Application For Enlistment/Up-Gradation of Enlistment in All Classes
Application For Enlistment/Up-Gradation of Enlistment in All Classes
Application For Enlistment/Up-Gradation of Enlistment in All Classes
1)
[The applicant should study carefully the Rules of Enlistment and the list of documents
to be annexed with the application form before filling the form. Applications found
deficient in any respect are liable to be rejected without any further correspondence]
CLASS: --------------------------------------------
JURISDICTION: ---------------------------------------------------
2. Nationality ..................................
3. Address
(a) Regd. Office .................................................................................................................
…………………………………………………………………………………………
…………………………………………………………………………………………
…………………………………………………………………………………………
………………………………………………………………………………………….
4. Contact Details:
(i) Telephone Number .........................................................
(ii) Fax No. ..............................................................
(iii) Mobile Number .............................................................
(iv) Email Id ............................................................
(v) Website URL (if any) ...................................................................................
6. Name, scanned passport size photo and signature of the Individual(s)/ Partner(s) /
Director(s) (Size of photo should be 2.5 X 3.5 cm having white background and printed
name at bottom)
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1. 2. 3. 4.
Paste photo Paste photo Paste photo Paste photo
9. Name of the Banker with full address, Banks Official E-mail Id and phone number
……………………………………………………….......................................
10. (a) Whether you or any partner/Director already enlisted with PWD or any other
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(b) If yes, give details in table below:
11. (a) Is any person working with the applicant is a near relative of the officer/official of
PWD [As per Enlistment Rules 16] If yes, give details Yes No
Draft No. Date Amount Issuing Bank & Branch drawn Executive
Branch upon Engineer in
whose favour
drawn
14. Does the applicant have sufficient T&P, Machinery, Equipment and
16. Number of Certificates from clients in original or self-attested copy as per proforma
given in Annexure-IV for works selected for evaluation of contractor’s performance
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(i) I/We (including all partners) certify that I/We have read the Rules of Enlistment of
Contractors in PWD as amended up to date and shall abide by them.
(ii) I/We certify that I/We will not get myself/ourselves registered as contractor(s) in
the Department under more than one name.
(iii) I/We certify that the information given above is true to the best of our knowledge.
I/We understand that if any information is found incorrect, our enlistment is liable
to be cancelled.
(b) That we have neither under our employment any such person nor shall we
employ any person within two years of his retirement except with the prior
permission of the Government
(v) I/We undertake that I/We will (if we do not own), hire or otherwise arrange the
Mini Batching plant/Hot mix Plant/Wet mix plant required for the particular work as
a result of this enlistment.
vi) I/We undertake that, if we do not possess in my/ our name a valid electrical license
as required, I/we shall associate with an agency having such a license for execution
of work which requires such a license.
Signature(s) of applicant(s) as
applicable:
(Sole Proprietor OR All Partners OR Either All Directors or the Chief Managing Director if
authorised specifically by a Board Resolution)
1.
2.
3.
4.
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ANNEXURE-II {Refer Annexure-I Sl. 17 (vii)}
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applicant) countersigned by the applicant
(Sole Proprietor OR All Partners OR, either All Directors or the Managing Director or
Director if authorised specifically by a Board Resolution)
1.
2.
3.
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ANNEXURE-III(1) (Completed Works) (Refer Rule 12.2)
(1) In case of enlistment- Works completed during the last five years or
(2) In case of revalidation- List of works completed during last enlistment/revalidation
period (It is mandatory to submit details of all the works completed irrespective of its cost)
Sl. Name of Date Date of Reasons for Tendere Total Name, Whether
No work & of completio delay & d amoun designation & any
Agreem start n compensati Amount t of the complete litigation
ent No. on levied, if compl address of the involved
any eted authority for including
Actual work whom the work arbitratio
Stipulated
was executed n
Certificate:
This is to certify that no adverse action on any of the above-mentioned works has been
taken by the concerned department against me/us. I/we understand that if any
information is found incorrect, our enlistment is liable to be cancelled.
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ANNEXURE-III (2) (Work not yet Completed) (Refer Rule 12.2)
(1) In case of enlistment- Works in progress and secured during the last five years or
(2) In case of revalidation- List of works in progress and secured during last enlistment/
revalidation period.
(It is mandatory to submit details of all the works completed irrespective of its cost)
ment of the
No. authority
for
whom
the work
is being
done
Certificate:
This is to certify that no adverse action on any of the above-mentioned works has been
taken by the concerned department against me/us. I/we understand that if any
information is found incorrect, our enlistment is liable to be cancelled.
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