE OF CONTRACTORDate:Seal