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INDIAN OIL CORPORATION LTD.

APPLICATION FORM FOR EMPANELMENT AS CONTRACTOR


ADVT REF…………

CATEGORY OF EMPANELMENT APPLIED FOR (Refer Annexure–I for category code no.):

1. _____________ 2 _____________ 3 _____________

3. _____________ 4._____________ 6._____________

1. Name of Company …….………………...……………………………………………


2. Address - Regd. Office: ………………………...……………………………………………
….……………………………………………………………………
………………………….……………………………………………
3. Address - Head Office: ………………………….……………………………………………
………………………….……………………………………………
………………………….……………………………………………

4. Telephone Number

Fax No. -

E-mail : …………………………………, Mobile No. : ………………………………………

5. Constitution of Firm / Company * Individual Sole Proprietorship Concern


Partnership Firm Public Ltd. Company
Private Ltd. Company
6. Name of person(s) holding power of attorney ………………………………………………
7. Contact details of top three key personnel with full address & contact details whose
CVs are attached *:
7.1 Name & designation of the person: ………………………………………………
Contact details ………………………………………………
………………………………………………
………………………………………………
………………………………………………

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7.2 Name & designation of the person: ………………………………………………
Contact details ………………………………………………
………………………………………………
………………………………………………
………………………………………………

7.3 Name & designation of the person: ………………………………………………


Contact details ………………………………………………
………………………………………………
………………………………………………
………………………………………………

8. Does the applicant possess valid Electrical Licence* Yes No


[Applicable for electrical jobs only– Please attach copy of valid Elect. Licence]

9. Details of one no. high value job executed in last 5 years ( completed after April 2001 )
in each year for the categories of work for which empanelment is desired shall be
submitted as per Annexure II. Copy of only one highest value work order and
completion certificate each year shall be submitted. *

10. Annual Turn Over of the Company in the last three Financial Years:*
(copy of annual reports / balance sheet & profit and loss account statement to be
furnished)

Year 04-05 05-06 06-07


Annual Turn Over
(Rs. in lacs)

11. Provident Fund Registration Number *: ___________________________________

12. Sales Tax Registration Number* : _______________________________________

13. Service Tax Registration Number * : ___________________________________

14. Income Tax Permanent Account Number *: _______________________________

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15. Declaration by the applicant :

15.1 I/We certify that I/We will not get myself/ourselves registered as contractor(s) in
Indian Oil corporation under more than one name.

15.2 I/ We declare that our Company / Firm have not been placed on any holiday list or
black list declared by Indian Oil Corporation Ltd. or its Administrative Ministry
( Presently MOPNG), except as indicated below :

(Here give particulars of black listing or holiday listing and in the absence thereof state
‘NIL’)

15.3 I/We certify that the information given above is true to the best of our knowledge.
I/We also understand that if any of the information is found wrong, I am liable to be
debarred and put on Holiday list.

Name & signature of applicant:

Date :

Note:
1) Incomplete application forms shall be liable for rejection without any
correspondence in this regard.
2) Work Orders without completion certificate shall not be considered
3) On registration, parties shall be informed in due course.

NB: * : Documentary evidence to be furnished

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Annexure – I

LIST OF CATEGORIES OF WORK FOR EMPANELMENT

Category Description
Code
CIVIL JOBS :
C-01 Shot blasting and painting
C-02 Refractory and Guniting jobs
C-03 Insulation jobs
C-04 Miscellaneous civil and structural jobs including building and road works
C-05 Cooling Tower jobs
C-06 Railway siding jobs
C-07 Civil maintenance jobs for buildings
C-08 Housekeeping and sanitation jobs
C-09 Pest control related jobs
C-10 Tank cleaning jobs

MECHANICAL JOBS
M-01 CS/ AS / SS Piping jobs
M-02 Online sealing of steam and hydrocarbon leaks
M-03 Rubber lining jobs
M-04 HDPE piping jobs
M-05 Maintenance and cleaning of heat exchangers
M-06 Maintenance jobs related to furnace, columns / vessels, etc of process unit
M-07 Construction and maintenance jobs of storage tanks
M-08 Maintenance / reconditioning of gate / globe / check valves
M-09 Chemical cleaning of equipment
M-10 Maintenance & operation of construction & heavy equipment
M-11 Turnaround jobs of process units on LSTK basis
M-12 Hiring of cranes and other construction equipment
M-13 Operation & maintenance of high pressure hydro-jetting machine
M-14 Radiography work
M-15 Stress relieving jobs

ELECTRICAL JOBS
E-01 Miscellaneous electrical maintenance jobs including cabling, earthing,
lighting and installation of panels and motors etc.
E-02 Repair and maintenance of transformers including filteration of
transformers oil
E-03 Repair and rewinding of HT motors
E-04 Repair and rewinding of LT motors
E-05 Installation and maintenance of electrical heat tracers.
E-06 Maintenance of Air-conditioners
INSTRUMENTATION JOBS
I-01 Miscellaneous instrumentation jobs including installation etc. of various
field instrument

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Annexure II
WORK EXPERIENCE
Category of Empanelment:

Work Order and


Name and
Completion Executed Value
Year Name of the work address of
Certificate (Rs.)
Client
Reference No.

00-01

01-02

02-03

03-04

04-05

05-06**

**- till the date of this advertisement


 Separate sheet shall be submitted for each category of job
 Only the work order copy and completion certificate of highest executed value shall be
submitted.

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