Annexure -H

(See clause 12 of Section 2 ITB& clause 4 of GCC)

ORGANIZATIONAL DETAILS
(To be Contained in Envelope - A)
S.
Particulars Details
No.
Registration number issued by Centralized PWD170014904
1. Registration System of Govt. of M.P. or Proof of (If applicable, scanned copy of proof of
application for registration.
application for registration to be uploaded)
Registration No. PWD170014904, Date
2. Valid Registration of bidder in appropriate class 20/05/2017
through Centralized Registration of Govt. of MP (Scanned copy of Registration to be
uploaded)
Name of Organization/ Individual/ Proprietary M/s MOHAMMAD ANWAAR ALAM
3.
Firm/ PartnershipFirm
Entity of Organization
Individual/ Proprietary Firm/ Partnership Firm M/s MOHAMMAD ANWAAR ALAM
4. (Registered under Partnership Act)/ Limited
Company (Registered under the Companies
Act1956)/ Corporation/ Joint Venture
Address of Communication Ward No.08 Ambedkar Ward Main Road
5.
Dindori, Distt. Dindori (M.P.)
6. Telephone Number with STD Code -
7. Fax Number with STD Code -
8. Mobile Number 7509031934
9. E-mail Address for all communications anwaar444alam@gmail.com
Details of Authorized Representative
10. Name MOHAMMAD ANWAAR ALAM
11. Designation Contractor
Postal Address Ward No.08 Ambedkar Ward Main Road
12.
Dindori, Distt. Dindori (M.P.)
13. Telephone Number with STD Code -
14. Fax Number with STD Code -
15. Mobile Number 7509031934
16. E-mail Address anwaar444alam@gmail.com

Note: In case of partnership firm and limited company certified copy of partnership deed/ Articles
of Association and Memorandum of Association along with registration certificate of the
company shall have to be enclosed.1

Signature of Bidder with Seal

Date: _____________

1
Section 2 Annexure - H