Application for Enlistment/Renewal as a Contractor in Municipal Corporation, Panchkula

1. Name of the Contractor - ………………………………………………….

2. Permanent Address:- ………………………………………………………

………………………………………………………………………………….

3. Correspondence Address:……………………………………………………………………………………

4. Contact No: …………………………………………………………………………………………………..

5. E- Mail ID: …………………………………………………………………………………………………..

6. Copy of Pan Card Enclosed:- Yes/No

7. Copy of ID Proof/Address Proof Attached:- Yes/No

8. Whether Enlisted in M.C. Panchkula Yes/No

9. If enlisted in M.C. Panchkula mention the Limit/Category of Contractor ………………………………

…………………………………………………………………………………………………………………….

10. Limit of Enlistment applied for …………………………………………………………………………….

11. Period of which enlistment is applied :…………………………………………………………………….

12. Service Tax No……………………………………………………………………………………………….

13. List of work executed in the year 2015-16 attached (Duly recommended by M.E.) - Yes/No

14. Bank Solvency Certificate attached (For application of more than 10 Lacs) – Yes/No

15. Affidavit of not blacklisted/undertaking by contractor attached: - Yes/No

16. List of Machinery with the contractor (Give Detail):- ………………………………………………..

…………………………………………………………………………………………………………………

Note:-
Fee Applicable:- Upto 10 Lacs : Rs. 1000/- for 1 year and Rs. 2000//- for 2 years
Above 10 Lacs upto 50 Lacs :Rs. 3000/- for 1 year and Rs. 6000/- for 2
years.

Dated: Signature of the Contractor

Recommendation of the official of enlistment:- ……………………………...