PROPOSAL FORM / QUESTIONNAIRE

FOR SURETY (BOND) POLICY

1. Full name of the Proposer____________________________

____________________________

2. Current physical address of the Proposer. __________________

___________________

3. Registered address of the Proposer. _________________

__________________

4. Short description of the activity of the Proposer__________________

__________________

5. Year of incorporation of the Proposer. _________________________

6. Name and address of all the Board Members of the Proposer. _______

________

7. Name and address of the Chairman of the Proposer. ______________

_____________

8. Total value of the Surety Bond required in INR _________________

9. Duration and inception date of the Surety Bond _________________

10. Name and address of the Principal / Beneficiary of the Surety Bond

________________________

11.Circumstances under which Principal can

invoke the Surety Bond. __________________
12.Whether Proposer’s Bank Guarantee provided to the Principal in some
other contract has ever been invoked or called? _______________

13. If yes, please give a short note on these circumstances and the out-

come.______________________________

14. Whether in past 10 years anytime any Government (whether Central

or State Govt) Agency or department initiated any action against the

Proposer?___________________________

15.If yes, please give a separate note, on the facts, circumstances and

outcome of such an action. ________________________

16.Details of all their ongoing projects along with updated stage of

litigation, if so against the NHAI / Governments?

17.Details of updated on going process of blacklisting if so, under any

contract with NHAI / Government?

18. Please enclose last 3 Years Audited Accounts and Balance Sheet. ___

19.Please indicate Paid Up and Authorized Capital of the Proposer. ____

20. Any other information which Proposer feels can be material and

relevant for this proposal. _________________________

21.Draft agreement of the Project for which Surety Insurance is sought

for?

22.Feasibility Report / Detailed Project Report of the project by the

authority?
 23.Details of the project where contractor has failed to achieve target

progress or complete the project as per schedule agreed at time of

sanctioning of funds?

24. Details of the project where contractor has failed to complete

rectification as per time given in non-conformity reports (NCR) in

design/ completed works/ maintenance or reported in Inspection

reports issued by quality Inspectors deployed by the authority or

officers of the authority?

25. Details of the project where contractor failed to submit Performance

security within the permissible time as defined by authority?

Signature of the Proposer___________________________________

Full name of the signatory_____________________

Position/Designation of the signatory___________________

Date_______________

Place_______________