INDIAN FARMERS FERTILISER COOPERATIVE LIMITED

PHULPUR UNIT, P.O. : GHIYANAGAR, ALLAHABAD -212 404 (UP) INDIA

Web site:
E-Mail:
Ph. No.:
Fax No.:

www.iffco.in
kkverma@iffco.in, rnsingh_purchase@iffco.in,
0091-05332-251250/251251/251334/251793 (Phulpur Exchange)
0091-05332-251332 (Purchase) /251253 (General)

APPLICATION FORM FOR PRE-QUALIFICATION/ REGISTRATION OF VENDORS/ CONTRACTORS

Dear Sirs,
Enclosed herewith please find "APPLICATION FORM FOR PRE-QUALIFICATION / REGISTRATION OF
VENDORS / CONTRACTORS". Application form duly filled in and complete in all respect must be submitted
within 30 days of press advertisement together with non - refundable registration formalities processing fee
of Rs. 500/- by way of Demand draft for each application. The demand draft should be drawn in favour of
IFFCO LTD. Phulpur (Allahabad) / Allahabad. Trading houses should submit their authorisation certificate
from their respective manufacturers wherever applicable. You must submit all supporting documents for
each clause of financial status, technical capability & capacity, experience etc. You must also submit
technical catalogue for the sub-category applied. Vendors should mail their application form addressed to :
DY. GENERAL MANAGER (PURCHASE)
INDIAN FARMERS FERTILISER COOPERATIVE LIMITED
PHULPUR UNIT, P.O. : GHIYANAGAR,
ALLAHABAD - 212 404 (UP) INDIA
Note: While completing the application form following points should be considered :
(1) Wherever space is not sufficient, please use separate sheet.
(2) Whichever portion of questionnaire is not applicable to you. Please clearly specify NOT APPLICABLE.
(3) Do not use ( - ) dash and do not leave blank space.
(4) Please put tick (Right) mark for YES and X (Cross) for NO.
(5) Full address means complete postal correspondence address, Phone Nos., Mobile Nos, Fax Nos, Email, Web site address and name of contact person / (s) with designation.
(6) Application forms for pre-qualification / registration of vendors / contractors received incomplete / without
supporting documents / without requisite fee may be rejected without any information to the applicant.
(7) IFFCO can verify the information given by you in application form and if found incorrect then the
Application Form may like to reject.
(8) As IFFCO carries out its procurement activities through e-procurement system, please provide your email id and web site address. Parties to confirm that they are having / shall procure Class III B Digital
Certificate for submission of bids on our website. It may be the important requirement for consideration for
registration.
(9) Please fill application form in capital letters only.
IFFCO reserves the right to verify the submitted information / documents, IFFCO also reserves the right to
accept / reject the application wholly or partly without assigning any reason whatsoever.
Thanking You.
For INDIAN FARMERS FERTILISER COOPERATIVE LIMITED

DY. GENERAL MANAGER (PURCHASE)

Your Ref. No. : PP/ VR/ 2013 2017

Date of application : .............................

To,
DY. GENERAL MANAGER (PURCHASE)

INDIAN FARMERS FERTILISER COOPERATIVE LIMITED

PHULPUR UNIT, P.O. : GHIYANAGAR,
ALLAHABAD - 212 404 (UP) INDIA
APPLICATION FORM FOR PRE - QUALIFICATION / REGISTRATION OF VENDORS /
CONTRACTORS.
1.0 Categories of items for which applied.
Sr.
No.

Category
Code

Category Description

GENERAL INFORMATION
2.0 CORPORATE RECORD
2.1

Name of the Firm :

2.2

Postal Address

2.3

Telephones

2.4

Mobile No.

2.5

E-mail address

2.6

Fax No. / (s)

2.7

Web site Addresses :

3.0

Type /Structure / History of the Organization / Firm

(a) Proprietary Firm
(i) Name of the Proprietor & Address :
..............................................................................................................................................
..............................................................................................................................................
..............................................................................................................................................
..............................................................................................................................................
..............................................................................................................................................
(b) Partnership Firm
(i) Name of the Partners & Full Address :
..............................................................................................................................................
..............................................................................................................................................
..............................................................................................................................................
..............................................................................................................................................
..............................................................................................................................................
..............................................................................................................................................
..............................................................................................................................................
Contd..2/-

4.0

:2:
(c) Limited / Private Limited
(i) Name of the Directors / Chief Executives with Full Address :
..............................................................................................................................................
..............................................................................................................................................
..............................................................................................................................................
..............................................................................................................................................
..............................................................................................................................................
(ii) Name of the Firm & Full Address
..............................................................................................................................................
..............................................................................................................................................
..............................................................................................................................................
..............................................................................................................................................
..............................................................................................................................................
(d) Small Scale Industries
(i) Name of the Firm full Address & Name of the Executive / (s) with full Address
.............................................................................................................................................
..............................................................................................................................................
..............................................................................................................................................
..............................................................................................................................................
Registration No. with Authorities Address
(A) i. Sales Tax / Trade Tax registration No. and date of registration :.........................
..............................................................................................................................................
(A) ii Full Address of Sales Tax / Trade Tax Authorities
....................................................:.........................................................................................
..............................................................................................................................................
..............................................................................................................................................
(A) iii TIN No.
.......................................................................................................................................
..............................................................................................................................................
(B) i. Central Sales Tax registration No. and date of registration :.....................................
..............................................................................................................................................
(B) ii Full Address of Central Sales Tax Authorities :........................................................
..............................................................................................................................................
..............................................................................................................................................
..............................................................................................................................................
..............................................................................................................................................
..............................................................................................................................................
(C) i. Excise registration No. and date of registration : ...................................................
..............................................................................................................................................
(C) ii Full Address of Excise Authorities :
..............................................................................................................................................
..............................................................................................................................................
..............................................................................................................................................
..............................................................................................................................................
..............................................................................................................................................
(D)
Excise Range full Address : .......................................................................................
..............................................................................................................................................
..............................................................................................................................................
(E) i. PAN No. (Permanent Account Number) of the Firm and date of allotment : ............
..............................................................................................................................................
(E) ii Full Address of Income Tax Authorities
..............................................................................................................................................
..............................................................................................................................................
..............................................................................................................................................
..............................................................................................................................................
Contd..3/-

:3:
(F) Small Scale Industries: Whether registration under Micro, Small & Medium
Enterprises Development Act 2006 ..
1. Registration No. & Date ............
2. Name of the Authority with whom registration is made
..............................................................................................................................................
5.0

For Stockist / Dealer

a. Proof of Stockist / dealer i.e. Certificate and Agency agreement :
b.
Name and Address of Principal (Manufacturers) :
c.
Name of Items deals in :
d.
Period & Area covered :
e. Proof in support of above enclosed : Yes/No

6.0

In case of I.S.O certified firm (i.e. ISO 9001 /9002/14001 etc., please Indicate the
certification no. and attach Photocopy of certificate / (s).) :
.......................................................................................................................................

7.0

List of Clients : Please Furnish Statement of order executed for large Industrial
Organisations. Also furnish Copies of orders with performance Certificate of last two
years (recent period).

8.0

FINANCIAL STATUS : Please indicate following details and attach relevant certificates.
(A) Bank Solvency Bank Solvency Certificate in Original must be submitted against cat.
code no. 5301, 5302, 5306 & 5307 for Rs.30 lakh, cat. code no. 5701,6201, 6202 & 6209
for Rs. 20 lakh and for rest cat. Rs. 10 lakh issued after 01.06.2012 by a Nationalized
bank/ Scheduled bank/Any branch of foreign bank in India.
(i) Value of Bank Solvency in Rs. .......................................................................................
(ii) Full Address of issuing Bank : .........................................................................
..............................................................................................................................................
..............................................................................................................................................
(B) Latest Income tax Clearance Certificate for last two years : Please enclose
photocopy of Income - Tax Clearance Certificate for our reference.
(C) Duly audited balance Sheets for the last two financial year: Please enclose
photocopy of Duly audited balance Sheet for our reference.
(D) E.P.F. Registration Number / P.F. Registration Number : Applicants desirous for
pre-qualification for Work / Service Contracts must mention the number, name of the
authority with detailed address and submit the proof. : ......................................................
..............................................................................................................................................
..............................................................................................................................................
(E) Excise Control Code / Service Tax Registration Number : Applicants desirous for
pre-qualification for Work / Service Contracts must mention the number, name of the
authority, Category code of services & its description with detailed address and submit
the proof.
.............................................................................................................................................
..............................................................................................................................................
..............................................................................................................................................
(F) Labour License Number : Applicants desirous for pre-qualification for Work / Service
Contracts must mention the number and name of authority with detailed address and
submit the proof.
..............................................................................................................................................
.............................................................................................................................................
..............................................................................................................................................
..............................................................................................................................................
(G) Digital Certificate :Details of digital certificate for e-procurement and its validity.
.............................................................................................................................................
Contd..4/-

:4:
9.0

TECHNICAL CAPABILITY / CAPACITY :

A. DETAILS OF PRODUCTS MANUFACTURED / DEALT :
............................................................................................................................................
.............................................................................................................................................
..............................................................................................................................................
............................................................................................................................................
..............................................................................................................................................
B. DETAILS OF MANUFACTURING FACILITIES AVAILABLE: Please mention details
of your own workshop facilities / Testing facilities etc. in detail.
.............................................................................................................................................
..............................................................................................................................................
.............................................................................................................................................
.............................................................................................................................................
C. QUALITY ASSURANCE PLAN ALONG WITH APPROVAL OF THIRD PARTY
INSPECTION AGENCIES :
.............................................................................................................................................
..............................................................................................................................................
.............................................................................................................................................
.............................................................................................................................................
D. AVAILABILITY OF AFTER SALES SERVICE AND SUPPLY OF SPARES :
.............................................................................................................................................
..............................................................................................................................................
..............................................................................................................................................
..............................................................................................................................................

10.0

PAST PERFORMANCE :
10.1 Enclose Photocopies of orders executed during last three years :
10.2 Details of Performance of equipment supported with documentary proof including
certificates from clients.
10.3 Any other information which vendor / contractor would like to furnish
..............................................................................................................................................
..............................................................................................................................................
..............................................................................................................................................
.............................................................................................................................................

11.0

Detailed list of Enclosures :

11.1 DD No. ..................Date ..................Name of Bank with Branch Code etc. ............. ..
11.2 .....................................................................................................................................
11.3 .....................................................................................................................................
11.4 .....................................................................................................................................
11.5 ....................................................................................................................& so on.

SIGNATURE OF AUTHORISED SIGNATORY

NAME :____________________________________
DESIGNATION: __________________
NAME AND ADDRESS OF THE FIRM WITH SEAL