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ESIC 1 Signature of contractor with seal Hindustan Prefab limited FORM „A‟ FINANCIAL INFORMATION Financial Analysis - Details to be furnished duly supported by figures in balance sheet/ profit & loss account for the last five years duly certified by the Chartered Accountant, as submitted by the applicant to the Income Tax Department (Copies to be attached) YEARS I. i) Gross Annual Turnover on construction works ii) Profit/ Loss II. Financial arrangement with the Financial Institution like over drafts/loan, Bank Guarantee Limit etc. for carrying out the proposed work III The following certificates are enclosed: a) Solvency Certificate (not older than six month) from Bankers of Applicant. b) Current Income Tax Return filed with Income Tax Dept. duly acknowledged (with seal). Signature of Applicant(s) Signature of Chartered Accountant with Seal 2012-13 2013-14 2014-15 2015-16 2016-17 ESIC 2 Signature of contractor with seal HPL FORM –‘B’ DETAILS OF SIMILAR WORKS COMPLETED DURING THE LAST FIVE YEARS ENDING LAST DAY OF THE MONTH in which tender invited. S. No Name of work/ project and location Owner or sponso ring organiz ation Cost of work in crores Date of commen cement as per contract Stipulat ed date of complet -ion Actual Date of completion Litigation /Arbitrati on pending/ in progress with details* Name and address /telephone number of officer to whom reference may be made Remarks 1 2 3 4 5 6 7 8 9 10 *Indicate gross amount claimed and amount awarded by the Arbitrator. Signature of Applicant(s) ESIC 3 Signature of contractor with seal HPL FORM „C‟ PERFORMANCE REPORT OF WORKS REFERRED TO IN FORM “B” 1. Name of work/ Project & Location 2. Agreement No 3. Actual Cost of Completion 4. Tendered Cost 5. Date of Start 6. Date of Completion i) Stipulated date of completion ii) Actual date of completion 7. Amount of compensation levied for delayed completion, if any 8. Amount of reduced rate items, if any 9. Performance Report (1) Quality of work Very Good/Good/Fair/Poor (2) Financial Soundness Very Good/Good/Fair/Poor (3) Technical Proficiency Very Good/Good/Fair/Poor (4) Resourcefulness Very Good/Good/Fair/Poor (5) General behavior Very Good/Good/Fair/Poor Dated : Executive Engineer or Equivalent ESIC 4 Signature of contractor with seal HPL FORM ‘D’ DETAILS OF TECHNICAL & ADMINISTRATIVE PERSONNEL TO BE EMPLOYED FOR THE WORK S.NO. Design ation Total number Number available for this work Name Qualifi cation Professional experience and details of work carried out How these would be involved in this work Remarks 1 2 3 4 5 6 7 8 9 Signature of Applicant(s) ESIC 5 Signature of contractor with seal

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