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ANNEXURE - A: DECLARATION

Tender NO.3/6/SGZP/2023-24/TN-148/ Dated:


Line No/Work No:
Name of the Work:

I / We, ______________________________________ hereby declare that currently I / We am/ are


having the following works in hand.

Name of Division Date of Stipulated Agreement Cumulative


Work under which start of dated of value agreement
work is work completion value
being
executed

1 2 3 4 5 6

Further we declare that the information furnished above are true and correct to the best of my
knowledge.

Date:

Place:

Submitted:

Chief Executive Officer


South Goa Zilla Panchayat,
Margao-Goa.

Signature Not Verified


Digitally signed by MARIA DAS FLORES
ALMEIDA
Date: 2024.02.29 11:07:08 IST
Location: Goa

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