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ANNEXURE - A: DECLARATION Tender No: 6/4/PWD/WDXIII(R)/ASW/25/2018-19 Dated: 04/10/2018 Work No: Name of the Work: I / We, ________________________________________ hereby declare that currently I / We / am/ are having the following works in hand (Plan and Non-plan) (i.e. to be physically completed). Further I / We declare that the information furnished above are true and correct to the bestof my / our knowledge.Date:Place: SignatureName / SealSubmitted: Executive EngineerWD XIII,PWD, Mapusa-Goa Name of Work Division under which work is being executed Date of start of work Stipulated dated of completion Agreement value Cumulative agreement value 1 2 3 4 5 6

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